Question: Hi there, I have been taking Geodon for several years after having had problems with Abilify and Risperdal which caused problems with tremors among other things, Seroquelwhich I reacted to very adversely and could not tolerate, and maybe a couple of others. I have had by far the best success with Geodon for my psychotic sympoms with the fewest side effects. However about four months ago I started having severe problems breathing, basically what happens is when I am feeling tired late at night after dinner and taking Geodon, about bedtime I would start with feeling very agitated and almost immediately start having extreme difficulty breathing, my mouth opens involuntarily and Icant breathe at all except by forcing my mouth shut with my hands and focusing on trying not to panic and to try to breathe through my nose. One night this happened and it was so terrifying I went to the ER where they gave me Benadry which has subsequently helped but usually takes about an hour to kick in to where I am not struggling with the involuntary mouth movement and the inability to breathe. At first the episodes seemed to be triggered by eating something sweet so I stopped consuming anything with high sugar content and went to an allergist who concluded I am not allergic to sugar (he did a scratch test for peaches, milk, chocolate and a few sweet things I am not sure of) and suggested it is either the Geodon or I should see a neurologist. My general practioner seems to think it is the Geodon or a function of depression and anxiety (i do ECT for depression as medication never helped, but I dont think ECT is responsible for this and neither does my psychiatrist. My psychiatrist doesnt think the Geodon is the problem but I cant think of or find any other explanation for this breathing problem, and it has started to occur at other times most recently in both the morning and late afternoon on days when I have not eaten sugar and so it seems to be getting more frequent and happening some days before I have taken my Geodon in the evening. The only thing I can recognize as a trigger at this point is fatigue, which is also increasing. I have had most tests for cancer and have beemn to a pulmonologist for a cat scan to check out lung cancer and that was negative. I am absolutely convinced this is not a panic attack or all in my head as I was a psychotherapist who treated anxiety disorders for over thirty years and though I panic when I cant breathe it is a result not the cause. Could the Geodon be the cause and if so what medication might I try next or should I see a neurologist or some other specialist? I am at a total loss to know what to do, but the episodes are becoming more frequent. Any advice you can offer would be greatly appreciated. No one has ever heard of this type of problem before, especially the involuntary mouth movement which happens when I stop being able to breathe normally. Also I might mention I have been to my general practioner twice and he is certain I am not diabetic and simply has no clue about how to help. If the Geodon is the culprit would switching to possibly Latuda or Vraylar be a reasonable alternative? As I have stated before the Geodon has been the only drug for the psychotic symptoms that occur with my depression that has not caused major side effects in any other way so I am loathe to change it but I dont know what else to try. I have been taking 150 mg of benadryl in capsules when this happens and like I said it takes about an hour of feeling terrfied and extreme difficulty breathing before the episode starts to fade. And honestly I dont know how much the Benadryl actually helps, but it seems to. I also take alprazolam .5 milligrams for the panic but it doesnt help me regain normal breathing. I have googled my symmptoms for weeks trying to find a known disease with these symptoms to no avail. Feeling pretty desparate for not having an answer for what feels life threatening when it happens. Thank you in advance. XXXXXXX XXXXXXX Ps i am asking for a consultation with a neurologist since that is the next step recommended by the allergist but this doesnt sound like a question for a neurologist if you could direct me to a specialist who might have a better idea I would be greatly appreciative.

Thank you Dr. XXXXXXX Are you a psychiatrist? Do you think i should follow up with a neurologist as well as addressing this with my psychiatrist? Also, in your opinion could the Vitamin E and tetrabenzine resolve the issue or just prevent it from getting worse? Clearly it would be scary to have to continue living with this situation. Would switching to Clozaril eliminate the problem? I would like to know the rationale that I could present to my psychiatrist. I have to say too that I fear being on Clozaril as it seems problematic in its own right though I may have a prejudice against it. For one thing I have had to struggle a great deal in the past with weight gain and I know that is a significant issue with Clozaril. Why Clozaril and not something else? My understanding is that TD is not reversible, so this is scary. Do you feel your recommendations will eliminate the problem? Or if you dont know just tell me. I appreciate that you at least have an idea of what the problem is. I would not have thought of TD as I dont have the grimacing or tongue problem or any other symptom of it. Perhaps you could elucidate a bit more. I am grateful for your answer but it is somewhat anxiety provoking all the same as I am sure you can appreciate. Thank you.

Thank you once again. I have spent some time researching Treatments for TD and ran across a new drug called Ingrezza which is supposed to actually supposed to reduce or eliminate TD rather than relieve symptoms. I spoke to my insurance company and the pharmacist there said he believes it is worth looking into. However this drug and clozaril are not preferred drugs and would be considerably more expensive than Latuda which the pharmacist suggested I try in combination with the new drug Ingrezza, which would cost around $120 per month. They wont be able to tell me how expensive clozaril will be until tomorrow as that office is closed on Sunday but it would be definately more expensive than Latuda. do you have an opinion about or know much about .Ingrezza? The pharmacist suggested I might do as well on a combination of Latuda and Ingrezza as the drug combo you mentioned if it would be too expensive to use both Clozaril and Ingrezza instead of the tetrabenzine. I think what I am asking is if You know of or have an opinion about the Ingrezza and see any potential benefit from it that might be used in combination with either Clozaril or Latuda vs your suggestion of the tetrabenzine and Clozaril combo. I dont think Ingrezza has been on the market long enough to know with certainty how effective it is but Clozaril may be rather expensive. Just wonder what would be the best combo in terms of expense. could you see any advantage to trying the Ingrezza in combination with Latuda if expense turns out to be a factor? Or would I be better off with Clozaril and the tetrabenzine. I am sure that my psychiatrist will also have an opinion but I would like to enter the conversation with as much knowledge as possible. And certainly will also follow up with a neurologist as well. Thank you again for your kind and thoughtful response.