Increase benzo dose or not dilemma

Well I’m taking clozapine 225mg and my paranoia is coming back. Pdoc said to increase clozapine to 250mg. But 250mg will also worsen partial seizure and postural hypotension so I will have to increase my benzo(clobazam) from 5 to 10mg to fix seizures. But increasing benzo also creates memory problems and forgetfulness. Increasing benzo also helps with anxiety.

Should I increase my benzo or not ? Another option is to not increase the benzo but instead add low dose valproate for seizures in morning. Adding valproate will also worsen my handwriting cuz of tremors and I cant take beta blockers as it worsens psychosis/anxiety.I have tried all other anticonvulsants - i can only tolerate valproate or clobazam(benzo)

1 Like

Well its either seizures or memory problems, I’ll go with memory problems, and it also helps anxiety.

2 Likes

I think i will go with poor memory as well cuz increasing benzo has 2 benefits - no seizures + no anxiety.

clobazam 5mg + valproate 200mg = (+)no seizures, (-)poor handwriting(tremors)
clobazam 10mg = (+)no seizures, (+) no anxiety, (-) poor memory

2 Likes

cant you increase your AP instead of benzos

1 Like

Yea if i increase my AP, it will worsen twitches/jerks and i will have to increase my benzo to fix it.

Dont the benzos lose affect after a while since I believe you build tolerance to them

1 Like

cant they add a second generation anti psychotic to the mix

clobazam is a type of benzo which doesnt cause tolerance [1]

[1] https://www.epilepsy.com/medications/clobazam/advanced

Could you change from benzo to gabapentin?

Yea we were thinking about adding amisulpride to the mix, but amisulpride as well worsen qtc interval. My qtc is already high on clozapine 225 = 466ms. Adding another AP(amisulpride) will worsen qtc prolongation.

WIll have to discuss about adding another AP to this mix with my pdoc

I cant take abilify and risperidone they worsen my anxiety/psychosis.

1 Like

Pdoc declined to add gabapentin, he said I will sleep all day on it. I’ve tried pregabalin and i was sleeping all day on it.

Well last night i took increased benzo(clobazam) 10mg and today i was feeling less paranoid/anxious. I dont even know the reason for my crying on clozapine 225 - it could be anxiety or paranoia or both

I had change of heart John. I think i will go with valproate and clobazam 5mg and wont increase my benzo. I never had tolerance to anti-seizure properties of my benzo in last 2 years on it but I did infact developed tolerance to anti-anxiety properties of my benzo.

So there is only 1 benefit of both increasing and not increasing benzo

clobazam 5 + valproate 200 = (+) no seizure, (-) poor handwriting(tremors), (-)sedation on high valproate doses
clobazam 10 = (+) no seizures, (-) poor memory

I have not started valproate. I’m still thinking about my situation

1 Like

I wouldn’t willingly increase any of that crap unless the clozapine dose is a decrease from before. If your doctor decreased your clozapine thinking your psychosis wouldn’t worsen well she is wrong and the meds protecting you from the other symptoms need to be taken. But if the psychosis increased without an decrease in meds you either are having an increase for some other reason (maybe a life crisis or stress), or sadly you are developing a tolerance to clozapine.

I was stable on clozapine 275 few years ago but i had adverse effects- bed wetting, postural hypotension and myoclonic jerks. So pdoc decreased clozapine from 275 to 200mg, I was fine for some time on 200-225 but the psychosis eventually came back so now I’m taking 250mg.

I was going to say you could wear Depends for the bed wetting but the other two symptoms are serious so you’ll have to decide which is worse. More drugs and their side effects, psychosis, or paranoia and live with the least of all evils. Unless they can find another drug pretty soon as far as I understand it clozaril is the end of the line. You can’t always expect perfection in schizophrenia treatment. I myself eventually learned to live with some psychosis after over 20 years of looking at different drugs.

pdoc was shocked that i was wearing diapers since 1 year on 275 but i never told him. So he decreased the dose as i said above from 275 to 200mg

I’m stuck on paliperidone that seems to continually raise my weight and is expensive in the US so those are the main problems I have with it at full strength.

Update: After increasing clozapine to 250, im having major postural hypotension. Will reduce to 225mg tonight. Will think about adding another antipsychotic to the mix.

1 Like

Should i tolerate postural hypotension on clozapine 250mg, or decrease my dose and fix postural hypotension on 225mg ?