Clozapine?
For the week that mum stopped taking clozapine she couldn't sleep or even nap :( She was worried about relapse and consequently hurt herself. She's been managing such feeling via distraction by doing some activities.
On the appointment date, the doctor confirmed my suspicion that mum's white blood cell count was low and hence the suspension of clozapine. After getting the above information from us and discussing with the specialist, she said that they needed to wait for the results of the blood test before telling mum to either resume clozapine or take a substitute.
I guessed that the blood test result was still not good because late afternoon they called to inform us of the change in medicine i.e. from clozapine to risperidone (1mg per night). The following week's appointment remained.
For the next 6 days days, mum managed to sleep but not of good quality. Better than when not on clozapine but worse than was on it. However, finally sleep quality reverted to clozapine-period on the 7th day. According to the doctor, that was expected because it would take the medicine to slowly take effect, like any other psychiatric medicine.
Meanwhile, her dizziness worsened and her blood sugar deteriorated slightly to around 4.4. from 4.6 - 4.9 range. Perhaps because of that, the psychogeriatric, via the medical officer, offered 3 choices:
(1) Try clozapine again but start from small dosage all over again and institute the weekly blood test & appointment again until such a time the pattern in the results shows it's ok to decrease the frequency.
(2) Go back to olanzapine.
(3) Try one of two newer drugs which generally have fewer side effects.
I discussed with mum and she agreed to choose (3). Not only does it have fewer side effects, generally, option (1) may cause problem again (low white blood cell counts) when dosage is increased to desired level and option (2) didn't work out in the end (and hence it was changed to clozapine). Problem was that the hospital didn't have the medicine and so we needed to buy it outside.
So the doctor called the specialist (he was giving a talk off site) and came back to give us a sample strip of asenapine along with instruction of how to ingest it. The idea was to rule out any immediate adverse effects and whether it would not be as effective as previous medicine, for a week. Hence, the next appointment was set in 8 days time.
On the appointment date, the doctor confirmed my suspicion that mum's white blood cell count was low and hence the suspension of clozapine. After getting the above information from us and discussing with the specialist, she said that they needed to wait for the results of the blood test before telling mum to either resume clozapine or take a substitute.
I guessed that the blood test result was still not good because late afternoon they called to inform us of the change in medicine i.e. from clozapine to risperidone (1mg per night). The following week's appointment remained.
For the next 6 days days, mum managed to sleep but not of good quality. Better than when not on clozapine but worse than was on it. However, finally sleep quality reverted to clozapine-period on the 7th day. According to the doctor, that was expected because it would take the medicine to slowly take effect, like any other psychiatric medicine.
Meanwhile, her dizziness worsened and her blood sugar deteriorated slightly to around 4.4. from 4.6 - 4.9 range. Perhaps because of that, the psychogeriatric, via the medical officer, offered 3 choices:
(1) Try clozapine again but start from small dosage all over again and institute the weekly blood test & appointment again until such a time the pattern in the results shows it's ok to decrease the frequency.
(2) Go back to olanzapine.
(3) Try one of two newer drugs which generally have fewer side effects.
I discussed with mum and she agreed to choose (3). Not only does it have fewer side effects, generally, option (1) may cause problem again (low white blood cell counts) when dosage is increased to desired level and option (2) didn't work out in the end (and hence it was changed to clozapine). Problem was that the hospital didn't have the medicine and so we needed to buy it outside.
So the doctor called the specialist (he was giving a talk off site) and came back to give us a sample strip of asenapine along with instruction of how to ingest it. The idea was to rule out any immediate adverse effects and whether it would not be as effective as previous medicine, for a week. Hence, the next appointment was set in 8 days time.
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