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Olanzapine As A Prn?


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#1 TemperaMental

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Posted 11 January 2008 - 07:06 AM

Hi people. I've been a fan of crazymeds for a while, but this is the first time I've posted.

I am diagnosed with bipolar disorder, with psychotic symptoms and rapid--cycling course/devilish mixed states (trifecta - woo!), and my psychiatrist is keen to prescribe me olanzapine (Zyprexa) as a p.r.n to take when it all gets a bit too much. Apparently a p.r.n. is indicated because it avoids some of the nastier side-effects, and because I am a 'responsible patient' with good insight (gold star for me!).

Anyway, I couldn't find much info as to the usefulness/efficacy/safety of this method of administration for Zyprexa, so I was hoping that people could share their experiences or point me in the direction of some reading material. Does it work fast enough? Isn't it just a knock-out drop unless your body's had time to become accustomed to it?

Oh yeah, I'm a PhD-level neuroscientist, so feel free to hit me with the hard stuff :mad: . I had a brief trawl on Pubmed, but didn't really find what I was looking for.

FWIW, I currently take 1g valproate daily as a mood stabiliser and 7mg zopiclone as a prn sleep med. I've never taken an antipsychotic before, so I have no idea what to expect, though there's only one way to find out.

Thanks!
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#2 Glen

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Posted 11 January 2008 - 09:12 AM

Anyway, I couldn't find much info as to the usefulness/efficacy/safety of this method of administration for Zyprexa, so I was hoping that people could share their experiences or point me in the direction of some reading material. Does it work fast enough? Isn't it just a knock-out drop unless your body's had time to become accustomed to it?


Is it really surprising that Eli Lilly does not fund research into prn use? Perhaps if it was to study zyprexa's use as a replacement for sprinkles on cupcakes we would have some good research.

Seriously, from my own observations (not experience though) and listening to others here, it is the best prn / emergency med there is. If you need to calmed down NOW it should be first the first choice. That being said if you respond very well to it, you and or your doctor may get comfortable with the idea of using it for prophylaxis. IMO, for that purpose it really should be one of the last choices.
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#3 TemperaMental

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Posted 11 January 2008 - 10:07 AM

Is it really surprising that Eli Lilly does not fund research into prn use? Perhaps if it was to study zyprexa's use as a replacement for sprinkles on cupcakes we would have some good research.


Good point - I really must remember to be more cynical in future! :mad:

Thanks for the positive view though. I guess my doctor's clinical experience agrees with your observations, which is why he wants to go that route.
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#4 NOS

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Posted 11 January 2008 - 04:19 PM

I started out taking Zyprexa PRN. I was in a pretty depressed state, and my doc gave me a script for a few them to get me through until I could get started on another medication. It did work really well, really fast. Within a couple of hours of the first dose, I felt better. It didn't make me as tired as I had anticipated, but it definitely chilled me out. The goal was to get me started on another medication and just take the Zyprexa as needed to avoid the weight gain and all that comes along with that. Unfortunately, the other meds we tried didn't work out, and now I'm on Zyprexa daily. If it weren't for the weight gain, I'd have no complaints about this med. Best of luck to you!
-Lauren
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Pertinent and probably some not so pertinent info:

DX: Not sure which of these are current or accurate anymore, but my money's on the last one to account for the symptoms...Generalized Anxiety Disorder, ADD, Depressive Disorder NOS, Bipolar Disorder NOS, Possible Fibromyalgia/Chronic Fatigue Syndrome (doc has suggested this, prescribed accordingly, but has yet to do any sort of evaluation to determine...I'm uninsured), PTSD

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#5 In_Remission_aftermath

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Posted 27 January 2008 - 12:32 AM

i am wondering what prn dose of zyprexa people are taking. I know doses vary a lot, but in general... what are you taking prn? thanks!

#6 TemperaMental

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Posted 28 January 2008 - 04:17 AM

Thanks very much for all the responses.

Aftermath: I begged my doctor for the teeniest possible amount as a starter, so I've got the 2.5mg pills, and an instruction to take either 1 or 2 of them as needed. So far I've only had to use it once, and my God did I sleep beautifully that night, and was amazingly clear-headed the following day.

Having said that, I've seen some data that suggests that anything less than 10mg/day is just pissing in the wind as far as psychosis is concerned, but hey, whatever works for you ....

I came across another interesting paper on my travels too, this one a big meta-review suggesting that most of the benefits of antipsychotic treatment are apparent very early on in the course of treatment: http://archpsyc.ama-...ourcetype=HWCIT

So maybe PRN is going to be an optimal strategy in a lot of cases, especially with periodic psychoses, and a way of avoiding some of the harsher long-term side-effects (not to mention the outrageous costs) of these types of drugs. Obviously it won't be right for every patient, but it's something to think about.
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#7 In_Remission_aftermath

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Posted 28 January 2008 - 05:26 PM

Thanks very much for all the responses.

Aftermath: I begged my doctor for the teeniest possible amount as a starter, so I've got the 2.5mg pills, and an instruction to take either 1 or 2 of them as needed. So far I've only had to use it once, and my God did I sleep beautifully that night, and was amazingly clear-headed the following day.

wow, 2.5 is a very small dose. I think the pills I have are 5 or 10mg? maybe I'm wrong. I can't keep em all straight! haha. But thanks for the reply, maybe i will try lower dose next time...

Having said that, I've seen some data that suggests that anything less than 10mg/day is just pissing in the wind as far as psychosis is concerned, but hey, whatever works for you ....

I came across another interesting paper on my travels too, this one a big meta-review suggesting that most of the benefits of antipsychotic treatment are apparent very early on in the course of treatment: http://archpsyc.ama-...ourcetype=HWCIT

So maybe PRN is going to be an optimal strategy in a lot of cases, especially with periodic psychoses, and a way of avoiding some of the harsher long-term side-effects (not to mention the outrageous costs) of these types of drugs. Obviously it won't be right for every patient, but it's something to think about.


ohh that is very interesting, especially the last paragraph of what you said. I had sort of come to this conclusion myself, re: my own care. It only makes sense for me to go prn since I have no insurance and dont accept side effects like huge weight gain or whatever else they decide to come up with next. Also the periodic nature of my psychotic states... as you said, it is good for me because even though there is pretty much always a low-level of symptoms, the overwhelming shit is periodic, so I can just take prn zyprexa when that happens.
cheers, TemperaMental.


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