I have a Schizophrenia, Paranoid type patient that cannot take Clozaril. His Doctor is considering a combination of Thorazine, Fanapt or Lamictal, with Aricept and Cogentin. What are the ADRs involved with with combination? This person had been on Clozaril for several years with good results, was a productive citizen, living in an apartment and had been employed - due to agranulocytosis he is no longer a candidate for Clozaril use. He is currently prescribed a combination of Invega, Depakote, Seroquel, and Inderal with faint response. He has severe psychosis and cannot participate in even a casual conversation or complete simple daily tasks. He has been in a State Psychiatric Hospital for the past 6 years due to his psychosis and non-response to anti-psyhcotic medication combinations. What can you advise?
On the minor note, combining Thorazine with aricept or cogentin does have interaction
good - what about the combo of all 4 meds?
Thorazine is highly sedative, if the patient is having difficult functioning as he is now, switching to Thorazine might not be the best alternative
has there been any drug trials with this combo? - thorazine, fanapt, aricept and cogentin -- or thorazine, lamictal, aricept and cogentin? and what would be the likely outcome toward improving this person's mental status? - he is a 52 y/o white male.
As for the combination, technically it is not superior to what the patient is already on
thorazine - he does exhibit impulse control issues and can be physically aggressive
Aricept is not approved for schizophrenia, unless the patient have an underlying memory problem, adding this drug is still questionable
Are you still there?
he has very low ability for recognition, memory, and ability to function on a daily productive basis - he generally eats, performs daily hygiene with verbal prompting and stands around cussing. He obviously responds to unseen others and cannot effectively engage in conversation due to his "voices" - I understand that Aricept is not for Schizophrenia - but my thought was, he exhibits possible Alzheimer-like symptoms - the Aricept may help with Improved and maintained thinking, benefit him in the ability to perform activities of daily living activities, and assist beneficially with his negative behaviors. the thorazine would help further with his disorganized and psychotic thinking.
are you still there?
I'm not sure if Lamictal would be there best option here - doctor stated he may try to add this - but patient is already taking Depakote - doesn't that have interactions?
think maybe the Fanapt would be a better choice?
this is my thinking on this, with all the medications he is getting some of the symptoms are a result of the side effects from the drugs
what would you recommend?
Before we go any further, thorazine can not be combine with fanapt because of QT prolongation
In my experience, it is question of finding the right balance of dose and combination of drugs for these patients. It will require adjusting the dose both ways till
he also takes (for Cardiovascular - Hypertension) norvasc, appresoline, Prinivil, (Chronic constipation) Fenofibrate, (Health maintenance) MVI, (Hyperglycemia) glucophage, ( Tardive Dyskinesia) Valium with the Inderal.
Major interaction with this cocktail is between thorazine and inderal/fanapt other interactions are moderate
so, thorazine and fanapt would not be good choices here? correct? - if doctor adds Lamictal to his existing combo of Invega, Depakote, Seroquel, and Inderal ???? - what about the interaction of Lamictal and the Depakote?
the effects on adding lamictal to his drug therapy will minimal as to the interactions. It does interact with depakote
but only by increasing the half life of depakote and vice versa
ok - thanks
you are welcome
you have helped