meds - page 2

Lets talk clozaril- I work in a small out patient mental health clinic. Of our three docs, only one is prescribing clozaril for his pts. These 3 folks are doing remarkable well. I'd like to see... Read More

  1. by   maureeno
    clozaril was especially valuable for the negative symptoms of schizophrenia, withdrawal, flat affect, social isolation. still we rarely see it due to life threatening
    SE, and need for frequent blood draws.
  2. by   joyceaus
    I work in psche in Australia and we use clozaril frequently for treatment resistant Schizophrenia. It seems to particularly work in young patients. We have a clozaril consultant RN in our hospital who follows up blood tests etc. There is a regime of full blood counts weekly, fortnightly then monthly once stablised. The medication is only issued for the time between blood tests.

    cheers from australia:
  3. by   CliveUK
    sanakruz - the risperidone depot comes in kit form - a white powder that you have to mix with the 'special solution', shake and then serve - through a big needle provided with the kit.

    I know I sound rather pessimistic about the new antipsychotics, but the risperidone depot has proved absolutely useless with the patients we have tried it on. Yes, they had no side-effects...but no actual effects either!
  4. by   MomNRN
    A young man at my school (moderate MR, bipolar) just started with Geodon. He takes Neurontin 400mg TID. Had been using Ativan as needed for aggressive behavior. Recently while spending a week at the local mental health ctr, they thought the Ativan may be contributing to the aggressive behavior. They are now trying the Geodon. Would also like to hear more about it.

    When I left school today, he was having another aggressive outburst. While in the time-out room, he began smearing feces on the wall and floor. A really sad situation, further complicated by the fact that he is a large kid (+300 lbs). When he gets aggressive, it gets dangerous.

    He was on his way to the hospital for another admission. Family is trying to get group home placement.

    Any thoughts on the Geodon?
  5. by   maureeno
    I have switched jobs in the last two weeks
    moving from an involuntary acute hospital unit
    to a residential/vocational community mental health center

    I am their first staff nurse
    I know 3/4 of the clients from years of working
    and plan to stay with them untill we are all old old old


    anyway
    many are on Clozaril
    and re-reading this thread is giving me more comfort about it

    I'm hoping we can move to monthly blood tests soon
    http://www.healthyplace.com/Communit...clozaril_2.htm
  6. by   nursedarla
    To be honest I have to say I've found Geodon useless unless given IM in conjuction with IM Ativan - but who's to say which is actually effective? Cost on the Consta (long-acting IM Risperdal) is not pretty. For a shot every two weeks at the minimum dose, it's like $220. I've only seen one patient on it and that was discontinued after two doses because of other problems, so I couldn't even guess yet if it's worth it.
  7. by   Nurse Ratched
    Gave the Consta for the first time two weeks ago. Haven't seen the pt since but will be interesting to see if it does anything. Not holding my breath tho, as she is a FF of our mental health unit for the past 25 years at least (as long as the longest-tenured staff member can recall.)
  8. by   sanakruz
    This consta was well marketed! I had 3 different reps make nice with me-
    But we wont be giving it cuz we dont got no refiderratr....
  9. by   tomlove99
    Quote from maureeno
    haven't seen enough Geodon yet to know anything.
    what I wish is drug trials would not just be vs. placebos.
    I took Stellazine for 30 years, mostly 10mg daily. Celexa was added in 2002. I stopped the Stellazine in June of 2003 because of concerns with EPS and Akathesia. I started relapsing in Sept. of 2003 and the Dr. added Geodone. Thought processes and behaviour have been fine since then.
  10. by   StuPer
    As it stands here in Australia Clozapine is still considered the best antpsychotic, but because of the risks is not a first line treatment. Abilify is only just appearing round here, notably through general practitioners, rather than psychiatrists. The few patients I've met who have been started on Abilify do not appear to be finding much in the way of benefit. Recently came across a client who had been on Zyprexa, but because of the weight gain was started on Abilify with the plan to cease the Zyprexa if he tolerated the Abilify. 3 days after running out of Zyprexa he experienced a return of his auditory hallucinations and increased paranoia. 3 days of 10mg Zyprexa and the voices were gone..... you figure it out.
    However I don't know if you picked it up, but Eli Lily issued a warning to medical practitioners on 20/2 warning aginst using Zyprexa in the elderly/dementia client due to the significant increase in risk of sudden death and heart attack. Makes you wonder about younger clients and the long term effect on they're coronary health.

    Can I ask if anyone has experience of the IM Zyprexa rapid acting?, it has just been released here and I was wondering if anyone had had any experience good/bad?
    regards StuPer
  11. by   Lindar
    Quote from CliveUK
    sanakruz - the risperidone depot comes in kit form - a white powder that you have to mix with the 'special solution', shake and then serve - through a big needle provided with the kit.

    I know I sound rather pessimistic about the new antipsychotics, but the risperidone depot has proved absolutely useless with the patients we have tried it on. Yes, they had no side-effects...but no actual effects either!
  12. by   Lindar
    You have a right to distrust the new antipsychotics. I also find most are ineffective. I work in a Geriatic Psyche unit and I have to tell you we are loving Seroquel. I have seen overnight success in relatively low doses. The Psychiatrist on our unit has been using it to control some of the negative behavoirs in Alzheimers Patients. We had a man on the unit that was grossly confused and required total care by staff. After just one dose of 100mg of Seroquel he woke up the next morning and dressed himself and fed himself. He remained confused but care give strain was reduced. This same Psychiatrist tell me though that in middle aged adults the dosage requirements are higher, sometimes 800mg qd and the cost is about $800 to $1,000 per month. We are limited to using Seroquel for patients going to nursing homes that have medicaid that will pay for it. It's unfortunate but it's the way things are sometimes.
  13. by   Lindar
    Quote from Lindar
    I agree and in some elderly Risperdal has caused some stroke like symptoms. After just one dose we had patients drooling with a one sided weakness. Side effects disappeared after discontinuation of the drug and after Ct Scans revealed nothing.

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