Posted by LouisianaSportsman on April 13, 2014, at 0:54:42
In reply to replace Abilify with perphenazine?, posted by Christ_empowered on April 10, 2014, at 16:54:55
Right now, youre only on 30mg. aripiprazole, 1,200mg. oxcarbamazepine, and up to 300mg. gabapentin PRN? Correct?
I find your gabapentin dosage to be significantly low, but you know I love gabapentin lol. Consider raising it. I found it useful for anxiety and depression. YMMV.
Youre contemplating Remeron, right? If so, 30mg. is a start-up dosage if looking to avoid sedation. I thought Ive read somewhere where you were afraid of getting fat before. Well, I have bad news about mirtazapine.
One of the things I notice is you're on Trileptal. I remember you might have tried Oxtellar XR which I think is better than Trileptal in terms of how oxcarbamazepine formulations go, but Ive come to the conclusion that no form carbamazepine beats Equetro (carbamazepine XR) 1. Carbarmazepine, not oxcarbamazepine, has the science and research backing it for bipolar. 2. Equetro is actually indicated for the disorder. 3. It is time-released.
I would look into #120 200mg. capsules of Equetro. (or #90 300mg. capsules to be easier, itd be a 150mg. increase this way; you multiply carbamazepine by 1.5 to obtain equivalency to oxcarbamazepine) Theres no quantity dispensed limit on my insurance so you should be good. But you seem to be good with Trileptal? I was just throwing Equetro out as an idea just in case you ever became unhappy. I would just stick with Trileptal if everything is working out.
What antipsychotics have you tried? You must have been around the AAP block if youre throwing out perph? I understand trying to save the taxpayers money, but thats the only reasoning I can understand. Basically, I assume 30mg. of Abilify is too much for you? Your PDOC wont lower it?
I guess if you have no choice in changing AAPs then you can try changing to Fanapt. Youre supposed to dose it twice a day, and this shouldnt be an issue if youre taking 600mg. of Trileptal morning and night. Just take 8mg. of Fanapt with those doses for about a 16mg. dose (max dose 24mg., lowest is 12mg.)Obviously, youre having some sort of issue with depression or you wouldnt want to be on mirtazapine. Why did you quit Tofranil? Obviously, you dont seem to mind taking a TCA or a sedating medication so my best suggestion to you is Oleptro (trazodone extended-release).
Trazodone typically needs to be dosed TID, but with this XR version, you have a much more stable plasma concentration than the IR dosing and it stays above the antidepressant concentration level. And you would likely develop a tolerance to the sedation. In fact, this new formulation of trazodone XR has been tested in depressed patients with a surprisingly low incidence of sedation.
Trazodone is a pretty proven antidepressant and here we have it in a form you dont have to dose TID and isnt as sedating. They only have 150mg. and 300mg. bisectable tablets and have 375mg. as a listed max dose in the PI sheet. Cant take no more than 400mg. trazodone.
Id consider something like this:
#75 150mg. Oleptro (375mg. max dose)
#60 8mg. Fanapt (16mg. as close to 18mg., the mid-range dose as you can get to replace your maxed-out Abilify which you don't seem to like)
1,200mg. Trileptal (consider Equetro)
Gabepentin PRN (consider more of it actually or changing to Lyrica if financially possible)
poster:LouisianaSportsman
thread:1063976
URL: http://www.dr-bob.org/babble/20140328/msgs/1064156.html