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On 6/22/2019 at 8:53 PM, clinic said:

Went to the pdoc today and had a heavy debate with him. I told him i have 2 main problems - anxiety and too much sleeping.

He said we are not 100% sure if anxiety is induced by clozapine. He said we can decrease clozapine by 25mg every week and add olanzapine only if paranoia comes. But I declined, i said we add olanzapine first 2.5mg and then 5mg.  He agreed after heavy arguments - he said  we can take 5mg for 10 days, then reduce clozapine from 200mg to 175mg. If it works then he said to meet him again. He will further reduce clozapine dose.

If anxiety does not improves after eventually when i come to clozapine 100mg, then i might need to try another benzo(clonazepam)

 

Went to pdoc again today to change meds. We removed olanzapine from prx ansd changed it to amisulpride. So i will be taking clozapine + amisulpride now.

He said clobazam and clonazepam r different benzo and can be taken together

Edited by clinic

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1 hour ago, clinic said:

Went to pdoc again today to change meds. We removed olanzapine from prx ansd changed it to amisulpride. So i will be taking clozapine + amisulpride now.

He said clobazam and clonazepam r different benzo and can be taken together

What's your dosing going to be like for amisulpride? Lower doses are preferential to pre-synaptic D2 receptors which will promote dopamine release but won't appreciably block post-synaptic receptors to balance that out. I think that stops at about 100mg? I feel like @HydroCat knows about this?

And yes, your pdoc is technically correct about clobazam and clonazepam. Clobazam is pretty different from the rest of the benzos in its specificity to the alpha-2 subunit of the GABA-A receptor and therefore can technically be combined with any of the others which are more broad-spectrum for alpha-1 and alpha-2 GABA-A subunits. The binding at the alpha-1 subunit is the cause of the sedation from benzos.

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54 minutes ago, browri said:

What's your dosing going to be like for amisulpride? Lower doses are preferential to pre-synaptic D2 receptors which will promote dopamine release but won't appreciably block post-synaptic receptors to balance that out. I think that stops at about 100mg? I feel like @HydroCat knows about this?

And yes, your pdoc is technically correct about clobazam and clonazepam. Clobazam is pretty different from the rest of the benzos in its specificity to the alpha-2 subunit of the GABA-A receptor and therefore can technically be combined with any of the others which are more broad-spectrum for alpha-1 and alpha-2 GABA-A subunits. The binding at the alpha-1 subunit is the cause of the sedation from benzos.

Pdoc said start at 50mg amisulpride. Increase 50mg every week till 200mg. Once there than start decreasing clozapine by 25mg.

Thats what im worried about the most, that low amisulpride doses will increase dopamine and cause psychosis.

Edited by clinic

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4 hours ago, clinic said:

Pdoc said start at 50mg amisulpride. Increase 50mg every week till 200mg. Once there than start decreasing clozapine by 25mg.

Thats what im worried about the most, that low amisulpride doses will increase dopamine and cause psychosis.

In theory, antagonizing presynaptic Dopamine receptors enhances Dopaminergic activity.

I had a bad experience with Amisulpride.

But,

Looking at this pharmacologically Dopamine-enhancing drugs were good for me, so Amisulpride probably was indeed a post-synaptic Dopamine antagonist (at least 100+ mg was). This was awful for me depression-wise, but should be pretty good as an antipsychotic.

I'd give it a try, but bear in mind that too low a dose may have the opposite effect

Edit: Since you are still on Clozapine it should reduce the risk.

Edited by HydroCat
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10 hours ago, HydroCat said:

In theory, antagonizing presynaptic Dopamine receptors enhances Dopaminergic activity.

I had a bad experience with Amisulpride.

But,

Looking at this pharmacologically Dopamine-enhancing drugs were good for me, so Amisulpride probably was indeed a post-synaptic Dopamine antagonist (at least 100+ mg was). This was awful for me depression-wise, but should be pretty good as an antipsychotic.

I'd give it a try, but bear in mind that too low a dose may have the opposite effect

Edit: Since you are still on Clozapine it should reduce the risk.

Thx for the reply.

Should i worry about prolactin on amisulpride ? Is prolactin elevation on amisulpride equivalent to paliperidone/risperidone ?

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2 hours ago, clinic said:

Thx for the reply.

Should i worry about prolactin on amisulpride ? Is prolactin elevation on amisulpride equivalent to paliperidone/risperidone ?

According to research, Prolactin level is regulated by Dopamine D2. Antagonizing D2 by antipsychotics including Amisulpride potentially elevate Prolactin levels.

Amisulpride itself is very selective towards D2 and D3 and in this sense it is "stronger" than less selective ones (ex. Clozapine).

I'd recommend monitoring Prolactin closely with this one.

 

 

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