[costello]

My son is taking increasingly large doses of olanzapine, and it doesn't seem to be helping in the way it used to. He was prescribed 7.5 mg, but he was taking so many PRN that he ran through a month's supply in 9 days. He's been taking up to 30 mg per day. And yesterday he took 40 mg! We saw his pdoc on Monday, and he told him not to take more than 30 mg per day.

He says it helps. It clears up his thinking, but his behavior is odd in a number of ways. For example, his OCD type stuff is back. Just as one example, when he's walking across a floor with a pattern of lines running perpendicular, he won't step on the spots where the lines cross. He does this at home and in public. He's been coming to work with me, and a couple days ago we went to the cafeteria. He was walking across the floor taking these large slow funny steps. It looked like something a six year old might do. I've never seen him act that way.

The weird thing is he's not having any of the side effects he normally gets on a high dose of olanzapine. On this dose I'd expect to see him complaining of akathisia, eating a lot, gaining weight, and sleeping 12 hours per day. None of that is happening. There's just a slight hand tremor.

Is he going to have to change medications? What's going on here?

[costello]

Oh, and he also started talking about going somewhere last night - like taking a trip to another state. He's done this before, just got in his car and started driving. Usually when he gets to his destination he turns around and comes back immediately. He did have one trip, though, where he attempted suicide in Albuquerque. He was asking last night if he could recover from another experience like the Albuquerque trip.

[costello]

I feel like I'm in one of those monster movies, and I'm firing my best, most powerful weapons at the monster, and the monster just keeps coming at me. I always thought olanzapine would stop the monster in its tracks.

[Sometimes psychotic]

Hugs Costello....so you're not going to want to hear this and there is no science to back it up but anecdotally my pdoc says that making changes to the meds often results in them losing effectiveness...it sort of suggests that in some cases there is something going on aside from the dopamine targeting, possibly something epigenetic. The reality is we don't know how the meds work in the first place....sure there's d2 blockade but it doesn't work for everyone with psychosis so what else is going on. The only other thing is if he's smoking and went from not smoking his needed dose may have doubled.

[costello]

Originally Posted by Sometimes psychotic

The only other thing is if he's smoking and went from not smoking his needed dose may have doubled.

He is smoking. And he's smoking a lot. He smoked before and quit. Then he went back to smoking while he was off the medication. Now, I could be wrong, but it seems to me he's in an arms race - every time he takes more olanzapine, he increases the amount he's smoking. I've asked him to stop smoking so much, because I'm around him a lot these days, and I'm starting to get sick from all the smoke. I did point out to him that more smoking means the med is clearing his system faster.

[costello]

He's also blinking his eyes a lot. I'm not sure if that's new or not. I think I would have noticed if he'd done that before, because it's very distracting.

[Sometimes psychotic]

Originally Posted by costello

He is smoking. And he's smoking a lot. He smoked before and quit. Then he went back to smoking while he was off the medication. Now, I could be wrong, but it seems to me he's in an arms race - every time he takes more olanzapine, he increases the amount he's smoking. I've asked him to stop smoking so much, because I'm around him a lot these days, and I'm starting to get sick from all the smoke. I did point out to him that more smoking means the med is clearing his system faster.

Quite possible...if he went to vaping instead it wouldn't impact the meds because it's the actual smoke and not the nicotine that has this effect.....

[costello]

Originally Posted by Sometimes psychotic

Quite possible...if he went to vaping instead it wouldn't impact the meds because it's the actual smoke and not the nicotine that has this effect.....

Ok, I'll suggest that to him.

[insilence]

i have mental techniques where i focus inside and squeeze, relax, or push along using my mind and focus nerves, hearing cortex, ears and shrink, squeeze, relax, push out and that reduces the volume and occurances.

[costello]

Originally Posted by insilence

i have mental techniques where i focus inside and squeeze, relax, or push along using my mind and focus nerves, hearing cortex, ears and shrink, squeeze, relax, push out and that reduces the volume and occurances.

Thank you, insilence. I'll pass that along to my son.

[Gavinandnikki]

Did he go from brand name to generic? For some medications, that makes a huge difference.

[costello]

Originally Posted by Gavinandnikki

Did he go from brand name to generic? For some medications, that makes a huge difference.

I thought about that. He is using the generic, but he has been since the patent expired some years ago. Currently he has a bottle of 20 mg pills. He wanted a PRN of 5 mg this morning, so I went to cut one up for him. It's this funny oval shape, not round like he's always had before. Maybe I've just never seen the 20 mg tablet before; I don't remember. But it made me wonder if this was a different manufacturer than the previous meds he took.

[Sometimes psychotic]

Originally Posted by costello

I thought about that. He is using the generic, but he has been since the patent expired some years ago. Currently he has a bottle of 20 mg pills. He wanted a PRN of 5 mg this morning, so I went to cut one up for him. It's this funny oval shape, not round like he's always had before. Maybe I've just never seen the 20 mg tablet before; I don't remember. But it made me wonder if this was a different manufacturer than the previous meds he took.

Generics are often made by like 3 different manufacturers and the pharmacy will just buy whatever the cheapest one is so there can be more variation in generics than there ever was with the brand name but they must be within about 10% or the activity level of the brand in order to be legal so if he has increased his meds so much it would likely compensate for alterations at the generic level.

[junkDNA]

hugs to you and your son costello

[newtus]

Costello.

let us know and keep us updated with what and how hes doing.

[Victoria'smom]

Use pill identifier to find his old manufacture and tell his pharmacy he needs that brand usually it takes 48hrs to get in. I'm very sensitive to brand changes.

[ofthevalley]

My 20 mg pills are round with the number 20 on them.

I hope he's feeling better soon!

[costello]

Thanks, everyone.

I'm really ragged tonight. I called in sick today, because it was clear my son wasn't doing well. He needed to be with me, and he was in no condition to come to work. So, I spent the whole trying to keep him sane. And it seemed to work. He's better now than he was this morning. But we just got home, and he hopped in his car and said he was going for a drive, and he'd be back later - maybe.

I told him I don't care. I'm so tired. He's been smoking like a chimney. I'm starting to get headaches and sore throats from it. But he had to smoke in the car. He was having a lot of anxiety, and there was no place to pull over. He opened the window, but it still all came in at me.

I don't know. I just need to be away from this problem for a while.

[costello]

Originally Posted by ofthevalley

My 20 mg pills are round with the number 20 on them.

That's interesting. That's not how his look.

[costello]

This is what his pill looks like: R 20 0168 Pill - olanzapine 20 mg

[Loial]

It's been a few years since I took Olanzapine but if I recall correctly I had oval shaped pills too although they were probably a different brand being as I'm in the UK.

I hope you manage to get to the bottom of the differences in his medication. I'm sorry both you are your son are having to go through a hard time again...