the maze runner Posted June 30, 2019 Share Posted June 30, 2019 Which is better? What are the advantages and disadvantages of olanzapine and clozapine. I've just been taken off olanzapine and put on clozapine. What should I expect to happen? Link to comment Share on other sites More sharing options...
Iceberg Posted June 30, 2019 Share Posted June 30, 2019 Side effect profile can be similar, with the big exception of the blood count thing. cloz hits tons of receptors, so it can come with nasty sedation and equally nasty weight gain. However, if other things aren’t working cloz is usually the go to. Another thing- olanzapine can work wayyyyy faster as far as therapeutic/antipsychotic effect. The sedation can hit much faster though Link to comment Share on other sites More sharing options...
the maze runner Posted June 30, 2019 Author Share Posted June 30, 2019 thanks @Iceberg. yes i've been on olanzapine for a long time but I still complain about psychotic symptoms so my doc rx-ed clozapine. Link to comment Share on other sites More sharing options...
Butterflykisses Posted June 30, 2019 Share Posted June 30, 2019 I am currently on Clozapine, but have been on zyprexa I have found clozapine to be the absolute most effective medication for my psychosis. I had more psychotic breakthroughs while on zyprexa then I have on clozapine Clozapine is a very high maintenance medication...lots of blood work, and it is extremely sedating when starting...I found once I hit 100mg the sedation gradually lessened. Now on 300mg taken at bedtime does help me fall asleep and stay asleep...but no sedation during the day like it was in the beginning. I have been up to 500mg/ day...some side effects were more pronounced...but I found I get good coverage on 300mg/day but there is room to increase if need be in the future Keep in mind the expense...since having to get it filled on a weekly basis for 6 months...then every other week for 6 months, then once a month...can be expensive if you have copays for your meds not fully covered by insurance. It all adds up I wish zyprexa would have helped me as much as clozapine, it would be less of a hassle...but clozapine works, it really works...I have been on almost all antipsychotics..this is the only one that makes my Schizoaffective more manageable...I still have to have a low stress environment, and am completely disabled and unable to work...but Clozapine keeps me from having to be constantly in the hospital or worse... Link to comment Share on other sites More sharing options...
aura Posted June 30, 2019 Share Posted June 30, 2019 Clozapine works way better for me than olanzapine. The blood tests are annoying, but for me they are worth it. Link to comment Share on other sites More sharing options...
the maze runner Posted July 1, 2019 Author Share Posted July 1, 2019 Well yes I know that clozapine is supposed to be really effective and that it is the medication of last resort(in the US). I am in India and here it is not treated so much like a medicine of last resort rather prescribed quite freely as a matter of fact. Link to comment Share on other sites More sharing options...
Iceberg Posted July 1, 2019 Share Posted July 1, 2019 (edited) I have heard several US pdocs advocate for expanding its use. My current pdoc (who has been around a long time) says he’s used it on dozens of patients and never had the agranulocytosis happen. To me the limiting factor is the weight gain, sedation, and the blood tests themselves over what they are actually testing for (it can be a lot of money) depending on the definition of “treatment resistant” some docs feel that two failed thorough trials of APs (AAPS) is enough to bring cloz into consieration. Honestly, if I did that it might have cut down on the years I lost to mental illness https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353603/ this is the link with the think about being resistant after two aap trials and using clozaril (in intro) Edited July 1, 2019 by Iceberg Link to comment Share on other sites More sharing options...
the maze runner Posted July 1, 2019 Author Share Posted July 1, 2019 ok. i am currently supposed to be taking 50 -100mg in the evening doc has said he'll take it up to 250mg. Link to comment Share on other sites More sharing options...
Iceberg Posted July 1, 2019 Share Posted July 1, 2019 10 minutes ago, the maze runner said: ok. i am currently supposed to be taking 50 -100mg in the evening doc has said he'll take it up to 250mg. There is actually a blood test to measure levels (but I’m in US)- but my advice is that for such a stong med with tough side effects your probably better to be a bit underdosed and add on than be overdosed.... which was very nasty in my case Link to comment Share on other sites More sharing options...
the maze runner Posted July 1, 2019 Author Share Posted July 1, 2019 yes i think that's correct. i just want to know how long it takes for the clozapine to kick in fully. some sources say 6 weeks. Link to comment Share on other sites More sharing options...
Iceberg Posted July 1, 2019 Share Posted July 1, 2019 3 minutes ago, the maze runner said: yes i think that's correct. i just want to know how long it takes for the clozapine to kick in fully. some sources say 6 weeks. Or more Link to comment Share on other sites More sharing options...
the maze runner Posted July 1, 2019 Author Share Posted July 1, 2019 i've read great reviews of clozapine that's why i am kind of a bit impatient for it to work. https://www.drugs.com/comments/clozapine/ Link to comment Share on other sites More sharing options...
the maze runner Posted July 1, 2019 Author Share Posted July 1, 2019 9 hours ago, Butterflykisses said: I am currently on Clozapine, but have been on zyprexa I have found clozapine to be the absolute most effective medication for my psychosis. I had more psychotic breakthroughs while on zyprexa then I have on clozapine Clozapine is a very high maintenance medication...lots of blood work, and it is extremely sedating when starting...I found once I hit 100mg the sedation gradually lessened. Now on 300mg taken at bedtime does help me fall asleep and stay asleep...but no sedation during the day like it was in the beginning. I have been up to 500mg/ day...some side effects were more pronounced...but I found I get good coverage on 300mg/day but there is room to increase if need be in the future Keep in mind the expense...since having to get it filled on a weekly basis for 6 months...then every other week for 6 months, then once a month...can be expensive if you have copays for your meds not fully covered by insurance. It all adds up I wish zyprexa would have helped me as much as clozapine, it would be less of a hassle...but clozapine works, it really works...I have been on almost all antipsychotics..this is the only one that makes my Schizoaffective more manageable...I still have to have a low stress environment, and am completely disabled and unable to work...but Clozapine keeps me from having to be constantly in the hospital or worse... Thanks. I also believe that my schiz symptoms appear only when I am stressed. The more stressed the worse it gets. Link to comment Share on other sites More sharing options...
clinic Posted July 1, 2019 Share Posted July 1, 2019 (edited) These are adverse effects of clozapine[1] Agranulocytosis Seizures and myoclous jerks(dose dependent) Sedation Delirium OCD/Anxiety [1] [2] Tachycardia Postural hypotension Weight gain Drooling saliva Elevated liver enzymes constipation Nausea Bed wetting Akathisia [1] https://schizophreniabulletin.oxfordjournals.org/content/24/3/381.full.pdf [2] https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/Document/September-2017/0806CP_Cases.pdf My ocd and anxiety r worsened after i increased my clozapine Edited July 2, 2019 by clinic Link to comment Share on other sites More sharing options...
Iceberg Posted July 2, 2019 Share Posted July 2, 2019 18 hours ago, clinic said: These are adverse effects of clozapine[1] Agranulocytosis Seizures and myoclous jerks(dose dependent) Sedation Delirium OCD/Anxiety [2] Tachycardia Postural hypotension Weight gain Drooling saliva Elevated liver enzymes constipation Nausea Bed wetting Akathisia [1] https://schizophreniabulletin.oxfordjournals.org/content/24/3/381.full.pdf [2] https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/Document/September-2017/0806CP_Cases.pdf My ocd and anxiety r worsened after i increased my clozapine So while you posted the links, seems like it could be misleading to name all the side effects without indicating that some are much rarer than others. And is that second link based solely on case reports? Link to comment Share on other sites More sharing options...
Iceberg Posted July 2, 2019 Share Posted July 2, 2019 If you just look at the olanzipine side effects without incedents there’s a ton of scary shit there too Link to comment Share on other sites More sharing options...
the maze runner Posted July 2, 2019 Author Share Posted July 2, 2019 this is day 4 on clozapine. the self talk has almost gone away. no more booming voices in the skull. ability to do one small task at a time is also increased. sleep which was very shallow on day 1 after quitting olanzapine is much much better. as in more restful and refreshing. Link to comment Share on other sites More sharing options...
clinic Posted July 2, 2019 Share Posted July 2, 2019 8 hours ago, Iceberg said: So while you posted the links, seems like it could be misleading to name all the side effects without indicating that some are much rarer than others. And is that second link based solely on case reports? Only Agranulocytosis and Delirium are rare. No that second link is also mentioned in first link. Link to comment Share on other sites More sharing options...
Iceberg Posted July 2, 2019 Share Posted July 2, 2019 13 hours ago, the maze runner said: this is day 4 on clozapine. the self talk has almost gone away. no more booming voices in the skull. ability to do one small task at a time is also increased. sleep which was very shallow on day 1 after quitting olanzapine is much much better. as in more restful and refreshing. Great news! Link to comment Share on other sites More sharing options...
notloki Posted July 2, 2019 Share Posted July 2, 2019 There is a good chance olanzapine will mess with your metabolism, changing lipids, raising glucose, causing weight gain, and insulin resistance. Essentially it's the onset of diabetes. Some people blow up (gain large amounts of weight in a short time). This may continue to an official Diabetes diagnosis (defined as an A1c of 7 here in the US). Given all this, clearly this is not a drug you stay on for a long time but it is very effective short term. Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 6, 2019 Share Posted July 6, 2019 On 7/2/2019 at 6:55 PM, notloki said: There is a good chance olanzapine will mess with your metabolism, changing lipids, raising glucose, causing weight gain, and insulin resistance. Essentially it's the onset of diabetes. Some people blow up (gain large amounts of weight in a short time). This may continue to an official Diabetes diagnosis (defined as an A1c of 7 here in the US). Given all this, clearly this is not a drug you stay on for a long time but it is very effective short term. Is Seroquel any better than olanzapine? Do I just stop olanzapine? I've been on it for 2 months, 10 mg only. Weight loss. Labs were all just fine. Clozapine paradoxically increased my WBC and caused severe drooling that impacted my CPAP machine and caused weight gain and more. I gave it 6 months. I even took a high dose of a med that supposedly helped reduce the drooling. Plus cost. Lab work and weekly fills and the drooling med. It wasn't doable for me. I feel like I have no options. I hate being treatment resistant. Link to comment Share on other sites More sharing options...
argh Posted July 6, 2019 Share Posted July 6, 2019 (edited) 6 minutes ago, Wonderful.Cheese said: Is Seroquel any better than olanzapine? Do I just stop olanzapine? I've been on it for 2 months, 10 mg only. Weight loss. Labs were all just fine. Clozapine paradoxically increased my WBC and caused severe drooling that impacted my CPAP machine and caused weight gain and more. I gave it 6 months. I even took a high dose of a med that supposedly helped reduce the drooling. Plus cost. Lab work and weekly fills and the drooling med. It wasn't doable for me. I feel like I have no options. I hate being treatment resistant. Seroquel is said to have less efficacy than olanzapine but less metabolic issues. I recall that you were on a high dose of Seroquel a year or so ago. What was the reason you got off it? I cant quite remember. this link has a chart of which antipsychotics have on weight gain/metabolic syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574691/ curious, have you tried any of the typical antipsychotics? Or is eps such as td a huge dealbreaker for you? Edited July 6, 2019 by argh I am being productive 1 Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 6, 2019 Share Posted July 6, 2019 Just now, argh said: Seroquel is said to have less efficacy than olanzapine but less metabolic issues. I recall that you were on a high dose of Seroquel a year or so ago. What was the reason you got off it? I cant quite remember. Because I was on Seroquel, invega, and abilify and still very psychotic and depressed. So pdoc said clozapine would miraculously cure me. But no. Then vraylar then zyprexa again. All with abilify still on board. I don't know what is best anymore. Sorry. I don't want to thread hijack either. For me, clozapine was a no go. But ymmv. Good luck with the cloz to the OP! Link to comment Share on other sites More sharing options...
the maze runner Posted July 7, 2019 Author Share Posted July 7, 2019 yes @Wonderful.Cheese i agree with @argh suggestion to give typical antipsychotics a chance. clozapine is indeed a powerful drug. the only other drug ive taken which gave me as much mental clarity was haldol. 1 Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 7, 2019 Share Posted July 7, 2019 (edited) On 7/5/2019 at 8:20 PM, argh said: Seroquel is said to have less efficacy than olanzapine but less metabolic issues. I recall that you were on a high dose of Seroquel a year or so ago. What was the reason you got off it? I cant quite remember. this link has a chart of which antipsychotics have on weight gain/metabolic syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574691/ curious, have you tried any of the typical antipsychotics? Or is eps such as td a huge dealbreaker for you? 6 hours ago, the maze runner said: yes @Wonderful.Cheese i agree with @argh suggestion to give typical antipsychotics a chance. clozapine is indeed a powerful drug. the only other drug ive taken which gave me as much mental clarity was haldol. TD and EPS is unfortunately a dealbreaker for me. Otherwise I’d be trying one for sure. I did briefly try haldol but couldn’t get myself to take it after a week due to fear of TD, sadly. Sometimes I wonder if I could have gotten by with a much lower dose of clozapine and given it a chance like 6 months at that dose instead of 600 mg. My pdoc tends to max out doses of meds for me because of my history. She is already very worried with me being on “only” 10 mg zyprexa. Even though I’m beyond maxed out on Abilify too. My pdoc ramped the dose up rather quickly of the clozapine because understandably I was very psychotic and still depressed because of the death messages and voices. She rapidly increased it to 600 mg. I wonder if I would have stayed at like 200 mg or so or even less maybe if I could have gotten by and had less side effects maybe? The only worrying thing was my high WBC count that was happening but I don’t recall if that only happened once I got to such a high clozapine dose. But is lower to mid dose clozapine safer than mid dose zyprexa overall? Or no? Thanks for the great info! @argh @the maze runner what dose of clozapine are you on and do you know your target dose? Just wondering what your experience is. Thank you! Edited July 7, 2019 by Wonderful.Cheese Link to comment Share on other sites More sharing options...
CeremonyNewOrder Posted July 7, 2019 Share Posted July 7, 2019 4 hours ago, Wonderful.Cheese said: TD and EPS is unfortunately a dealbreaker for me. Otherwise I’d be trying one for sure. I did briefly try haldol but couldn’t get myself to take it after a week due to fear of TD, sadly. Sometimes I wonder if I could have gotten by with a much lower dose of clozapine and given it a chance like 6 months at that dose instead of 600 mg. My pdoc tends to max out doses of meds for me because of my history. She is already very worried with me being on “only” 10 mg zyprexa. Even though I’m beyond maxed out on Abilify too. My pdoc ramped the dose up rather quickly of the clozapine because understandably I was very psychotic and still depressed because of the death messages and voices. She rapidly increased it to 600 mg. I wonder if I would have stayed at like 200 mg or so or even less maybe if I could have gotten by and had less side effects maybe? The only worrying thing was my high WBC count that was happening but I don’t recall if that only happened once I got to such a high clozapine dose. But is lower to mid dose clozapine safer than mid dose zyprexa overall? Or no? Thanks for the great info! @argh @the maze runner what dose of clozapine are you on and do you know your target dose? Just wondering what your experience is. Thank you! I find every time I increase clozapine, it takes a week or two to feel results. It doesn't provide instant relief like the other APs. It has been about three years until I got to 400mg and the next time I see my pdoc I want to ask for an increase. I forgot cheese, did you ever try rexulti? I don't think it is good for psychosis but it has helped me with mood and depression. Link to comment Share on other sites More sharing options...
the maze runner Posted July 9, 2019 Author Share Posted July 9, 2019 @Wonderful.Cheese I am currently on 125mg clozapine even though my dr. has said 100mg. I take an extra 25mg in the morning hours. the target dose of clozapine according to my dr. is 250mg. it's been now more than a week on clozapine and I am beginning to see some very positive changes in my life. I have yet to notice any negatives. If there is a negative and I don't know there is it may be a mild version of cognitive impairment. Overall I feel more happy and self satisfied. More than what Ive felt in years. Link to comment Share on other sites More sharing options...
Simba Cub Posted July 9, 2019 Share Posted July 9, 2019 (edited) Olanzapine was touted as the replacement for Clozapine, with all of the oomf with none of the nasties. Didn't quite work out, although Olanzapine DID prove itself in it's own right. In terms of Clozapine, you should expect a few things come what may. Drowsiness, certainly. Putting on weight. Drooling. And of course there are the blood tests to warn your doctors of a potentially fatal side effect. That being said, Clozapine is the dogs wotsits and additionally is very good for insomnia, depression and anxiety. Edited July 9, 2019 by Simba Cub Link to comment Share on other sites More sharing options...
the maze runner Posted July 13, 2019 Author Share Posted July 13, 2019 does clozapine have a lot of cognitive negative side effects coz that's what i am experiencing. Link to comment Share on other sites More sharing options...
Iceberg Posted July 13, 2019 Share Posted July 13, 2019 3 hours ago, the maze runner said: does clozapine have a lot of cognitive negative side effects coz that's what i am experiencing. At higher doses it made me very foggy Link to comment Share on other sites More sharing options...
the maze runner Posted July 14, 2019 Author Share Posted July 14, 2019 is there a specific way of dealing with that. like for example with donepezil or modafinil or something similar. Link to comment Share on other sites More sharing options...
Iceberg Posted July 14, 2019 Share Posted July 14, 2019 1 hour ago, the maze runner said: is there a specific way of dealing with that. like for example with donepezil or modafinil or something similar. My pdoc gave me adderall but I don’t know that every doc would be comfortable with that. For me the fog was sedation Based so I doubt donepezil would have done much Link to comment Share on other sites More sharing options...
the maze runner Posted July 14, 2019 Author Share Posted July 14, 2019 26 minutes ago, Iceberg said: My pdoc gave me adderall but I don’t know that every doc would be comfortable with that. For me the fog was sedation Based so I doubt donepezil would have done much that's cool. in fact adderall is not available in my country so i guess the max my doc would give me is modafinil Link to comment Share on other sites More sharing options...
Iceberg Posted July 14, 2019 Share Posted July 14, 2019 1 hour ago, the maze runner said: that's cool. in fact adderall is not available in my country so i guess the max my doc would give me is modafinil Makes sense Link to comment Share on other sites More sharing options...
the maze runner Posted July 17, 2019 Author Share Posted July 17, 2019 my doc agreed to add modafinil. Link to comment Share on other sites More sharing options...
Iceberg Posted July 17, 2019 Share Posted July 17, 2019 37 minutes ago, the maze runner said: my doc agreed to add modafinil. Good luck with it Link to comment Share on other sites More sharing options...
the maze runner Posted July 18, 2019 Author Share Posted July 18, 2019 well clozapine is certainly doing its job and so is modafinil. i've experienced on previous occasions of taking modafinil that the effects tend to reduce a bit due to tolerance. i will keep this updated about that aspect as well. Link to comment Share on other sites More sharing options...
the maze runner Posted July 23, 2019 Author Share Posted July 23, 2019 I've had to increase my dosage of clozapine because modafinil was exacerbating my psychotic symptoms. On my last visit with my doc he said to take 50-100mg clozapine and I am still within that range. I am yet to decide whether to continue with modafinil as my doc had agreed to it only reluctantly and also it is precipitating psychosis. Link to comment Share on other sites More sharing options...
Iceberg Posted July 23, 2019 Share Posted July 23, 2019 Does your pdoc do the cloz blood level? I’ve found it helpful- cuz I’m on a low dose (50 am 125 pm) but based on my level we realized it’s not actually low for me. Probably not where you are Link to comment Share on other sites More sharing options...
the maze runner Posted July 24, 2019 Author Share Posted July 24, 2019 10 hours ago, Iceberg said: Does your pdoc do the cloz blood level? I’ve found it helpful- cuz I’m on a low dose (50 am 125 pm) but based on my level we realized it’s not actually low for me. Probably not where you are no i was expecting to be prescribed the blood tests but considering that agranulocytosis happens in only 1-2% of the population my dr. has not recommended it. also we don't have this kind of legal system in my country where it is mandatory to get the blood tests. i have also now decided to stop modafinil as it was worsening an already bad psychosis. my next visit i will ask my doc how to strike the balance between staying sane and also being able to do intellectual work. Link to comment Share on other sites More sharing options...
Simba Cub Posted July 25, 2019 Share Posted July 25, 2019 On 7/6/2019 at 2:16 AM, Wonderful.Cheese said: Is Seroquel any better than olanzapine? Do I just stop olanzapine? I've been on it for 2 months, 10 mg only. Weight loss. Labs were all just fine. Clozapine paradoxically increased my WBC and caused severe drooling that impacted my CPAP machine and caused weight gain and more. I gave it 6 months. I even took a high dose of a med that supposedly helped reduce the drooling. Plus cost. Lab work and weekly fills and the drooling med. It wasn't doable for me. I feel like I have no options. I hate being treatment resistant. Seroquel is an interesting drug. It's the "softest" one meaning it has the least dodgy side effects, but it WILL make you VERY drowsy - probably! Ironically, it is the atypical antipsychotic closest to Clozapine out of the rest. Link to comment Share on other sites More sharing options...
the maze runner Posted July 26, 2019 Author Share Posted July 26, 2019 would it make sense to take olanzapine and clozapine both together? somehow olanzapine works as a stimulant in my system. Link to comment Share on other sites More sharing options...
Iceberg Posted July 26, 2019 Share Posted July 26, 2019 43 minutes ago, the maze runner said: would it make sense to take olanzapine and clozapine both together? somehow olanzapine works as a stimulant in my system. But the combo might have synergistic efffects and you could open yourself up to magnified shared side effects like sedation, fogginess and weight/metabolic issues Link to comment Share on other sites More sharing options...
the maze runner Posted July 26, 2019 Author Share Posted July 26, 2019 I have news. Olanzapine works like crack cocaine in my system. I don't know why but it does. as far as i know this kind of paradoxical reaction is unheard of in the psychiatric world. Does anybody have any info on this. I was visiting drugs.com the other day and one user reported that olanzapine made his/her psychosis 'much worse'. How is this possible? It also enables me to think more clearly. Link to comment Share on other sites More sharing options...
the maze runner Posted July 26, 2019 Author Share Posted July 26, 2019 One user says this at drugs.com "This medicine literally makes you zero IQ. I'd rather take Risperidone which ruins my libido than having zero IQ." How is this possible when I can take it and literally fly through interviews the answers come so naturally to me. It gives me a cognitive boost. Link to comment Share on other sites More sharing options...
CeremonyNewOrder Posted July 27, 2019 Share Posted July 27, 2019 7 hours ago, the maze runner said: One user says this at drugs.com "This medicine literally makes you zero IQ. I'd rather take Risperidone which ruins my libido than having zero IQ." How is this possible when I can take it and literally fly through interviews the answers come so naturally to me. It gives me a cognitive boost. Because everyone has a different reaction to Zyprexa. Just pay attention to what it is doing for your, which is positive. 1 Link to comment Share on other sites More sharing options...
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