I posted the exact same topic on Aug 2021 when he was put on 20 mg of olanzapine and 600 mg of quetiapine after a psychotic episode.
4 years later it’s down to 10 mg of olanzapine and 150 mg of quetiapine, but the tapering seems to have stopped.
Does anyone know about being on antipsychotics for the long term? I worry about dopamine supersensitivity, metabolic effects and potential extrapyramidal symptoms, which at present is limited to restless legs at night.
He takes more drugs to control the side effects of the APs like dextroamphetamine to counteract early-morning drowsiness, gabapentin for restless legs, and Metformin for the metabolic issues. And they all have side effects of their own.
This is controlling his schizophrenia. I think that long-term use is recommended, I’m just not sure at what dose. Somewhere I read it was 50% of the “usual” dose, which I think would be lower than what he’s taking. Like maybe 5 mg of olanzapine and 75 mg of quetiapine.
Self-regulating psychiatric meds is never advised. This is a very important question you are asking, and it absolutely needs to be answered by his psychiatrist. (Hopefully with you present so you can bear witness to the doctor’s advice.) Steady control of his illness should always be the goal, but it has to be monitored professionally. I hope you get the answers you need soon.
Thanks @Catherine. My son is 38. I suppose I could ask him how he feels about me attending a session with him with his psychiatrist. Family members do like to be present when a loved one is undergoing major medical treatment, like a surgery, and want to be informed about what’s going on, so I don’t see how this would be much different.
Our psychiatrist ordered a GeneSight for my daughter. The psychiatrist said,
“Genesight is helpful to know how her body would metabolize these medications. This gives us an understanding of dose adjustments based on rate of elimination of drug. Since $%#$% has had several trials, it makes sense to consider it. However the limitation of this test is inability to comment on drug efficacy. It only gives us a picture of metabolism (explaining why a drug is eliminated too fast or too slow) but no information on how well it works. If insurance is fully covering it, it doesn’t hurt to get it done. I wouldn’t rely on it to pick the med based on efficacy but it gives us some insight into dose adjustments.”
Also, our psychiatrist also ordered a blood test to check the level of her main med which is clozapine.
“I reviewed the Clozapine level this morning and it is at 125 which is below therapeutic range. I want you to know that you were not at risk of toxicity even with a dose of 350 mg. If it was challenging to tolerate the dose of 350 mg, it is okay to stay at 300 mg as long as the symptoms are manageable. I am assuming you have lowered the dose to 300 mg over the weekend. Continue to monitor and let me know if we need to make any changes.”
I hope your son can get these test done to check his levels.
You’re absolutely right. My son wouldn’t have made much progress had I not been at every appointment because his illness (disorganized schizophrenia) made it impossible for him to interpret things being said to him correctly or relay what happened at the appointment back to me correctly. My son is just a bit older than yours (41) I still go to every appointment with him, because even though his medicine keeps him sane and reasonable, he still has communication processing and relay issues. He seems to understand that I am there to back him up and not to belittle him in anyway. He understands advocacy. It’s not his strong suit, but it is definitely mine.
Thanks for the support Catherine. I’ll ask him if he’d like to have a separate set of ears during the appointment. I say “ears” because since the pandemic every 30-min. monthly appt. has been via telephone. I don’t like this, because I think there are non-verbal communication channels that the doctor is not able to use. I might bring this up also. I’ll clear all questions with my son beforehand so that I’m not being interfering or meddling.
1 mg of olanzapine is about equal to 32.3 mg of quetiapine. I see the “usual” dosages of olanzapine = 10 - 20 mg and for quetiapine 400 - 800 mg. So the average usual dose would be 15 and 600. 15 = 484 quetiapine equivalents for olanzapine.
Say the usual dose, then, would be about 550 quetiapine equivalents, which is the average usual dose between the two meds. I’m saying “equivalents”, because his doc likes to mix olanzapine and quetiapine.
1/2 the usual dose would be about 275 quetiapine equivalents. That might be 5 mg of olanzapine (162 quetiapine equivalents) and 100 mg of quetiapine.
Anyway, this would be question for his psychiatrist, if he’ll let me attend the next session.
