Low Dose Clozapine / Quetiapine Patient Views

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

I take Quetiapine and Clozapine for my audio and visual hallucinations and paranoid delusional thinking.

My father also has diabetes and heart disease so I’m guessing this is why Clozapine wasn’t the option his neurologist went for. Nuplazid worked for a little bit but it’s clear now it’s only getting worse. We have him on 50 mg of Seroquel, it was upped from 25mg

My spouse was diagnosed in 2005. She began having Hallucinations and psychosis (thinking everyone was out to get her, everyone was stealing from her, etc.) a few years ago. Doctors began treating her hallucinations aggressively. We tried Nuplazid but sadly it did not work for her. Finally her psychiatrist tried Clozapine and Seroquel and that did the trick (thankfully!!). Her hallucinations are gone as well as her psychosis. We have even cut back on her Seroquel with no ill effects. But the neurologist won't be the one to solve this issue more than likely. It will be a psychiatrist.

Hope this helps

Thank you so much! We have my loved one on Seroquel for the agitation but we’ll talk to his neurologist for clozapine. What were the dosages that you settled on?

Clozapine is the drug of last resort for hallucinations and psychosis. If this doesn’t work there is not much left in the arsenal from what I understand. This is what our doctors have told us.

I would also note that the dose of seroquel is important. Many practitioners hesitate to raise the dose but in schizophrenia we see doses in the 800mg/d range. I’ve seen many patients with significant psychosis on 100mg seroquel do quite well at 200, 300, 400mg. Just something to consider.

Probably better to increase Seroquel. Clozapine requires weekly blood draws to check for agranulocytosis

MDS here.

Seroquel is a dopamine blocking antipsychotic. It is a very commonly used treatment for psychosis in PD patients because its parkinson side effects are quite mild on the whole for this class of medication.

However, there are other medications that are also used for this purpose. Clozapine is probably more potent and effective in reducing psychosis in PD than Seroquel, but requires some monitoring of risks that may be inconvenient.

Pimavanserin is a non-dopamine antagonist that can actually be used in combination with a dopamine antagonist antipsychotic to further reduce psychosis in PD.

Although not antipsychotics per se, cholinesterase inhibitors like rivastigmine/galantamine/donepezil are effective in reducing psychosis in PD and can also be added to antipsychotics.

Benzodiazepines like clonazepam might be helpful with acute agitation but can sometimes worsen the underlying psychosis overall.

Levodopa can exacerbate psychosis but the effect is usually minor and the consequence of reducing it can be very detrimental to the patient’s overall condition.

Although i’m not the patient’s physician and we don’t have the patient’s medication regimen available, it seems to me that there is quite a ways to go before this person is on maximal practical antipsychotic treatment. I would recommend being very persistent with the patient’s physician in implementing aggressive therapy.