Posted by med_empowered on June 4, 2005, at 4:27:23
In reply to mellaril to zyprexa equivilancy, posted by linkadge on June 4, 2005, at 3:45:35
hi! Switching people over from old antipsychotics to the newer agents can be kind of tricky...since the old drugs are more potent D2 blockers (70-90% blockade at average dosages versus 65+% for atypicals) sometimes the best way to go is lowering the dose of the old drug and adding a full-dose atypical. Given that your mom only takes 100mgs, though (the max is 800mgs/day, and severe disorders usually require at least 200mgs) it seems like a switch over should be pretty simple. You could do a taper of the Mellaril (down to 0), a brief washout, and then start introducing the Zyprexa, starting at maybe 2.5 or 5mgs...this would help prevent a number of side effects, since taking 2 antipyschotics at once (even at low-doses) can cause awful side-effects with little or no benefit (though sometimes it is the way to go). On the other hand, if your mother would do better with a cross-taper/titration in which she was *awlays* on at least 1 antipsychotic, and the potential of somewhat increased side-effects is acceptable, you could try cutting the Mellaril *very* gradually--say, 20mgs ever 4 days-1 week, give or take-- while introducing the zyprexa at equally slow, steady intervals. From my (limited) experience with Zyprexa, it seems like cutting a 5mg tablet into 4ths, and introducing 1/4 after each "cut" of the Mellaril might be the way to go. I looked up conversion protocols for switching patients from old APs to new ones; most of them were for severe, hospitalized cases using full-dose anti-psychotics (not your mother's case) and were designed primarily to get the new drug in as fast as possible, while risking side effects (but presumably preventing relapse). Have you considered maybe trying Seroquel? Given its calming, sedating effect, your mom might get the same soothing, calming effects that low-dose Mellaril (theoretically) provides, but without the associated risks. Plus, since they're both low-potency and have very similar dosage ranges, you could do a "cleaner" conversion, more like a 1:1 kind of ratio. My guess would be 150-200+/- mgs of Seroquel would provide similar relief of symptoms, but not necessarily similar D2 blockage--any atypical you substitute will provide less D2 blockage and more serotonin action. I know it must seem from my posts that I work for the Abilify people (I don't), but I do think its good stuff for a lot of people...you could do a short washout and start your mom out on 10mgs, which is effective for full-blown mania and psychosis as well as (presumably) any off-label purposes anti-psychotics are usually used for. The EPS profile isn't as good as Seroquel, but the risk of other serious side effects--diabetes, weight gain, heavy sedation, cognitive impairment,heart "issues," etc.--are considerably better than any other antipsychotic available. Good luck!
poster:med_empowered
thread:507544
URL: http://www.dr-bob.org/babble/20050601/msgs/507547.html