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Zyprexa And Seroquel


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#1 Stacia

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Posted 16 October 2007 - 11:08 PM

How nuts would it be to take 10mg of Zyprexa and 25mg of Seroquel for a number of months?
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#2 sorrel

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Posted 17 October 2007 - 06:33 AM

I was wondering the same thing as Jook. That seems kind of pointless.

With those dosages, I'm guessing you're taking the Zyprexa as an antipsychotic (or anti-manic) and the Seroquel for sleep. You'd probably be better off just taking a (much) higher dose of the Seroquel, because then it could cover both functions. Or, alternately, you could consider the Zyprexa plus a heavy-duty antihistamine (eg Atarax.) (Because Seroquel at 25mg basically is an antihistamine.) Or, you could try Zyprexa at a higher dose (15-20mg) which may be sedating enough to cover the sleep function too.

Plenty of people do take 2 antipsychotics, but there's usually no reason to, and it kicks up the risk of problems and side effects.
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#3 Sasha

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Posted 17 October 2007 - 11:11 AM

On the other hand, if that's your current regimen, and it's working as you need it to, with no problemmatic side effects, I'm kind of wondering why you'd want to mess with it right now?
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#4 Pillboxfox

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Posted 17 October 2007 - 04:10 PM

How nuts would it be to take 10mg of Zyprexa and 25mg of Seroquel for a number of months?

Why bother taking 25mg of Seroquel? Its way too little to make any difference. You need a few hundred miligrams of that stuff for it to work as an antipsychotic.

PBF
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Diagnosis: Bipolar type 2 disorder and substance abuse disorder (working hard on staying clean)
Daily med combo: Lithium 600mg + Remeron 30mg + Zyprexa 5mg (all taken at bedtime)
Lithium level: 0.5
PRN meds: Librium 10mg capsules, Haldol 2mg tabs
Emergency/crisis meds: Xanax 0.5mg tabs, Prolixin (fluphenazine) long-acting injection
Previously tried: Seroquel, Risperdal, Nozinan (levopromazine), Depakote, Lamictal, Effexor, Serzone, Trazodone, Celexa, Wellbutrin, Klonopin, Ativan, Restoril, Serax, Valium

#5 Silver

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Posted 17 October 2007 - 04:43 PM

PBF, it's the same deal as with MJ's Zyprexa microdose.
Seroquel's not an antipsychotic 'til at least 200 mg, you are correct.
Stacia's not talking about using it as an antipsychotic, from what I'm reading. This isn't about making the voices go away. She's talking about using it for sedation / anxiolytic effects, while keeping Zyprexa around for mood/affective stabilization. Please correct me if I'm wrong, Stacia.

I snarkily refer to 25 mg as the antihistamine dose all the time. Still. It has alpha-1 adr. effects that are really significant, especially compared to Zyprexa (pretty minimal in the a-1 adr department.) Seroquel hits 5HT2A, but not that hard - nowhere near as hard as Zyprexa. Adding prazosin and an old-line antihistamine might work; on the other hand, from the old board, I recall Stacia never really responding to big nasty antihistamines.

Combining OLZ and SQL seems of questionable utility to me too.

Except for that alpha-1 thing. That looks interesting to me.

Of course, prazosin is so cheap you can spackle your walls with it.
Seroquel is not.
Something to consider. I don't know the state of Stacia's insurance.

The answer isn't to just go to a high dose of SQL. Different drug from OLZ. She's getting a good mood response to OLZ. Makes sense to push that one, and address the sedation/anxiety issue separately if needed. She might get that addressed by just increasing the dose of OLZ. A-1 adr blockers will address sedation/anxiety. She might well get that from very low dose SQL, or a straight alpha blocker, or whatever. There's more than one way to skin a cat or put Stacia to sleep.

Edited by Silver, 17 October 2007 - 04:45 PM.

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#6 Silver

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Posted 17 October 2007 - 05:08 PM

THe alpha-1 blockade is a big part of its anxiolytic effect, I suspect; definitely a factor in why it works so well in PTSD.
Also why it's unfortunate if given with beta-blockers, as hypotension results very often.

Because of this, I predict you will see a lot of it used as people come back from Iraq. (And then the litigious vultures - who have thus far circled Zyprexa - will circle SQL.)
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#7 Silver

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Posted 17 October 2007 - 05:22 PM

Beta blocker.
Not very sedating.
Good for overall anxiety, though.
Beta-blockers haven't proven out as well for nightmares as the alpha blockers. Different creatures.

Alpha-1, alpha-2, and beta blockers all have a very different 'feel' in terms of their psych effects. Clonidine (alpha2) knocks me out cold and leaves me limp; prazosin (alpha1) leaves me sleepy and mellower. Pindolol makes me verrrryyyy calm and nonreactive but doesn't make me sleepy at all. And pindolol doesn't make my asthma flare up... but Inderal will have me scrambling for an inhaler, and I haven't used an inhaler in 5 years. Different selectivity internally inside the classes.
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#8 Stacia

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Posted 17 October 2007 - 10:35 PM

Why would you need to??

Jook

Having yet to read all the replies, I wanted to answer this since I should have included the reason before running out to work.

The why is that for the first time in almost a year, I've dusted off the trusty Klonopin. I'm getting anxious is the answer. I'm reasonably sure it's not hypo creeping back in, but hell, everytime I think I understand this mental stuff, it goes and morphs into a different presentation or turns out to be something else. To make a long story short, my baby dose of Zyprexa neither sedates me nor de-anxietizes me. However, it does help some with depression. The Q is about 10mg cuz if my pdoc doesn't have an alternative, I'm pretty sure I'll be going up in the near future. The Q also is about Seroquel because unless there's some exponential Z increase factor, I don't think it's gonna cover anxiety (or sleep).

(Yes, I feel like I'm eating my words from the other thread. I've been on Seroquel almost a year, Klonopin for a short time to deal with yet to be dx'd hypomania, and major dissociated depression for the year before that. I don't want dissociation back, but this nervousness sucks.)

***
In reply to why not just increase Seroquel... I would love to take it, however, I prefer to breath regularly. If I take 75mg at one time, I cannot breath thru my nose at all, a lot of pressure sits on my inner hear (lovely SEs to that), and I can't sleep without something like serious sleep apnea. In short, I'm capped at 50mg a pop spaced out 2-3 hours. That's also when S is most sedating for me. A 150mg when hypomanic is doable, 200mg when not, just plain isn't, at least not if I plan to work and have some semblance of a life.

Silver is right, antihistimines have never been very sedating for me. I haven't tried the heavy hitters, but have tripled up on Benedryl and been unphased.

Inderol? Don't know much about it.

Btw, I'm not really expecting my pdoc to go along with this idea. I was just curious what folks here thought about it.

Edited by Anastacia, 17 October 2007 - 10:56 PM.

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#9 Silver

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Posted 18 October 2007 - 08:49 AM

If you have a weird atopic / allergic response history, people will shy away from propranolol / Inderal for you because of the asthma-breathing thing. "The breathing thing" is a big deal. You understand. You dig the breathing, as I recall.
Pindolol is somewhat safer, maybe, in that case.
But they're beta-blockers.

a-1 is the Likely Suspect in SQL here, so that's prazosin/terazosin we're discussing.
Or St. Joseph's Baby Seroquel.

To come full circle.
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