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Banana121: brother's road to recovery


Banana121

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Hello, I just wanted to say that 8 months later, he started getting waves that were light and lasted about a week with 2 week windows.

 

End of march he had a wave that lasted 11 days then a window that lasted 8 days.

 

Another wave that lasted 16 days and was quite bad, gradually getting worse till 6th, 7th, 8th and  9th day and these were the worst days. Gradually getting better until 16th day when his wave ended. Window for 6 days.

 

Now he is going through a wave, it is the 9th day and it is so bad, he can't sit still but he is also shouting a lot, agitated, aggressive and can't sit in a room with people or he starts shouting and getting agitated except with his dad (on his worst day, he will pick a fight with him). He is also going up to two days at a time without sleeping in this wave.

 

A family member is thinking of sending him to the hospital but I don't want him sent and given loads of medication again. As an alternative to the hospital we were thinking of reinstating a small amount instead. I wanted an opinion on this as it has been a year and 3 weeks off risperidone. Thanks.

 

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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  • Moderator Emeritus
1 minute ago, Banana121 said:

I wanted an opinion on this as it has been a year and 3 weeks off risperidone. Thanks.

It would be very risky to reinstate this far out and could make matters worse.  The windows and waves that your brother is going through are normal and an encouraging sign of healing.

 

The Windows and Waves Pattern of Stabilization

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg to 1.875mg 1986-2020, two CT's and reinstatements

Nov. 2020, 7-week Ativan-Valium crossover to 18.75mg Valium

Feb. 2021, begin 10%/4 week taper of 18.75mg Valium 

End 2021  year 1 of Valium taper at 6mg

End 2022 year 2 of Valium taper at 2.75mg 

End 2023 year 3 of Valium taper at 1mg

Jan. 24, 2024: Hold at 1mg and shift to Imipramine taper.

Taper is 95% complete.

 

Imipramine 75 mg daily since 1986.  Jan.-Sept. 2016 tapered to 14.4mg  

March 22, 2022: Begin 10%/4 week taper

Aug. 5, 2022: hold at 9.5mg and shift to Valium taper

Jan. 24, 2024: Resume Imipramine taper.  Current dose as of Feb. 22: 7.6mg

Taper is 90% complete.  

  

Supplements: multiple, quercetin, omega-3, vitamins C, E and D3, magnesium glycinate, probiotics, zinc, melatonin .3mg, anti-candida, iron, serrapeptase, nattokinase


I am not a medical professional and this is not medical advice but simply information based on my own experience, as well as other members who have survived these drugs.

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  • Moderator Emeritus

Hi Banana,

 

I am helping my daughter recover from risperidone. I just want to make sure I understand where your brother is in his timeline.  Your timeline says he stopped Olanzapine in March of 2018 and Risperidone in April in 2018 but said above he has been off 1 year and 3 weeks.  So did he continue to take meds off / on throughout 2018 and part of 2019?  I think it is very important to know when the last time was he took any meds or supplements.    My daughter is now at 14 months and 2 weeks off of risperidone.  She jumped to zero from .025mg.She is doing better but still has windows and waves.

 

Did your brother jump to zero from 2mg?  Everyone is different but it is not uncommon for people who CT or Fast Taper an antipsychotic to take at least 2 years to start to feel better.  As Gridley says above, it sounds like he is having VERY typical windows and waves.    It takes along time to settle, especially if there was a lot of back and forth with dosages before he finally jumped to zero.  Focus on the windows.  Help him to understand the waves pass and more windows will return.  This is a marathon, and not a race.  I hope you are able to discuss with him and your family that healing is healing.....and to not 'try to fix' it with more pills....which caused the problem in the first place.

 

Good Luck, Glosmom

2016 - Oct -Daughter started Risperdal (for steroid induced psychosis that never went away after stopping prednisone)

Nov - dose increases stopped at 1.5mg in Dec

2017 - Jan- weaned from 1.5 to 1.0 in 2 weeks then 1.0 to .5 in two weeks and then off. Feb. 3 weeks of increased psychosis, pacing, insomnia, other awful symptoms so late Feb  - Back on 1.5 mg Risperdal. May  - decrease to 1.25mg, two weeks later 1.0mg - symptoms started again. June - held steady at 1.25mg for 6 weeks and switched to liquid (3 ml syringe). July - started 10% taper every 3 weeks, October -  .8 mg, December - .7 mg .

2018 -Jan- 0.65 mg,  Feb- 0.59,  Mar-0.50, late April - .40mg, July- .36 mg, Aug - switched from 3 mL syringe to 1 mL syringe for more accuracy (her dad and i were not sure we were giving her the same dose when in between the 'dashes' on the 3 mL syringe.) Aug -.30 mg (3mL syr)/.44 mg (1 mL syr) difference due to med in the tip of both syringes). Sept- .28 mg (3mL syr)/.42 mg (1 mL syr). Oct - .16 mg (3 mL syr)/.30 mg (1 mL syr). Nov.- .06mg (3mL syr)/.20 mg (1mLsyr). Dec. - tip only/unmeasurable (3mL syr)/.10 mg (1mLsyr)

2019- Jan -.06 mg (1 mL syr), Feb- .025 mg (1 mL syr), Feb 27, 2019 - jumped to zero!!

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17 hours ago, Gridley said:

It would be very risky to reinstate this far out and could make matters worse.  The windows and waves that your brother is going through are normal and an encouraging sign of healing.

 

The Windows and Waves Pattern of Stabilization

 

 

Thank you for letting me know.

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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17 hours ago, Glosmom said:

Hi Banana,

 

I am helping my daughter recover from risperidone. I just want to make sure I understand where your brother is in his timeline.  Your timeline says he stopped Olanzapine in March of 2018 and Risperidone in April in 2018 but said above he has been off 1 year and 3 weeks.  So did he continue to take meds off / on throughout 2018 and part of 2019?  I think it is very important to know when the last time was he took any meds or supplements.    My daughter is now at 14 months and 2 weeks off of risperidone.  She jumped to zero from .025mg.She is doing better but still has windows and waves.

 

Did your brother jump to zero from 2mg?  Everyone is different but it is not uncommon for people who CT or Fast Taper an antipsychotic to take at least 2 years to start to feel better.  As Gridley says above, it sounds like he is having VERY typical windows and waves.    It takes along time to settle, especially if there was a lot of back and forth with dosages before he finally jumped to zero.  Focus on the windows.  Help him to understand the waves pass and more windows will return.  This is a marathon, and not a race.  I hope you are able to discuss with him and your family that healing is healing.....and to not 'try to fix' it with more pills....which caused the problem in the first place.

 

Good Luck, Glosmom

Hello, your right, he had CT'ed off 2mg and been off since April 2018, so it's actually been 2 years and 3 weeks. The waves and windows started around March 2020. I assumed it had been a year. It's nice to know he is having typical windows and waves. Thanks for the reply, I'll talk to my family and explain to them that this is healing. Yesterday evening he did calm down, sometimes it's so hard but once you get through it get better.

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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  • 2 months later...

Hello, his clonazepam was lowered from 3mg to 2mg on 10 or 11 Aug, so I put it back up to 3mg on 12 Aug.

 

He left hospital 12 Aug and I wasn't told clear instructions on how to dose the Epilim. I figured out they wanted to raise his dose even more at home. I want to keep it the same it was in hospital.

 

His Epilim was raised on 8th or 9th to 22.5ml at night, on the 12th I gave 17ml at night. 13th Morning I gave 5ml morning.

 

I want to keep his dose to 15ml at night. I wanted to know if it's okay to do this at this time and how to do this as I messed up on the dosing last night and this morning. Should I still give him 15ml at night or less because I also gave it in the morning. I also want to keep his Epilim to be taken only at night. Thanks.

 

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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Also want to note that yesterday we moved his clonazepam and olanzapine an 1 hour or 1 hour and 15 minutes later. Was good in hospital until his 11th Aug. Since then he has been having anxiety and getting angry, paranoid.

 

Got worse yesterday on 12th Aug. He said he felt a little agitated before evening clonazepam (6pm), probably because we moved the dose an hour later, then calmed down. Felt more angry and anxious an hour after dose then calmed down.

 

After Epilim dose felt anxious  for 45 mins?

 

2 hours after Olanzapine got angry and anxious then calmed down 30 or 45 mins later.

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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Because I gave 5ml in morning should I still give 15ml at night or less. I want to keep him on 15ml. Please advice soon, thanks.

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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  • ChessieCat changed the title to Banana121: brother's road to recovery
  • Administrator

Banana, it sounds like your brother's bad patches might be because of accidentally skipped doses or dramatic dosing schedule changes. Dosing needs to be kept very regular or upsets can occur out of the blue.

 

20 hours ago, Banana121 said:

Because I gave 5ml in morning should I still give 15ml at night or less. I want to keep him on 15ml. Please advice soon, thanks.

 

Please explain more -- what drugs are you referring to, what times of day, what dosages in milligrams?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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56 minutes ago, Altostrata said:

Banana, it sounds like your brother's bad patches might be because of accidentally skipped doses or dramatic dosing schedule changes. Dosing needs to be kept very regular or upsets can occur out of the blue.

 

 

Please explain more -- what drugs are you referring to, what times of day, what dosages in milligrams?

Thank you very much for replying. The medication he takes are:

10:20am - Clonazepam - 1mg

6:00pm - Clonazepam - 2mg

9:20pm - Epilim liquid 15ml (Sodium Valproate 600mg)

10:30pm - Olanzapine 20mg

 

I gave 15ml last night and he has been the same, mood and anxiety wise, except he didn't sleep at all last night and slept 12pm.

 

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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Just now, Banana121 said:

Thank you very much for replying. The medication he takes are:

10:20am - Clonazepam - 1mg

6:00pm - Clonazepam - 2mg

9:20pm - Epilim liquid 15ml (Sodium Valproate 600mg)

10:30pm - Olanzapine 20mg

 

I gave 15ml last night and he has been the same, mood and anxiety wise, except he didn't sleep at all last night and slept 12pm.

 

When he was discharged on the 12th Aug, they only gave me a limited amount of clonazepam and was instructed to taper it every 3 days from the day of discharge. The taper was 2mg, 1mg, 0.5mg, then I was told to stop. 

 

I thought this was too fast and wanted to hold as he is unstable because of the various drug and dose changes. I was told I would be able to order more but now I am told I cannot.

 

I have only eight 0.5mg tablets of clonazepam and am forced to fast taper this medication.

 

I have given him 2mg today and from then on I'm thinking of halving the dose everyday until the tablets finish which would be on Thursday, does this sound good?

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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  • Administrator

If he's been taking clonazepam daily since early July, it's likely he's physiologically dependent on clonazepam and possible the decreases have been causing withdrawal symptoms. You will need to talk to his prescriber if you see withdrawal symptoms so you can get more clonazepam for a longer taper.

 

I see his history includes several stretches of benzodiazepine use in the last 2 years.

 

Many of his current symptoms may be due to benzo inconsistent dosing, schedule changes, interdose withdrawal, or rebound anxiety.

 

1 hour ago, Banana121 said:

I have given him 2mg today and from then on I'm thinking of halving the dose everyday until the tablets finish which would be on Thursday, does this sound good?

 

This sounds like a fast taper which may very well cause withdrawal symptoms.

 

It's very difficult for us to help third parties. We need to know daily drug schedules and symptom pattern. If you change the drug schedule often, this can cause drug-related adverse reactions.

 

It sounds like he has had many drug changes since May.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Drug Interaction Report

This report displays the potential drug interactions for the following 3 drugs:

 

olanzapine

valproic acid

clonazepam

 

Moderate (2)

 

Minor (0)

 

Food (2)

 

Therapeutic Duplication (0)

Interactions between your drugs

Major

clonazePAM OLANZapine

Applies to: clonazepam, olanzapine

 

GENERALLY AVOID: The safety and efficacy of intramuscular olanzapine administered in combination with benzodiazepines have not been established. Deaths have been reported in patients who received IM olanzapine during postmarketing use. The cause has not been determined but in many of the deaths, patients were treated with multiple concomitant drugs including IM benzodiazepines and other IM antipsychotics that are known to have the potential to induce hypotension, bradycardia, and respiratory or CNS depression. In addition, IM olanzapine may have been administered to some patients in a manner that was inconsistent with product labeling and also to patients with significant medical comorbidities or other medical conditions associated with potentially fatal outcomes. As of September 30, 2005, there have been 29 cases of spontaneously reported fatalities temporally associated with the use of IM olanzapine. Nineteen of these fatal cases had been or were concurrently being treated with benzodiazepines (seven with more than one benzodiazepine; six with IM or IV benzodiazepines; five treated within 2 hours of death). Based on estimated exposure, the incidence of fatal reports was less than 0.01%, which is similar to that reported for other parenteral agents used to treat patients with acute agitation associated with mental illness. A causal relationship is difficult to establish because there tends to be a higher risk of mortality associated with this particular patient population regardless of treatment.

 

MONITOR CLOSELY: CNS- and/or cardiorespiratory-depressant effects may be increased during concomitant use of olanzapine and benzodiazepines, especially in elderly or debilitated patients. In clinical trials of elderly patients with dementia-related psychosis, the incidence of death in olanzapine-treated patients was significantly greater than in placebo-treated patients (3.5% vs. 1.5%). Risk factors for the increased mortality with olanzapine include age greater than 80 years, dysphagia, sedation, malnutrition and dehydration, concomitant use of benzodiazepines, and presence of pulmonary conditions such as pneumonia. Limited data in 15 healthy subjects receiving IM olanzapine followed by an IM benzodiazepine (lorazepam) found that the combination prolonged somnolence by 3.3 hours compared to IM olanzapine alone and 5.8 hours compared to IM lorazepam alone.

 

MANAGEMENT: Caution is necessary when olanzapine is used in combination with benzodiazepines. Ambulatory patients should be made aware of the possibility of additive CNS effects and counseled to avoid activities requiring mental alertness until they know how these agents affect them. They should also be advised to avoid rising abruptly from a sitting or recumbent position and to contact their physician if they experience symptoms of hypotension such as dizziness, lightheadedness, or fainting. Concomitant administration of IM olanzapine and parenteral benzodiazepine has not been studied and is therefore not recommended. Patients given this combination when necessary should be closely monitored for excessive sedation and cardiorespiratory depression.

 

References

Zacher JL, Roche-Desilets J "Hypotension secondary to the combination of intramuscular olanzapine and intramuscular lorazepam." J Clin Psychiatry 66 (2005): 1614-1615

Naso AR "Optimizing patient safety by preventing combined use of intramuscular olanzapine and parenteral benzodiazepines." Am J Health Syst Pharm 65 (2008): 1180-3

"Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.

 

Moderate

valproic acid clonazePAM

Applies to: valproic acid, clonazepam

 

MONITOR: A single study has suggested that combination therapy with clonazepam and valproic acid may cause severe drowsiness and decreased seizure control. Other studies have not supported this finding. Several case reports have suggested that the combination of clonazepam and valproic acid may precipitate absence status; however, this combination has had beneficial effects in the treatment refractory absence seizures. The mechanism and causality have not been determined. In addition, valproic acid may decrease plasma levels of clonazepam by inducing its hepatic metabolism.

 

MANAGEMENT: Monitoring for altered efficacy and safety is recommended if valproic acid (or its derivatives) and clonazepam are used together. Alternative therapy may be appropriate if significant side effects or loss of seizure control occur.

 

References

Jeavons PM, Clark JE, Maheshwari MC "Treatment of generalized epilepsies of childhood and adolescence with sodium valproate("epilim")." Dev Med Child Neurol 19 (1977): 9-25

Watson WA "Interaction between clonazepam and sodium valproate." N Engl J Med 300 (1979): 678-9

Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

View all 6 references

Switch to consumer interaction data

 

Moderate

valproic acid OLANZapine

Applies to: valproic acid, olanzapine

 

MONITOR: Concurrent use of olanzapine and valproic acid may potentiate the risk of hepatotoxicity. The exact mechanism of interaction is unknown. In a retrospective study of 52 children, combined treatment with olanzapine and divalproex was associated with more frequent elevations of hepatic enzymes than either agent alone, and mean and peak hepatic enzyme levels during the observed course of treatment were also higher. All 12 patients who received combined treatment had at least one peak enzyme elevation above the normal range, versus 10 of 17 who received olanzapine alone and 6 of 23 who received divalproex alone. With the exception of 2 patients who required discontinuation of combination treatment (due to development of pancreatitis in one and steatohepatitis in the other), the observed peak and mean enzyme levels were less than 3 times the upper limit of normal (ULN) and were asymptomatic. The long-term significance of these findings is unknown.

 

MANAGEMENT: The authors of the study recommend monitoring liver function tests every 3 to 4 months during the first year of treatment with either olanzapine or valproic acid, at least in pediatric patients. If no elevations of liver enzymes or marked weight gain occur after one year, a decrease in frequency of monitoring to every 6 months can be considered. Patients should be advised to notify their physician if they experience signs and symptoms of hepatotoxicity such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

 

References

Gonzalez-Heydrich J, Raches D, Wilens TE, Leichtner A, Mezzacappa E "Retrospective study of hepatic enzyme elevations in children treated with olanzapine, divalproex, and their combination." J Am Acad Child Adolesc Psychiatry 42 (2003): 1227-33

Switch to consumer interaction data

 

No other interactions were found between your selected drugs.

 

Drug and food interactions

Moderate

valproic acid food

Applies to: valproic acid

 

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

 

Moderate

OLANZapine food

Applies to: olanzapine

 

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

 

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

Link to comment
17 hours ago, Altostrata said:

If he's been taking clonazepam daily since early July, it's likely he's physiologically dependent on clonazepam and possible the decreases have been causing withdrawal symptoms. You will need to talk to his prescriber if you see withdrawal symptoms so you can get more clonazepam for a longer taper.

 

I see his history includes several stretches of benzodiazepine use in the last 2 years.

 

Many of his current symptoms may be due to benzo inconsistent dosing, schedule changes, interdose withdrawal, or rebound anxiety.

 

 

This sounds like a fast taper which may very well cause withdrawal symptoms.

 

It's very difficult for us to help third parties. We need to know daily drug schedules and symptom pattern. If you change the drug schedule often, this can cause drug-related adverse reactions.

 

It sounds like he has had many drug changes since May.

Sorry, I changed my signature. Since getting off Risperidone 2mg, he got sectioned over 2 years later. He has been having medication from 12th of June in hospital and got discharged on 12th of August.

 

Daily schedules, this is as much information as I could get from when he was in hospital and also includes recent.

 

Sun, 14th June,

1pm - Lorazepam 0.5mg

9pm - small dose of Risperidone

 

Thurs, 18th June

1pm - Lorazepam 0.5mg

9pm - Risperidone. Raising dose

 

Weds, 24th June

1pm - Lorazepam 0.5mg

9pm - Risperidone 3mg

 

Fri, 26th June. Switched from Risperidone to Olanzapine today

Stopped Lorazepam

Started Clonazepam today

 

Thurs, 2nd July

9am - Clonazepam 1 mg

1pm - Clonazepam 1mg

5pm - Clonazepam 1mg

9pm - Olanzapine 15mg

 

Weds, 8th July

9am - 5mg Olanzapine 

9pm - 15mg Olanzapine 

Clonazepam 2mg, x3 a day

 

Mon 13th July

9am - 5mg Olanzapine

9pm - 15mg Olanzapine

Clonazepam 2mg, 3x a day

 

Friday 17th July?

9pm - Olanzapine 20mg and Sodium Valparote 250mg

Clonazepam 2mg x3 a day

 

Weds 22nd July.

9am - 10mg Olanzapine & Sodium Valparote, 250mg

9pm - Olanzapine 10mg

Sodium Valproate, 250mg

 

Thurs, 23rd July. Lowered clonazepam today. To 5.5?

 

Mon, 27th July. Lowered clonazepam to 5mg?

 

Wed 29th July.

Sodium Valproate; 500mg & 750 mg

9pm - Olanzapine 20mg

Clonazepam; 1mg & 2mg twice a day = 5mg

 

Fri 31st July. Lowered Clonazepam?

 

Tues 4th Aug. Lowered Clonazepam?

 

Thurs 6th Aug. 

9pm - Olanzapine, 20mg & Epilim (Valproic Acid) 15ml, 600mg

Clonazepam dose?

PRN, Promethazine 100mg.

 

Sat 8th Aug.

9am - Clonazepam 1mg

9pm - Olanzapine 20mg & Clonazoepam 2mg & Epilim (Valproic Acid) 15ml, 600mg.

 

Sun 9th Aug or Sat 8th.

9am - Clonazepam 1mg

5pm - Clonazepam 2mg

9pm - Olanzapine 20mg

Epilim (Valproic Acid) 22.5ml, 900mg

 

Tues 11th or Wed 12th Aug.

Lowered Clonazepam to 2mg total.

 

Wed 12th Aug.

9am - Clonazepam 1mg morning

6pm - Clonazepam 

10:30pm - Olanzapine

Epilim (Valproic Acid) 22.5ml, 900mg

 

Thurs 13th Aug. 

10:20am - Epilim 5ml & Clonazepam 1mg

6pm - Clonazepam 1 mg

9:20pm - 15ml Epilim

10:40pm - Olanzapine 20mg

 

Fri 14th Aug.

10:20am - Clonazepam 1mg

6pm - Clonazepam 1mg

9:40pm - Epilim 15ml

00:00am - Olanzapine 20mg

 

Sat 15th Aug.

10:35am - Clonazepam 0.5mg

 

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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Fri 14th Aug. 3:40am Woke up. 

5:30am - anxiety. 
6:30am - okay 
7am - can't sleep. 
7:20am - anxiety. 
9am - good, just talking a little. 
9:20am - anxiety. 
10:10am - good
10:20am - Clonazepam 1mg
10:30am? - angry for a minute, anxiety.
12:20pm - Good
1:30pm? - Sleep 
6pm - Clonazepam 1mg
9:40pm - Epilim 15ml. Woke up, really good, talked only sometimes.
12am - Olanzapine 20mg
12:20am - anxiety.
12:35am - Good. 
12:50am - anxiety
1am - good
1:30am or later - sleep

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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  • Administrator

Since he's been taking clonazepam regularly since July 2, 2020, it's likely he's physiologically dependent on it and will get withdrawal symptoms if it's reduced too fast.

 

3 hours ago, Banana121 said:

Weds, 8th July

9am - 5mg Olanzapine 

9pm - 15mg Olanzapine 

Clonazepam 2mg, x3 a day

 

July 8, he went from 3mg clonazepam a day to 6mg? That's a big increase. Why was that done? It continued to at least July 23. The decreases between July 23 and August 6 may have caused withdrawal symptoms.

 

I don't see withdrawal symptoms in the symptom notes you've posted for Friday, August 14. What symptoms are currently troublesome? How is his sleep, usually?

 

If I were you, the first thing I'd do is make the clonazepam dosing 12 hours apart. The easiest way to do this is to move the morning dose earlier an hour each day, perhaps to 9 a.m., then move the nighttime dose to 9 p.m.

 

Olanzapine and Epilim need to be taken at the same times each day. Why is he taking them together at night? Taking them at different times may reduce drug-drug toxicity. Suggest olanzapine at night, Epilim earlier in the day. Still, must be monitored with liver function tests. It behooves his doctors to minimize dosages of both drugs, see https://onlinelibrary.wiley.com/doi/10.1111/jphp.12209

 

A decrease of 0.5mg clonazepam August 15 would be a 25% decrease of his daily dose if you maintained evening clonazepam at 1mg. This is in excess of the 10% reductions we recommend.

 

If you're going to regularize his schedule, I would move the drugs around first before any reduction of clonazepam. Don't make more than one drug change at a time, it confuses things.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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22 hours ago, Altostrata said:

Since he's been taking clonazepam regularly since July 2, 2020, it's likely he's physiologically dependent on it and will get withdrawal symptoms if it's reduced too fast.

 

 

July 8, he went from 3mg clonazepam a day to 6mg? That's a big increase. Why was that done? It continued to at least July 23. The decreases between July 23 and August 6 may have caused withdrawal symptoms.

 

I don't see withdrawal symptoms in the symptom notes you've posted for Friday, August 14. What symptoms are currently troublesome? How is his sleep, usually?

 

If I were you, the first thing I'd do is make the clonazepam dosing 12 hours apart. The easiest way to do this is to move the morning dose earlier an hour each day, perhaps to 9 a.m., then move the nighttime dose to 9 p.m.

 

Olanzapine and Epilim need to be taken at the same times each day. Why is he taking them together at night? Taking them at different times may reduce drug-drug toxicity. Suggest olanzapine at night, Epilim earlier in the day. Still, must be monitored with liver function tests. It behooves his doctors to minimize dosages of both drugs, see https://onlinelibrary.wiley.com/doi/10.1111/jphp.12209

 

A decrease of 0.5mg clonazepam August 15 would be a 25% decrease of his daily dose if you maintained evening clonazepam at 1mg. This is in excess of the 10% reductions we recommend.

 

If you're going to regularize his schedule, I would move the drugs around first before any reduction of clonazepam. Don't make more than one drug change at a time, it confuses things.

(Sat 15th Aug

10:35am - Clonazepam 1mg

2pm - Woke up, anxiety

2:30pm - okay

2:40pm - anxiety

Went out

6:15pm - Clonazepam 0.5mg

6:10pm - Talking differently, got angry

6:30pm - Okay

6:40pm - anxiety, got angry

9pm - angry for 30 mins? Tried to fight dad

9:30pm - Epilim 15ml, okay but slight anxiety and sometimes easily angered

11pm - okay

11:56pm - good

12am - Olanzapine 

Sleep after 2am

 

Unfortunately, I can't get more clonazepam, I have asked the hospital, GP and a helpline. I have 1.25mg left I was thinking of giving 0.75mg today (Sunday), 0.5 on Monday and 0.25 on Tuesday.

 

Hello, he was shouting at staff, lightly grabbed their wrist to get a cigarette and that's why they raised his clonazepam to 6mg.

 

In hospital he got, unwell, a lot of anxiety/akathisa and agitation every time they raised the dose of Risperidone, Olanzapine and epilim. They raised his dose every 4 days, on the 3rd or 4th day when he was just starting to stabilise and his symptoms were lessening on the new dose, they would raise it again because he was unwell even though raising the dose was making him unwell. I explained this to them nearly every day and they wouldn't listen.

 

In the symptom notes when I write anxiety, it's anxiety and akathisia. This is his most troublesome symptom as well as anger and paranoia/fear that others may hurt him. When it gets really bad, he says he wants to go to other peoples house or find a job in places he has been told he is not allowed enter. 

 

He also says he wants to move out the house, find a flat, go on the train, go to a hotel or tells us to get his bike out and keeps asking/mostly shouting for us to do it.

 

Tries to fight his dad, rarely other people.

 

Because of medication he normally sleeps 12 hours. 

 

Because I'm lowering clonazepam shall I still lower the dose?

 

Olanzapine and epilim were originally take together at 9pm because that's when the hospital gives his medication. When he came home on the 12th Aug we moved his medication an hour later then another hour and 15 minutes later. 

 

Should I move his Olanzapine and epilim to be more far apart or wait till he settles down after the clonazepam taper.

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

Link to comment

He's having trouble pronouncing/saying some words which I assume is from medication.

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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  • Administrator
7 hours ago, Banana121 said:

Sat 15th Aug

10:35am - Clonazepam 1mg

2pm - Woke up, anxiety

2:30pm - okay

2:40pm - anxiety

Went out

6:15pm - Clonazepam 0.5mg

6:10pm - Talking differently, got angry

6:30pm - Okay

6:40pm - anxiety, got angry

9pm - angry for 30 mins? Tried to fight dad

9:30pm - Epilim 15ml, okay but slight anxiety and sometimes easily angered

11pm - okay

11:56pm - good

12am - Olanzapine 

Sleep after 2am

 

He sleeps in the afternoon? Is he in the hospital or at home?

 

7 hours ago, Banana121 said:

In the symptom notes when I write anxiety, it's anxiety and akathisia. This is his most troublesome symptom as well as anger and paranoia/fear that others may hurt him. When it gets really bad, he says he wants to go to other peoples house or find a job in places he has been told he is not allowed enter. 

 

 

You need to sit down with the staff and have a serious talk about drug-induced symptoms like akathisia and the likelihood they have gotten him physiologically dependent on a benzo and cannot simply take that away, he's likely to get withdrawal symptoms, which will cause him to be even more angry and agitated.

 

I don't think I can be of more help. It's very hard to counsel a third party at all, it seems he's "in the system" and subject to whatever they do at the hospital. The family must intercede and get them to pay attention to drug-induced symptoms and withdrawal, the medical staff may be clueless.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
1 hour ago, Altostrata said:

 

He sleeps in the afternoon? Is he in the hospital or at home?

 

 

You need to sit down with the staff and have a serious talk about drug-induced symptoms like akathisia and the likelihood they have gotten him physiologically dependent on a benzo and cannot simply take that away, he's likely to get withdrawal symptoms, which will cause him to be even more angry and agitated.

 

I don't think I can be of more help. It's very hard to counsel a third party at all, it seems he's "in the system" and subject to whatever they do at the hospital. The family must intercede and get them to pay attention to drug-induced symptoms and withdrawal, the medical staff may be clueless.

Hello, I just wanna say again thank you very much for helping us out Altostrata.

 

He got discharged on the 12th August and has been home since. 

 

He sleeps 1 or 2am, I wake him up in the morning for clonazepam and he goes back to sleep and wakes up in the afternoon.

 

I'm in the UK and Benzodiazapines are not recommended to be used for over a month. I think they only use it in hospital. The receptionist at GP said I could talk to the mental health team on Monday 18th August and ask them for more so I'll try that.

 

Thanks for informing me of the interactions of Olanzapine and valproic acid. (https://onlinelibrary.wiley.com/doi/10.1111/jphp.12209). The day Valproic acid was added, he was slurring his words, drowsy and salivating a lot. 

 

He still salivates a lot sometimes, has trouble pronouncing words, feels tired all day, no energy.

 

Should I move his Olanzapine and epilim to be more far apart or wait till he settles down after the clonazepam taper?

 

Also, when it's time to reduce his medication, which one should I reduce first? Or shall I work on reducing both? 

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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  • Administrator

Is he nonverbal? Can he explain how he feels?

 

It appears he's had nonstop drug changes since June, is that correct?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
9 minutes ago, Altostrata said:

Is he nonverbal? Can he explain how he feels?

 

It appears he's had nonstop drug changes since June, is that correct?

He's not non verbal but when he is unwell he just displays symptoms and deals with them in his own way, he doesn't say he is currently feeling anxiety, I can tell from when he smokes a lot, wants to go out or fidgeting.

 

Sometimes he'll say he's angry or stressed.

 

He has had non stop drug changes since June, around every 4 days.

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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  • Administrator

Can you ask him how he's feeling when "angry" or "stressed"? What sensations does he have in his body? Why do you think he has akathisia? How does he feel when he wakes up at 2 p.m.?

 

Why does he go to sleep at 2 a.m. and not earlier?

 

Generally, it's important to take doses of clonazepam 12 hours apart to avoid interdose withdrawal. He does not seem to have interdose withdrawal, that would be at night. He may be getting paradoxical reactions.

 

Here are places where he may be experiencing an adverse drug effect:

On 8/16/2020 at 8:27 AM, Banana121 said:

Sat 15th Aug

10:35am - Clonazepam 1mg

2pm - Woke up, anxiety

2:30pm - okay

2:40pm - anxiety

Went out

6:15pm - Clonazepam 0.5mg

6:10pm - Talking differently, got angry

6:30pm - Okay

6:40pm - anxiety, got angry

9pm - angry for 30 mins? Tried to fight dad

9:30pm - Epilim 15ml, okay but slight anxiety and sometimes easily angered

11pm - okay

11:56pm - good

12am - Olanzapine 

Sleep after 2am

 

I don't know what's going on at 2 p.m. How does he feel when he wakes up at 2 p.m.?

 

Taking clonazepam doses too close together can cause a paradoxical reaction of anxiety, activation, agitation, or sleeplessness.

 

Taking a too-high Epilim dose can cause a paradoxical reaction of anxiety, activation, agitation, or sleeplessness.

 

Was he asking for cigarettes in the hospital because he was having nicotine withdrawal?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
On 8/17/2020 at 6:27 PM, Altostrata said:

Can you ask him how he's feeling when "angry" or "stressed"? What sensations does he have in his body? Why do you think he has akathisia? How does he feel when he wakes up at 2 p.m.?

 

Why does he go to sleep at 2 a.m. and not earlier?

 

Generally, it's important to take doses of clonazepam 12 hours apart to avoid interdose withdrawal. He does not seem to have interdose withdrawal, that would be at night. He may be getting paradoxical reactions.

 

Here are places where he may be experiencing an adverse drug effect:

 

I don't know what's going on at 2 p.m. How does he feel when he wakes up at 2 p.m.?

 

Taking clonazepam doses too close together can cause a paradoxical reaction of anxiety, activation, agitation, or sleeplessness.

 

Taking a too-high Epilim dose can cause a paradoxical reaction of anxiety, activation, agitation, or sleeplessness.

 

Was he asking for cigarettes in the hospital because he was having nicotine withdrawal?

When I ask him how he feels, he just says he feels agitated.

 

I think he has akathisia because when he has anxiety, he feels as if he wants to "do" something, keeps walking and fidgeting, constantly smoking.

 

Wakes up with brain fog.

 

His sleeping schedule got messed up recently because he didn't sleep all night a few days ago.

 

He sleeps around 13 hours a day.

 

He smoked a lot in hospital.

 

Current symptoms are, feeling tired all the time, brain fog, anxiety/akathisia, over eating a little after medication (in hospital when he first started Olanzapine he over ate to the point of throwing up in the middle of the night) and salivating a little at times, ruminating, sometimes easily angered and shouts or throws something.

 

Stopped clonazepam Tues 18th August in the evening.

Jan to Feb 2018: (Sectioned) Risperidone 1mg moved up to 6mg, Lorazepam (PRN), Olanzapine 5mg (PRN).

20 Apr 2018: Stopped Risperidone 2mg.

 

Sectioned 12 June 2020

14 June 2020: 0.5 mg Lorazepam.Risperidone, raising dose to 3mg or higher till 26 June 2020.

26 June 2020: Switched from Risperidone to Olanzapine. Started Clonazepam. Gradually raising clonazepam and Olanzapine

Olanzapine 20mg - 8th July 2020.

Clonazepam 2mg 3x a day = 6mg - 8th July to around 23 July.

Clonazepam gradually decreasing to 3mg around 6 Aug 2020.

Depakote 250mg (now on Epilim) - 17 July, gradually raising till 900mg on 8 or 9 Aug.

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  • Administrator

It sounds like he's taking too much olanzapine and maybe too much Depakote. You need to speak to his doctors.

 

3 hours ago, Banana121 said:

Stopped clonazepam Tues 18th August in the evening.

 

This may cause severe withdrawal symptoms.

 

As your brother is a third party and neither you nor I can control his actions, I cannot help you further.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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