Low Dose Clozapine / Quetiapine

We started at 12.5 mg of Clozapine and ramped up to the current dose of 50 mg. We just lowered my daughter's Seroquel from 50 mg to 25 mg with no ill effects so we’ll see. The Clozapine does require blood tests that go from weekly at the start to bi weekly to monthly if tolerated well and continue as long as my son is on the medication. We look at it as a small price to pay for the benefit received.

We tried Nuplazid for my spouse for 5 months before we moved on. Had high hopes that it would work for her hallucinations and psychosis but did nothing. Finally hit on a combination of Seroquel and Clozapine and her hallucinations and psychosis are now very well managed.

Hope this helps

Dr. Jennifer Goldman discusses the use of low-dose Clozapine and Quetiapine for treating psychosis in Parkinson's patients. She notes that Quetiapine has shown mixed results in clinical trials, with some positive impressions but inconsistent findings. Both drugs are used in low doses for Parkinson's psychosis, and common side effects include sedation and low blood pressure. Dr. Goldman emphasizes the importance of monitoring these side effects, especially since Parkinson's patients may already experience similar symptoms. She also highlights the risks of untreated psychosis, such as self-injury and harm to family members, and mentions a black box warning for elderly patients with dementia-related psychosis. A study on veterans showed negative outcomes like death and hospitalization in 40% of cases over a 180-day follow-up period, linked to worsened Parkinson's disease and other health issues.

Dr. David Shprecher explains that for patients with Parkinson's disease or related conditions like Lewy body dementia, it is crucial to avoid most antipsychotics for treating hallucinations, as they can worsen motor symptoms. He highlights that quetiapine (Seroquel) and pimavanserin (Nuplazid) are preferred options because they are less likely to exacerbate Parkinsonism. Specifically, pimavanserin does not worsen motor symptoms at all, and quetiapine, even at higher doses, is less likely to have this effect compared to other antipsychotics.

This paper reviewed multiple studies to evaluate how effective and tolerable quetiapine is for treating psychosis in people with parkinsonism. It analyzed data from seven randomized controlled trials (RCTs) involving 241 participants, comparing quetiapine to placebo and clozapine.

The review found that quetiapine was not significantly better than placebo or clozapine in improving psychosis symptoms in parkinsonism. However, quetiapine was better tolerated than clozapine and did not worsen motor function in patients.

For someone with Parkinson's experiencing psychosis, this paper suggests that quetiapine may not be the most effective option for symptom relief, though it might be easier to tolerate than clozapine. It highlights the need for careful consideration of treatment options.

This systematic review is reliable as it is based on seven RCTs, which are considered high-quality evidence. The journal is reputable in the field of neuropsychiatry, adding credibility to the findings.

This paper investigated the risks of severe neutropenia and agranulocytosis (SNA), as well as mild and moderate neutropenia (MMN), in patients with Parkinson's disease psychosis (PDP) who are treated with clozapine. The researchers analyzed data from 19 studies involving 691 patients, assessing the incidence of these conditions over short-term, medium-term, and long-term monitoring periods.

The study found that during the short-term monitoring period, no cases of SNA were reported among 573 participants. The incidence of SNA was extremely low during the medium-term (0.1%) and long-term (0.2%) periods. Similarly, the risk of MMN was found to be low, with a 0.4% incidence in the short- and medium-term periods and 1.3% in the long-term period. However, there was some evidence of potential bias in the medium-term dataset for SNA.

For individuals with Parkinson's disease psychosis, this study suggests that clozapine treatment carries a very low risk of severe blood-related side effects like SNA and a low risk of MMN. This information can help patients and caregivers feel more confident about the safety of clozapine as a treatment option for psychosis in Parkinson's disease.

This paper is a systematic review and meta-analysis, which is a high-quality type of study that combines data from multiple sources to provide robust conclusions. However, the potential bias in the medium-term dataset and the reliance on previously published studies may slightly limit the reliability of the findings.