I thought I'd create a thread specifically about PRN ("as needed") medications for use in controlling psych (not side effect) issues. I know that many of us have them at our disposal, or even use a med or two, like a PRN.

Does your psychiatrist prescribe or recommend use of a PRN medication? If so what? When/how do you use it/them? If you have two or more, what makes you use one over another? When does an adjustment of one of your base medications become necessary? If you have a base medication, that is.

PRN or p.r.n. means "pro re nata" in Latin, approximately meaning "for an occasion that has arisen".

[luvyrself]

I take it to mean “as needed”. Great thread, BD!

Thanks, yes it means "as needed".

My psychiatrist prescribes small doses of Ativan (lorazepam) and regular Seroquel (quetiapine) that I can take only "as needed" when I experience mood issues that my base med cocktail doesn't handle sufficiently. They are not for daily use and he assigns a limit to the number I can take, and approximately how many days in a period. If my need exceeds these limits, he wants to know, then usually he increases (or occasionally decreases) a dosage of a daily base medication in my cocktail.

In the past, I tended to choose the Ativan over the Seroquel, but now I've learned that, in some cases, Seroquel is the better choice. It depends on my symptoms. Pure anxiety with no mood issues is often helped better by my Ativan, but Seroquel can help that, too. If I am having breakthrough hypomania/mania symptoms, agitation, or mixed state, Seroquel is usually the best for me.

I don't want to rely on a benzo any more than necessary. I'm trying to use the Seroquel as a PRN more, for that reason. However, sedation is a consideration in my choice. If I am getting manic, Seroquel calms it a bit, but not to fatigue. If I am anxious, but not elevated in mood, I like that the Ativan doesn't sedate me. It's odd, though. Ativan never sedates me during the day, but does help me sleep at night, but so does the extra Seroquel. Again, I think my choice at night depends on the symptoms.

If I obeyed my doctor, I'd be taking 1mg of Ativan scheduled three times a day. I take it every night to help with sleep and I'll take another dose during the day if I feel it need it, as in, having trouble with anxiety or restlessness. I was supposed to have a Haldol PRN when I left the hospital, but the IP pdoc didn't send the rx over and I just haven't thought to bring it up with my pdoc, but I probably will next time I see one because I feel like it would be beneficial when my psychotic symptoms are acting up despite the risperdal, which I get the injectable version of every two weeks.

[still_crazy]

prn low dose gabapentin, prn extra abilify to top off my 15mgs/daily. works for me, i don't see the harm in it...

[bpcyclist]

Awesome thread, BD!! Well, as my sig indicates, right now I officially have just the Zyprexa as a prn for 'emergency' sleep issues, which is hilarious, because every single night is a sleep 'emergency.' I just can't sleep anymore. We've tried nearly everything. I do have a 20-lb blanket on back order. Maybe that will help. Buying a really nice pillow for myself for the holidays. And, just in case anyone wonders, we have stopped the Provigil (and the Adderall before it) and the sleep did not budge. Sigh.

As some are aware, I became quite manic and psychotic last week. Dr. C first resumed the Abilify, which I had unwisely stopped due to some hand movement SE. It's now back at 30 mg/day. When symptoms worsened, he then added Seroquel at just 25 mg qHS (bedtime), hoping that it might help me sleep, which in turn, might budge the psychosis a bit. It helped for a few days and then, no more sleep help. My pattern. Now, whether at this very low dosage there is any other benefit, I dunno. I was on 200 before. I doubt it is doing anything but making more expensive urine.

A good example of how complex it is to take care of people like me is that the 'emergency sleep' Zyprexa was supposed to be d/c'd when the Seroquel started at the time of this big relapse. The pharmacy didn't get the message and they keep texting me to come pick up the Zyprexa. Supposedly 10-15 mg qHS (prn). It is extremely tempting as someone who can't sleep, and who gets psychotic and manic when sleep-deprived, very tempting to go fill that rx and take it every night. Because I am suffering.

But I don't. The pharmacist b****ed at me the other day when I was getting my Provigil for not picking up the Zyprexa. Had no idea how to respond to that in, like, ten words or less.

This is way too long! Sorry! But I guess it illustrates how tough it can be to figure out how to manage these prn's in an illness that is by definition, cyclical. Oh well. What are you gonna do...

[Victoria'smom]

I have ambien PRN. If I haven't slept in 2 days I'm to take the ambien. She'd rather me take it more often then that. Now I have taken it as a last resort before the hospital but honestly I don't use it often.

[Guiness187055]

I take xanax as needed for agitation, panic and anxiety. I also take temazepam for sleep as a prn. I usually take the temazepam every night but rarely take the xanax.

[*Beth*]

I'm on 2mgs/day of Klonopin and am to take 3mg if I feel anxious and amped up.

I am also on 12.5mg of Zyprexa per day. I have recently experienced psychosis, so Dr. W., my pdoc, has told me to take an additional 2.5 Zyprexa prn if I feel too agitated.

I've been on the K-pin for such a long time that the 1 extra mg barely does anything. I have not tried the 2.5 extra of Zyprexa yet.

[unicornlady]

I used to have PRN gabapentin, but I was almost never using it, which I shared with my pdoc at some point. She discontinued that prescription, so now I have zero PRN meds.

[xRavenx]

I take PRN clonazepam for anxiety and to take the edge off of any symptoms I am having. It varies how much I take it, but on average, four days during the week. There will be periods of time when I am in an episode where my pdoc recommends that I take it once daily though.

[Wander]

My pRN's change with the circumstances. I take a regular dose of Clonazepam (3 mg right now), but take 2.5 mg of Lorazepam three times daily right now as I am very unwell. I also take Haloperidol for agitation, 5 mg three times a day, and Seroquel for sleep. When I am stable all I take is Ziprasidone (Geodon), Lithium, and the lowest amount of Clonazepam I can take without going into withdraws. I have been trying to taper off of Benzos but keep getting hit with episodes/PTSD that leads me to take higher doses to get an effect. Once I am stable I plan to stop all PRN, and slowly reduce my Benzos.

[Blue_Bird]

I'm prescribed Klonopin to take as needed, I don't take it often but when I really need it and do take it, it's pretty effective

[Merlin]

I take prn Zopiclone 7.5 for sleep if I am not asleep by 1:00 a.m. Sometimes I’ll start with a 1/2 a pill.

I have taken prn ativan when in hospital.

[Pookyl]

I have three PRN’s:
Saphris 5mg for manic, depressive breakthroughs/episodes

Seroquel IR 12.5-25mg if I haven’t slept for two nights

Valium 5mg for anxiety not responsive to non-medicated actions taken