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Should solian be given with Invega? Is it safe to give clozapine?

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Practicing since : 1998
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1. In this instance should Solian be given with Invega or removed from the equation ?
2. Is the current drug choice and dosage the best that can be administered ?
3. If not what are they ?
4. Should one contemplate giving Clozapine ?
5. Do you need any further information ?

Posted Fri, 21 Sep 2012 in Medicines and Side Effects
Answered by Dr. Susanta Padhy 1 hour later

Thank you very much for a good summary of the history making sense of the case.

In the treatment of Schizoaffective disorder, a balanced combination of antipsychotics (Invega, Paliperidone in your case) and mood stabilizer like Lithium, Valproate is required. It depends upon whether the psychotic symptoms or mood symptoms are prominent.

Solian, contains amisulpiride, usually given for negative symptoms, at lower doses (100 to 300 mg)

Amisulpiride at higher doses (400 to 800 mg per day) is effective for positive symptoms (illogicality, thought disorder, delusion etc.)

Amisulpiride at lower doses, sometimes, can worsen positive symptoms.

Clozapine is given in treatment resistant Schizophrenia when two antipsychotics given in adequate dose for adequate period failed to give response.

Repeated change of job, not getting adjusted with society / work is fundamental symptoms to psychosis.

I would personally feel, may be increasing the dose of palliperidone further, taper and stop Amisulpiride and adding a mood stabilizer would work better for XXXXXXX

Mood stabilizer might help further. Of course you need to discuss these options with his primary treating doctor and then go for change.

Along with medication, psychosocial rehabilitation should improve his functioning.

Hope this would give some clarification. Do write back for further discussion on this.

Wish XXXXXXX good health.

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