Been on clozapine since 5 years. Can’t bear the weight gain of clozapine anymore. I’m 100kg+ right now, and the weight wont come off. Stopping clozapine seem to be the only solution.
So, amisulpride seems to be very attractive option because it is less likely to cause weight gain and is very effective in reducing positive symptoms like clozapine. I was thinking about switching from clozapine to amisulpride but there are some problems with amisulpride and risperidone.
Amisulpride - I’m concerned about prolactin levels which is dose independent. That means reducing the dose of amisulpride wont help prolactin levels. 50mg and 500mg will have the same effect. Another problem is very high qtc prolongation compared to other antipsychotics caused by amisulpride which is dose dependent.
Risperidone also has prolactin issues but not like amisulpride, it has dose dependent prolactin elevation. Reducing risperidone dose will fix high prolactin or adding aripiprazole will also help. Another negative point is that risperidone will likely cause weight gain.
Any thoughts ? Should i switch to amisulpride or risperidone from clozapine ?