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Barring Clozapine, which is the most "beefy" antipsychotic?


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8 minutes ago, Simba Cub said:

The most often cited med is Olanzapine, although Quetiapine is the closest relative to Clozapine and Aripiprazole in many ways is the new boy on the street...

Would you consider typical APs?  Haldol, maybe?

Otherwise, for AAP's, I'd say you're right on Olanzapine with regard to wide spectrum usage.  Helps me with anxiety, depression, hypomania, agitation/anger, etc.  Just makes me too fat to use more than sparingly.

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From a combination of my experience and looking at affinity for 5-HT2A and D2 receptors...

For antipsychotic action: aripiprazole (Abilify), Saphris (asenapine), Rexulti (brexpiprazole), Vraylar (cariprazine), Latuda (lurasidone) (up to 160 mg), olanzapine (Zyprexa), paliperidone (Invega), high dose quetiapine (Seroquel/XR) (750-800 mg), risperidone (Risperdal), and high- to supratherapeutic-dose ziprasidone (Geodon) (60-80 mg 2x/day up to 160 mg 2x/day) (provided that adequate calories are consumed with each dose). Pretty much any of the typicals will be good for antipsychotic/agitation.

With quetiapine (Seroquel), you really have to get to the higher doses/max dose to get the antipsychotic effect (600 mg at minimum, should really be 750-800 mg for IR and 800 mg for XR).

For acute agitation: Saphris (asenapine), oral and intramuscular olanzapine (Zyprexa), low- to moderate-dose quetiapine (Seroquel) (probably 25-200 mg), risperidone (Risperdal), and intramuscular ziprasidone (Geodon)

For antidepressant effects: aripiprazole (Abilify), Saphris (asenapine) (possibly), low- to moderate-dose Rexulti (brexpiprazole) (0.5-2 mg) (for most people), low-dose Vraylar (cariprazine) (1.5-3 mg), Latuda (lurasidone) (up to 120 mg), olanzapine (Zyprexa), (paliperidone? (Invega)), mid- to mid-high dose quetiapine (Seroquel/XR) (300-600 mg), risperidone (Risperdal) (dose? probably low...), low- to moderate-dose ziprasidone (Geodon) (20-40 mg 2x/day)

Anxiety, I'm not sure about because I've never taken many antipsychotics for anxiety, but I will say that trifluoperazine (Stelazine) has been a life saver for me and anxiety, especially when paired with a benzo. Low- to moderate-dosed quetiapine (Seroquel) (25-200 mg) is supposed to be good for anxiety too, and as @Arj72 said, olanzapine (Zyprexa).

To my understanding, drugs of last resort are Fanapt (iloperidone) (not sure why...) and, of course, clozapine (Clozaril). Those are the antipsychotics available in the US.

There may be some antipsychotics available where you live that I don't know about. I believe amisulpride is available where you live, as is sulpiride. They're sort of multi-modal like quetiapine insofar as low doses are good for depression and higher doses for psychosis. Also, flupenthixol is also another one that may be available where you live, and is multi-modal in this same fashion.

Edited by mikl_pls
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1 hour ago, mikl_pls said:

From a combination of my experience and looking at affinity for 5-HT2A and D2 receptors...

For antipsychotic action: aripiprazole (Abilify), Saphris (asenapine), Rexulti (brexpiprazole), Vraylar (cariprazine), Latuda (lurasidone) (up to 160 mg), olanzapine (Zyprexa), paliperidone (Invega), high dose quetiapine (Seroquel/XR) (750-800 mg), risperidone (Risperdal), and high- to supratherapeutic-dose ziprasidone (Geodon) (60-80 mg 2x/day up to 160 mg 2x/day) (provided that adequate calories are consumed with each dose). Pretty much any of the typicals will be good for antipsychotic/agitation.

With quetiapine (Seroquel), you really have to get to the higher doses/max dose to get the antipsychotic effect (600 mg at minimum, should really be 750-800 mg for IR and 800 mg for XR).

For acute agitation: Saphris (asenapine), oral and intramuscular olanzapine (Zyprexa), low- to moderate-dose quetiapine (Seroquel) (probably 25-200 mg), risperidone (Risperdal), and intramuscular ziprasidone (Geodon)

For antidepressant effects: aripiprazole (Abilify), Saphris (asenapine) (possibly), low- to moderate-dose Rexulti (brexpiprazole) (0.5-2 mg) (for most people), low-dose Vraylar (cariprazine) (1.5-3 mg), Latuda (lurasidone) (up to 120 mg), olanzapine (Zyprexa), (paliperidone? (Invega)), mid- to mid-high dose quetiapine (Seroquel/XR) (300-600 mg), risperidone (Risperdal) (dose? probably low...), low- to moderate-dose ziprasidone (Geodon) (20-40 mg 2x/day)

Anxiety, I'm not sure about because I've never taken many antipsychotics for anxiety, but I will say that trifluoperazine (Stelazine) has been a life saver for me and anxiety, especially when paired with a benzo. Low- to moderate-dosed quetiapine (Seroquel) (25-200 mg) is supposed to be good for anxiety too, and as @Arj72 said, olanzapine (Zyprexa).

To my understanding, drugs of last resort are Fanapt (iloperidone) (not sure why...) and, of course, clozapine (Clozaril). Those are the antipsychotics available in the US.

There may be some antipsychotics available where you live that I don't know about. I believe amisulpride is available where you live, as is sulpiride. They're sort of multi-modal like quetiapine insofar as low doses are good for depression and higher doses for psychosis. Also, flupenthixol is also another one that may be available where you live, and is multi-modal in this same fashion.

If we’re including typicals - I might add haldol and probably Thorazine for the acute agitation category  as well. The haldol IM is super common for emergency hospital use, and I know that some inpatient wards (including a children’s ward oddly) that give Thorazine as a sedative instead of benzos when people are freaked out manic 

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  • 2 weeks later...
On 1/29/2020 at 1:05 AM, Iceberg said:

If we’re including typicals - I might add haldol and probably Thorazine for the acute agitation category  as well. The haldol IM is super common for emergency hospital use, and I know that some inpatient wards (including a children’s ward oddly) that give Thorazine as a sedative instead of benzos when people are freaked out manic 

I'd say Thorazine is a very sedating antipsychotic, but not a good or potent one when compared to others, both typical and atypical. 

Generally speaking, an antipsychotic's potency — not to be confused with efficacy — is at least in part determined by its D2 and D3 receptor-binding affinity. So, for typicals, ones like Haldol, Stelazine, and Prolixin would qualify. 

In conjuction with dopamine receptor binding affinity, it's all relative to Thorazine. In other words, scientists measured how much of a particular drug vs how much thorazine would it take to occupy x% of receptors. 

So potency really only correlates with a higher risk of extrapyramidal side effects, not how good it is at alleviating whatever you have going on. 

Atypical antipsychotics are even harder to measure as some don't bind very tightly to D2/D3 or hit many other receptors than just dopamine. And if you look at the "best" antipsychotic we have, clozapine, it has a pretty weak affinity for D2 as compared to other meds, but it can do a lot for people where all others have failed

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58 minutes ago, clinic said:

If you want to know which is the most effective and which is the most least, here's a chart from a study. [1] Most effective is clozapine, and least is Iloperidone[1]

 JAbgdyl.png

[1] http://www.kcl.ac.uk/ioppn/news/events/2013/september/Leucht-2013-15-antipsychotics-meta-analyses.pdf

Treating what though? What symptoms were being measured? 

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Keep in mind everyone has a different experience and reacts to drugs differently. I took clozapine and didn’t find it very effective, but I stabilized completely on Latuda which is considered a much weaker drug. It’s been my miracle drug, regardless of it being considered less effective than clozapine. 

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I've done some digging.

Olanazapine was designed to be the new Clozapine, minus the side effects and blood tests. It turned out to be powerful, but not quite as "beefy" as Clozapine.

Interestingly, despite this, Quetiapine remains the closest drug to Clozapine biologically.

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