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What are the side effects of long term use of Oleanz and Trinicalm Plus?

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Posted on Fri, 8 Jul 2016
Question: Dear Doctor

last march 2016 my wife hospitalised due to acute psychosis and depression. she was treated with chloropraximine 50 mg, oleanz 5 mg, lopez 2 mg in the night and trninicalm plus 3 times daily. after a month she was normal in all actitivities but sleepy mood. before march 2016 she was normal, enjoyable and happy person. what is the reason for this issue?

then may first week doctor reduced oleanz to 2.5 mg and lopez to 1 mg. she was ok but went to depressive mood occasionally , not able to take food, not able to concentrate normal activities like movie watching etc.,

then may first week doctor suggested to add c pram 5 mg in the night. after that she improved but not completely recovered.

in this period, sweating is more and we observed that slow movements

again yesterday we had discussion with
doctor and she prescribed the following

trinicalm plus 1/2 1/2 1
oleanz 2.5 0 0 1
c pram 5 mg 0 0 1
pacitane 1 mg 1 1 0 for slow movements

we are worried whether we are going in right directions.

some of my friends Psychiatrics suggesting instead of taking many combinationation

only oleanz 5 mg and c pram 10 mg in the night is sufficient

what are the side effects of these medicines
how long she has to take

is there any alternative therepy without medications
can we withdraw trniniicalm plus suddenly

wheter long term usage of trininicalm plus is advisable

is there any other investigations needed { thyroind, hemoglobin, bloog sugar is n normal range}

kindly guide me, because we enjoyed each and every moment in our family, childrens need to enjoy with mother.

doctor
Answered by Dr. Shubham Mehta (1 hour later)
Brief Answer:
Oleanz and c pram s and Lopez.

Detailed Answer:
Hello,
Welcome to HCM.
I can understand your concerns for your wife.

There is no exact cause or reason for psychosis. But stress in any form or genetics can contribute to development of psychosis.

In my opinion, oleanz and CPram S should be sufficient for her. Lopez can be taken if there is sleep and anxiety problems. Dose can be adjusted depending on her symptoms.

Trinicalm plus can cause this slowness of movement as side effect. This is a combination of older drugs which are used infrequently now.
It can be stopped at once.

She can be given pacitane till her slowness is resolved.

If there is no psychosis now, she can be taken to a psychologist for counseling sessions for depression.

No other laboratory investigation is needed for psychosis and depression.
Just keep a regular follow up with your psychiatrist.

Hope this helps.
Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Shubham Mehta (3 hours later)
Dear Doctor
Greetings
Thanks for your reply
I have some claerifications now
1. Can Trinicalm plus be suddenly stoped? Is there any withdrawal problems. Pl guide
2. Now she is taking oleanz 2.5 and c pram s5 mh. Whwther she can continue the same or dosage adjustment is needed
3 how long time will ot take for normal stafe as before
4. How long she has to take medicines
Thanks
doctor
Answered by Dr. Shubham Mehta (19 hours later)
Brief Answer:
Trinicalm can be stopped.

Detailed Answer:
Hi again.
Sorry for the late response.

Yes, trinicalm plus can be stopped suddenly. There should not be any withdrawal symptoms.

She would need dose adjustment depending on severity of her symptoms.

The exact time to get completely normal can not be predicted. But I would suggest that she should at least take the medicines for 6 months this time. This will decrease the chances of relapse.

Hope she gets well soon.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shubham Mehta (4 days later)
dEAR sIR

thanks for your reply

based on your suggestions, we discussed with her treating doctor to withdraw trinicalm plus and asked her to adjust oleanz and c pram s.

but she is not accepting to do it.
treating doctor is suggesting to proceed as:

1. trinicalm plus 1/2 1/2 1
2. oleanz 2.5 0 0 1
3. c pram s 5 0 0 1

we also discussed about side effects and following present observations:

1. she is having slow movements and involuntary movements like not returning her hand position immediately[occasional]

2.she is always like to go bed for rest and sleep

3. her mentstrural cycle not returned for last 3 months.

4. she is not able to take part in love life [after taking medicines] for the last one month

5. weight lost 2 -4 kgs for last 5 weeks

6. she is not showing some interest in normal activities like movie watching...[occasional].

now only after taking c pram s 5mg she is able to take food

in between I refered some of the ,medical websites, it is suggested than atleast c pram s 10 mg is needed for complete recovery from depression. Kindly suggest us for the dosage of c pram and oleanz.
so we need your guidance please.

what are the side effects of oleanz and cpram s? whether pacitane to be added or not

what is the remedy for love life and normal activities.


I would like to know which medication method to be followed?

Is it necessary to go for some other doctor visit?

Kindly help us to get back happiness in family/

thanks






doctor
Answered by Dr. Shubham Mehta (1 hour later)
Brief Answer:
Dose adjustment as detailed below.

Detailed Answer:
Hello again.
I have read your details thoroughly and will try to help you in all possible ways:
1. Slowness of movements is a possible side effect of trinicalm plus.
2. Increased sleepiness can be due to drugs as well as depression. It is difficult to differentiate at this moment.
3. Absent menses, loss of sexual drive, weight loss and decreased interest in daily activities are all due to depression.

First, the dose of C pram S should be increased to 10mg, as you have read online. The dose of Orleans should be increased to 5mg if trinicalm is stopped.
Second, these drugs cause weight gain. So this would be a advantage for her right now.
Pactiane can be added for 2-4 weeks to reduce slowness of movements. (although trinicalm plus has salt of pacitane in it).
Normal and love life will be restored once depression is treated successfully.

In my opinion, the treating physician should be open to discussion about the drug treatment, with his patients. It would be a good idea to take a second opinion as the supervision of local doctor is must while changing the dose of these drugs.

Hole this helps.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shubham Mehta (6 hours later)
Dear Sir

Thanks for your immediate response.

based on your inputs, we have discussed with another Psychiatrist with MD(NIMHANS) who is also professor in reputed hospital

he suggested her to take oleanz 5 mg and c pram s 10 mg only in night time. Ask her to stop trininicalm plus.

Can we proceed accordingly?
when these doses can be tapered
I would like to know whether just stopping trinicalm plus will solve recover from slowmness and involuntary movemnts of hands?

whether oleanz will also have side effects of slow movements and hair loss?

when she will get normal menstrual cycle? is there any gynec advise is needed?

I need to completely analysis the issue, because till 33 years she wasnot having any issues and problem, lovable person, In this regard, kindly guide us whether we need to go far imaging modalities like CT/MRI/PET....

Wheter she needs any neurologist opinion.

Please suggest me

sorry for may questions, because my self, two childrens need her back with smiling face and love.

these issues can be completely curable?

Is there any specific psychological counseling and cognitive thereapy is needed?

For complete investigation and long term benefit and to avoid recurrence, pl guide us,

After interacting with u doctor, we feel comfort and save our happy family
thanks
doctor
Answered by Dr. Shubham Mehta (10 hours later)
Brief Answer:
Can stop trinicalm plus.

Detailed Answer:
Hello again.
I feel happy that you find my suggestions helpful.

Yes, you can stop trinicalm plus as per his suggestions. After she stops trinicalm, the slowness and involuntary movements will disappear slowly.

Oleanz in such low doses is safe but it can cause weight gain. So she must do physical exercises and avoid fatty foods. It does not cause hair loss.

After stopping trinicalm, her menses should return to normal in about one month. If not, then you can take a Gynec opinion. There is no need of CT/MRI at present. These seem to be drug induced side effects and nothing more.

Please relax. These issues are completely curable.

You can go for psychological therapies once the side effects are resolved.

Just keep in regular follow with your local psychiatrist and take drugs regularly. She will be fine soon.

Do keep me informed about her condition.

I wish for her speedy recovery.
Take care.

Dr. Shubham Mehta.
Above answer was peer-reviewed by : Dr. Sonia Raina
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What are the side effects of long term use of Oleanz and Trinicalm Plus?

Brief Answer: Oleanz and c pram s and Lopez. Detailed Answer: Hello, Welcome to HCM. I can understand your concerns for your wife. There is no exact cause or reason for psychosis. But stress in any form or genetics can contribute to development of psychosis. In my opinion, oleanz and CPram S should be sufficient for her. Lopez can be taken if there is sleep and anxiety problems. Dose can be adjusted depending on her symptoms. Trinicalm plus can cause this slowness of movement as side effect. This is a combination of older drugs which are used infrequently now. It can be stopped at once. She can be given pacitane till her slowness is resolved. If there is no psychosis now, she can be taken to a psychologist for counseling sessions for depression. No other laboratory investigation is needed for psychosis and depression. Just keep a regular follow up with your psychiatrist. Hope this helps. Thanks.