Ask the pharmacist...

My psychiatrist diagnosed me with psychosis and has prescribed Thorazine. She says she is very 'scared' to have me on this and to increase it each visit as I am her only patient on it. Is there something about this medication that would cause her to be this concerned? All other medication has failed and progress is being seen with Thorazine. 

Thorazine is the US tradename for chlorpromazine – the very first antipsychotic drug. Chlorpromazine has been used for 60 years and given to millions of people.  For many years it was the most widely used antipsychotic. Nowadays it is much less used because newer drugs have less severe side effects. Chlorpromazine may cause skin sensitivity (to the sun), skin rashes, blood problems, liver problems, movement problems and much more. Having said that, most people tolerate chlorpromazine well, and, if closely monitored, it can be a safe and effective drug.

My husband is on Clozaril. Does this affect male fertility? 

Clozapine is not thought to affect male fertility. Although fertility is not tested directly when a drug is developed, we do know that people taking clozapine have fathered children. Clozapine doesn't affect the hormone prolactin, unlike many other antipsychotics, so infertility would not be expected in any case (increased prolactin can cause a loss of interest in sex and lowered fertility).

I have currently been changed onto lithium 800, alongside amisulpiride 400, twice a day and lamotrogine 200 twice a day. I have had a recent relapse since starting lithium and the amisulpiride was increased. I wondered if there was an opinion about this combination and whether going on lithium could affect me as I have relapsed. 

This is a typical combination of drugs in bipolar disorder and schizoaffective disorder. Lithium will help prevent relapse into mania and depression but it must be taken regularly at the right dose. Suddenly stopping lithium or missing doses can actually make relapse more likely. Taking too low a dose will mean that there is no protection against relapse. Everyone on lithium should take it regularly at the same time each day and have three monthly blood tests to check the dose is correct.

Is it appropriate for risperidone to be used to treat anxiety? 

Risperidone is not formally licensed for anxiety but it can be effective for some people. There are probably better drugs such as SSRIs (antidepressants) and pregabalin. Benzodiazepines (diazepam, lorazepam) are also effective but should only be used for a few weeks. If risperidone is to be used for anxiety, it should be prescribed only after standard treatments have been shown to be ineffective. When it is used, it should be used for a shorter time as possible.   

I am writing with a concern regarding my sister-in-law. She developed schizophrenia when she was 13. Eventually she was put on clozapine and has been living a pretty much normal life for 15 years. 

Then just before Xmas she got three red alerts and was taken off the drug. She has been put on another drug (I can't remember the name I'm afraid) but it isn't working and she has just been sectioned. 

My question is, do you need to have specialist knowledge to help people with schiozophrenia who have to come off clozapine? 

Clozapine is the most effective antipsychotic available. When people stop taking it they often relapse and other drugs seem ineffective. Specialist knowledge is of little help because nothing is as effective as clozapine so anything that replaces it will not be as good.

Blood testing is essential with clozapine because it can cause a serious blood disorder called agranulocyctosis (a near absence of white blood cells). This usually occurs in the first four months of treatment and almost all cases are seen in the first year. It is extremely rare for clozapine-related agranulocytosis to occur after this time. Some cases of neutropenia (a similar blood disorder which can sometimes lead to agranulocytosis) are put down to clozapine when they have actually occurred by chance. It is possible that neutropenia occurring after years of clozapine treatment has nothing to do with clozapine. It may then be possible to continue with clozapine if this is found to be the case. All late-occurring neutropenia in people on clozapine should be carefully investigated by a haematologist and psychiatrist with a view to restarting clozapine whenever possible. 

My partner has just been prescribed 10mg apripiprazole along with martizapine. Is this a good combination? 

Aripiprazole tends to cause agitation and insomnia. Mirtazapine causes sedation and reduces anxiety. So the two drugs may to some extent cancel out each other’s side effects. In this respect it is a good combination. The two drugs also work well together as a treatment for depression.

My 18-year-old daughter was diagnosed with narcolepsy as one of the symptoms of psychosis. She has been given Provigil. Will this only help with keeping her awake in the day? Or will it also help with the other psychosis symptoms? And are there any alternatives to the medication?

Modafinil (Provigil) is a stimulant drug used as a treatment for narcolepsy and some other syndromes associated with daytime sleeping. It does not help with psychotic symptoms but may have some minor benefit in depression. It is usually given only in the morning so that nighttime sleep is not affected. There is no real alternative. 

The combination of medications (quetiapine 400mg daily and sertraline 150mg daily) I take cause me to have a very dry mouth and eyes and my nose constantly feels blocked. I tried taking procyclidine to alleviate this but it made the problem much worse. Is there anything else I could personally do or ask my doctor for that would help with these symptoms?

These symptoms are caused by a metabolite (by-product) of quetiapine and are known as anticholinergic side effects. Procyclidine is an anticholinergic drug. This is why it makes these symptoms worse. There is no really effective treatment for these side effects but some people find that chewing (sugar-free) gum is helpful for dry mouth. Saline nose drops may help with dry nasal secretions. Artificial tears are also available for the treatment of dry eyes. 

My brother was on Abilify for his bipolar and did not get on with it.

The doctor has suggested he should try chlorpromazine. Can you tell if there are any bad side effects with this drug?

Chlorpromazine has been in continuous use for 60 years. It causes sedation, dry mouth, constipation, movement disorder, breast growth, milk production, impotence and many other adverse effects. Many psychiatrists now consider it obsolete because other, less toxic drugs are now available. Having said that, when carefully used in doses of 150-400mg a day, chlorpromazine can sometimes be effective and well-tolerated.