I know "you should never make med adjustments without talking to your prescriber" but hear me out on this one.
I just saw my pdoc last week (and don't have another appointment with her for two months) and she lowered my (oral) Risperdal. I am getting hypomanic so I went back to the higher dose to see if that'll stop it.
I also took some PRN Haldol because I started having hallucinations. I've been on the two together in the hospital and nothing bad happened, although technically Haldol isn't on my current med list but I have a stash for moments like this.
I'm pretty sure my NP would be on board with me doing this and would do something similar if I showed up to appointment like this. Is it really that bad? I mean I don't want to get an emergency appointment in a week and waste her time when I know what's going to work for me.

[Moose72]

I also have quite a stash of haldol. How did you get yours? Did you pdoc give you an extra script for prn? That's what I've got, though I don't use it that often. In fact, I have more than I'll probably use. Your Risperdal change makes sense, but I'd pass it by your pdoc anyway. Why would you be wasting her time? That's what she's there for!

Hi spikes. I am reluctant to ever give a person a "Hey, go ahead!" with such changes, but I have done similar in the long ago past. I guess if your pdoc isn't aware of you using Haldol as a prn (in conjunction with Risperdal), I'd at least pass it by a pharmacist to be 100% sure there are no issues taking both together. I know that there can, indeed, be issues with various bipolar medications taken together. For example, if I take my Tegretol XR (carbamazepine ER) with certain medications, it could potentially increase my Tegretol level or decrease the efficacy of the other medication. It depends on the medication what the result might be.

I don't think my psychiatrist would object as much to me going back to the just previous higher dose, than me lowering my dose on my own. Either way, I'd think he'd want the chance to veto such a decision, especially in the latter case. He's somewhat sternly told me he wants veto power in the latter case.

I find "prn" medications extremely useful, but in my case, my psychiatrist himself has prescribed them as "prn" and has given me guidelines on their usage (see examples in my signature below). If Haldol is not officially a "prn" medication for you, consider discussing making it so with your pdoc. My psychiatrist is also really great about giving me medication change suggestions over the phone, without the need for an emergency appointment. He did that just today! I know that many people don't have that benefit.

[quietlylost]

I think it's worth a call to your doctor's office. They should at least be informed of what you're doing or would like to do. Maybe they won't make you come in for a visit, but it's better that they're in the loop so they can offer information or support.

[*Beth*]

My pdoc used to be really pissy when I altered my meds. Then I reminded her that she's not available on Sat., Sun., Mon., and Wed. She has no back-up pdoc. I think it kinda dawned on her that there are 4 days per week when I cannot reach her.

In addition, I have so many years of experience with psych meds, how my body reacts, and so on.

So. I will say that if you can reach your pdoc (or NP) every day (or almost every day), it's probably wise to run your idea by her - especially if she's one of those that doesn't like it when you make changes on your own.

If, however, she trusts you to make minor changes, go for it. In addition, it sounds like you do have experience with the meds you're using. Personally, I think part of being a responsible psych patient is knowing when to make slight changes when need be.

Thanks. I've decided I won't take anymore Haldol until I run it by my pdoc. I got it last year when I was on it regularly + some extra for prn use. Pdoc is on board with me using ativan so if I get too agitated I'll take that instead and if it's hallucinations bothering me I'll just deal with it.

[*Beth*]

Originally Posted by spikes

Thanks. I've decided I won't take anymore Haldol until I run it by my pdoc. I got it last year when I was on it regularly + some extra for prn use. Pdoc is on board with me using ativan so if I get too agitated I'll take that instead and if it's hallucinations bothering me I'll just deal with it.

I do not mean to be unsupportive; I think your decision to use Ativan is a smart one. If it comes to hallucinations though, please be cautious about toughing it out. Taking a bit of Haldol at that point would be a good way to take care of yourself.

[pacman_789]

Have you ever tried just calling your doctor and leaving a voicemail stating your issues? I’ve seen a couple of psychiatrists over the years, and both were fine with making adjustments between appointments if I was having issues (as long as it wasn’t a frequent thing).

Getting a hold of my pdoc is more difficult than I care for right now (she doesn't give her number out to the patients). I see my therapist this week and if she thinks I need to get in touch with doc, she'll help me get through. Oh, and BethRags, I didn't think you were being unsupportive, I decided not to take anymore haldol because apparently there is an interaction with Risperdal that is rare but can mess with your heart. Probably should've looked that up before I took it, but oh well at least nothing bad happened. The Ativan is helping out but I'm limited to 3x a day and that doesn't feel like enough.

[*Beth*]

My pdoc has disappeared with no word. It is assumed that she's out because of the virus. There is no back-up pdoc so yes, I sure will be making my own med adjustments. Fortunately, I have only 1 that needs to be adjusted.

[NOS-NOS]

As I have found, only make your own med adjustments in a crisis and if you know it has helped in the past. For example, my psychotic symptoms were getting out of control, so I doubled my zyprexa, which I know worked in the past. Afterwards, I confirmed with my pdoc that this was the right thing to do and he concurred.

[*Beth*]

At this time I have no choice but to adjust my own meds. My pdoc has been showing up every few days at the clinic...so max 2 or (sometimes) 3 days per week.