What is the best med combo?

I was taking Invega depot 432mg and Vraylar 6mg and it controlled the voices pretty well. Then I went off of the depot to see if Vraylar alone would cover it. It didn’t. Now I’m on Vraylar 6mg and Geodon 40mg twice daily and it is sort of controlling the voices. I talk to my pdoc tomorrow. These are my options.

Option 1: Increase Geodon
Vraylar 6mg
Geodon 60mg twice daily
Pros: I think it would control the voices.
Cons: weight gain from Vraylar, perceived strange thoughts from Geodon, sexual dysfunction. Have to eat with Geodon and take it twice a day.

Option 2: Go back on the Invega depot
Vraylar 6mg
Depot injection Invega 432mg
Pros: controls voices in superior fashion
Cons: weight gain from both medications, poverty of speech/thought from invega, thought loops from Invega, slightly less sexual dysfunction from Vraylar interacting with Invega (I’m pretty positive the Vraylar upsets the sexual dysfunction from Invega)

Option 3: Go on Clozapine
Vraylar 6mg
Clozapine lowest dose
Pros: Clozapine is the gold standard and vraylar shows some benefit to voices
Cons: major weight gain from both medications, blood tests for clozapine, clozapine side effects

Option 4: Go on Clozapine AND Invega injection
Clozapine lowest dose
Invega injection 432mg
Pros: Clozapine is the gold standard and Invega works well for voices. I don’t think I’d ever hear these nasty voices.
Cons: major weight gain from both medications. Sexual dysfunction from invega. Maybe I could add a low dose of abilify for the sexual dysfunction.

I think the right choice for me would to be go on clozapine now and then over time switch the Vraylar to the Invega depot injection if the voices aren’t controlled. I could add A low dose Abilify for the sexual dysfunction and Metformin for the weight gain.

What do you think I should tell my doctor? Of course I don’t think any of you are doctors I just want thoughts.

Its different for everybody. We don’t have the same genes.

1 Like

Clozapine is a great option. :frog::frog::frog:

1 Like

@Aziz that’s true. What will work for you won’t exactly work for me

1 Like

@GrayBear I’ve heard it works very well.

1 Like

I personally was on Invega and wouldn’t want to go back on it. I’m meeting with my NP this week to talk about plans in case I need to get back on an AP. Because I’m almost positive I wouldn’t go back on paliperidone.

I take 500mg clozapine. I take lamotrigine and zoloft as well.