Jump to content
CrazyBoards.org

Recommended Posts

Here's a lesson. There is no high, ideal, maximum or minimum dose of any individual drug that applies to all patients. I'm on 450mg Clozapine. My blood count should at maximum be 600mg but I'm actually hitting 1,100mg, almost twice the toxic threshold. We're trying to balance it out with Trifluoperazine but if that's doesn't work, Amisulperide is on the agenda. Olanzapine is a no-no as is Quetiapine as they're hardly tested together and would most likely sedate me beyond all recognition.

Moral of the story is? Check your blood serum levels at least every 3 months. Otherwise you could be in for a nasty shock!

Share this post


Link to post
Share on other sites

WOW...

Have you ever tried aripiprazole with clozapine? It is supposed to be a very good combination.

I hope you can get your clozapine levels under control while retaining symptomatic relief.

Edited by mikl_pls

Share this post


Link to post
Share on other sites
1 hour ago, mikl_pls said:

WOW...

Have you ever tried aripiprazole with clozapine? It is supposed to be a very good combination.

I hope you can get your clozapine levels under control while retaining symptomatic relief.

Tried Aripiprazole and reacted VERY badly... it was a good attempt as Clozapine is sedating and Aripiprazole is activating.

Currently on Trifluoperazine as an adjunctive therapy, but if that doesn't work, I have instruction to try Amisulpride. I mentioned Olanzapine and Quetiapine as I have tolerated both well, but if I did try them, I'd probably sleep 23 hours a day!

Share this post


Link to post
Share on other sites
1 minute ago, Simba Cub said:

Tried Aripiprazole and reacted VERY badly... it was a good attempt as Clozapine is sedating and Aripiprazole is activating.

Oh my... :( That's not good.

I know someone on this site who's taking clozapine who takes Rexulti with it. It's not "Abilify 2.0" as many people claim, if you've never taken it. If it's available to you, perhaps it might be worth a try with the clozapine if the trifluoperazine doesn't help things out? Rexulti for me was sedating in low to mid doses (0.25-2 mg) and somewhat stimulating at the highest dose I tried (3 mg, 4 mg is max).

I don't know about you, but trifluoperazine, to me and apparently to others too as it has been documented in some literature, has a "mood brightening" effect, and in super low doses is somewhat stimulating to me (like 1 mg twice daily). I know that's not enough for symptom control for most people, and that higher doses it can be rather sedating, likely dose dependently (2 mg 3x/day was super sedating to me when I was taking it regularly, but the benefits were at the time better than the side effects). I take 5 mg 2x/day on an as needed basis and never feel sedated from a single dose, but at the same time I never feel emotionally stunted like most other first-gen antipsychotics do to me, especially haloperidol, even at 0.5 to 1 mg as needed. Loxapine I think was the only other FGA to not have an affective-blunting effect on me, and it's likely because its pharmacodynamic profile so closely resembles clozapine as well as producing the antidepressant amoxapine as a metabolite. The most of it I ever took was 10-20 mg as needed, sometimes taking it for a week or two at a time during a psychotic depressive episode I had a few years ago.

But I think before the Rexulti, giving the trifluoperazine + clozapine combo a go and trying to stabilize your clozapine levels while still achieving a therapeutic effect (balancing the doses of the two) is paramount at this point.

Does your pdoc know why your clozapine levels are so high despite your dose?

IIRC, trifluoperazine is metabolized solely by CYP1A2 but I don't think it inhibits it, and clozapine is highly metabolized by CYP1A2 and I think is an inhibitor of it, and anything that competes for metabolism with that enzyme can cause your clozapine levels to skyrocket (like the SSRI Luvox, which is commonly prescribed with clozapine to help with depressive/obsessive symptoms while maintaining the clozapine dose as low as possible).

Share this post


Link to post
Share on other sites

I actually did cloz + Vraylar for awhile, weird but I liked it better than cloz + Rexulti 

Share this post


Link to post
Share on other sites

On the other end, some chemicals interfere with the metabolism of clozapine, like nicotine, so you have to essentially double the dose to get the correct blood level and efficacy. 

Share this post


Link to post
Share on other sites
On 2/14/2020 at 6:28 AM, Simba Cub said:

Amisulperide is on the agenda.

I want to try amisulpride as well but im scared of hyper prolactin. Last time i tried amisulpride(50-100mg) for 1 week it increased my prolactin to 53 ng/ml (2-17).

I'm male and i dont want gynecomastia. Plus i dont tolerate abilify, it worsens my anxiety and paranoia.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...