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    Dr. G alternatives to Zyprexa in combination with lithium
    Anon_81448 posted:
    Hi Dr. G,

    Even though Zyprexa works fairly well for me, my pdoc is taking me off 15 mg, 5mg at a time every 2 weeks. Why would a pdoc, other than weight gain, discontinue Zyprexa for a patient?

    Are there any alternatives to Zyprexa (other than Abilify, Saphris and Latuda) that would complement my taking Lithium 1200mg and Zoloft 150mg?

    Any info appreciated. Thanks.
    ddnos responded:
    I'm sorry to butt in, but I know Dr. G will still reply and am curious what he will say. I'm just curious if, when your doc said he was taking you off Zyprexa even though it was going well for you, did you ask him why? That's all.

    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    Joseph F Goldberg, MD responded:
    Dear Anon,
    Why did your doctor say he was discontinuing the Zyprexa? Sometimes doctors stop it because of weight gain or rising blood sugar or cholesterol, but that's not an automatic necessity. Zyprexa is used for many things, from mania to psychosis to agitation to relapse prevention to depression (when combined with Prozac), so, much depends on why it was prescribed in the first place. It's hard to know what sort of alternatives to consider, and if there are alternatives,
    without knowing what aspects of bipolar disorder are being treated.
    Dr. G.

    Dr. G.
    asurvivor777 replied to Joseph F Goldberg, MD's response:

    He is doing it because of weight gain and rising blood sugar but the Zyprexa works pretty well on paranoia and agitation. I have an aappointment at the end of the month (I'll be on 5 mg of Zyprexa by then) and talk options with my pdoc.
    Joseph F Goldberg, MD replied to asurvivor777's response:
    Dear asurvivor777,
    Likely all atypical antipsychotics carry some risk for weight gain and rising blood sugar, but some are riskier than others. Zyprexa is a high-risk offender, while Geodon, Latuda, and the first-generation antipsychotics (eg, Halol, Prolixin) appear to be fairly low risk. Whether ot not one of these other medicines would work as well as Zyprexa would be the key unknown. Be aware there is also a fairly broad literature on using medicines such as metformin, Topamax, amantadine, zonisamide, and others to attempt to offset or counteract weight gain or blood sugar changes, which are sometimes options worth considering if it proves difficult to find another medicine to stand-in for Zyprexa.
    Dr. G.
    asurvivor777 replied to Joseph F Goldberg, MD's response:
    Thanks so much Dr. G. Just concerned about going down to 5mg of Zyprexa 15mg to 10 mg to. I'm concerned about becoming symptomatic again. Would stepping down help with this?
    Joseph F Goldberg, MD replied to asurvivor777's response:
    Dear asurvivor777,
    Dropping by 5 mg every two weeks provides a reasonable way to monitor for signs of relapse. If I thought that a patient of mie needed to be on an antipsychotic though I would probably cross-taper (ie, begin the new antipsychotic while the old one is still in the picture), and I would make sure to discuss with my patient beforehand which antipsychotic I had in mind as a replacement. Also, if symptoms recurred despite the overlap with the new antipsychotic, I would probably make sure my patient understood to go back up on the Zyprexa before thigs worsened.
    Dr. G.
    asurvivor777 replied to Joseph F Goldberg, MD's response:
    Thank you Dr. G.

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