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    Includes Expert Content
    Dr. G; medication question
    monkeybee posted:
    Hi Dr. G! I'm sorry to ask a side effect question after you just posted that book but i'm not even sure the term for the side effect I am questioning. Here are the medications I am taking: Lithium:1350mg, Lamictal:400 mg, Abilify: 30mg, Klonapin: 1mg, and newly Geodon: 80 mg. I am wondering if any of these medicines cause your head and neck to droop (like Haldol does)? Do you know what I am talking about?

    Joseph F Goldberg, MD responded:
    Dear Sarah, Abilify plus Geodon is a bit redundant in that both block the same dopamine receptor, which, among other things, can cause increased muscle tone or what's known as a muscle dystonia. It's worth mentioning to your doctor who will likely examine your muscle tone (neck, arms) and presumably either alter the dosing of these or else add a medicine like Cogentin to counteract increased muscle tone if he or she thinks the combination of both antipsychotics is necessary despite their receptor redundancy. Dr G
    monkeybee replied to Joseph F Goldberg, MD's response:
    Dr. G, I just got out of the hospital. They increased my lithium to just above my theraputic dose (1800 mg), removed the geodon and added saphris (10mg). I am feeling a little better. The saphris is for intrusive thoughts ( they can't do an ssri because of my bipolar). Do the saphris and ability combo make anymore sense to you? Thanks!
    Joseph F Goldberg, MD replied to monkeybee's response:
    Dear monkeybee, Saphris, like Geodon, is another antipsychotic that would both be redundant with the Abilify and also pose the same dilemma of competing with the Abilify for the same dopamine receptor; they have the same target in the same brain circuit and can't both occupy the same receptor site at the same time. An optimized dose of Abilify in mania is 15-30 mg/day per the manufacturer's studies. If an optimized dose failed to produce a benefit in one of my patients I would likely stop it and move on to a more potent antipsychotic, like Zyprexa, rather than add a second drug in the same class. Only your own doctor of course can make treatment recommendations for you specifically, so my comments necessarily are just general statements, not treatment recommendations. Dr G
    monkeybee replied to Joseph F Goldberg, MD's response:
    Thank you Dr G. The lithium increase was 6 or 7 days ago. Have I felt the full effects of the increase if the increase were going to work? They advised me that I wouldn't leave the hospital at 100% but I wonder if this is just becuse it takes a little time or if it is also because we need to try different meds (besides lithium because it clearly works). What do you think?
    Joseph F Goldberg, MD replied to monkeybee's response:
    Dear Monkeybee,

    Generally, when the dose of lithium is changed, we measure a blood level after about 5-7 days. Depending on what your blood level is, your doctor would then be in a better position to gauge whether you're getting the fullest benefits of lithium.

    Dr. G.
    monkeybee replied to Joseph F Goldberg, MD's response:
    Thanks Dr. G. They had checked my level. It was 1.1 or 1.2....very high but not too high they explained.

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