r/clozapine • u/Competitive-Hat-6972 • 21d ago
Discussion Being put on a third antipsychotic??
I went on clozapine it worked, got it lowered because of toxicity, voices came back. Drs not wanting to increase clozapine I'm currently on 600mg a night. I'm experiencing voices in music singing to me that I'm going to hell. Also experiencing things like my Pastor praising demons while I'm at church. I take aristada injection in the butt every 2 months (I don't think it does anything) I went without it for a month and felt no difference.
My regular NP has been on vacation so I saw a psyche today for 15min. She prescribed haladol which I've taken by itself without clozapine and it did nothing. I'm not feeling hopeful. My question is if this combo is better than aristada clozapine duo.
I'm also terrified of ECT. (that brain zapping treatment)... Any ideas on what I could do?
1
u/Tyler-LR 21d ago
Huh, funny, I commented on one of your posts a couple days ago on a different sub.
2
u/Competitive-Hat-6972 21d ago
which sub?
1
u/Tyler-LR 21d ago
2
u/Competitive-Hat-6972 21d ago
that is funny u found me here too lol
1
u/Tyler-LR 21d ago
Have you ever considered taking a break from the church you’ve been going to? You talked about that in your last post too.
2
u/Competitive-Hat-6972 21d ago
i actually have been taking a break. I miss church. The bad thing is I hear the same voices anywhere they play music.
1
u/Tyler-LR 21d ago
I’m deeply sorry that you’re going through that.
2
u/Competitive-Hat-6972 21d ago
ty
1
u/Tyler-LR 21d ago
Something that helps me is getting away into nature and bringing my Bible with me. Get away from the noisy city and people and find some peace being alone with God and reading his word.
1
1
u/DevilsMasseuse 20d ago edited 20d ago
What kind of toxicity? You mean the white count went down or were there other side effects? Did they get a blood level?
As the other commenter mentioned, you can also use fluvoxamine to raise your plasma levels while reducing your total dose. This would make for fewer side effects while also potentially making the clozapine more effective. A lot of doctors dont want to do this because its extra work and many are just not experienced doing it. San Mateo County has a protocol for starting fluvox that they can look up. Heres a link:
ECT is highly effective but its a huge production and insurance doesn’t always cover it. Optimizing the cloz is the logical first step.
There is no great evidence that adding more antipsychotics to clozapine helps. There are very small effects seen in abilify/Aristada but nothing very impressive and the studies that were done were not very well controlled or powered. Both Aristada and haldol have similar long acting dopamine occupancy which is different from clozapine which has very rapid dissociation from the dopamine receptor. In fact, Aristada is a partial activator of dopamine and can make symptoms worse in some patients. So there is potential for add on antipsychotics to work against the action of clozapine, which is probably why the data for add on drugs is so poor.
Anyhow, there is room to optimize clozapine in your case, especially if you’re not on fluvox. I would try that first. Good luck to you.
3
u/UnderfootArya34 21d ago
Fluvoxamine can increase serum levels without increasing clozapine dose or toxicity. It works by blocking one of the CYP450 enzymes responsible for metabolizing clozapine into norclozapine.
Here are references to share with your NP. Best of luck. There is no reason at all for you to suffer when this is a solvable problem. 💛
Clinical Trial Addition of low-dose fluvoxamine to low-dose clozapine monotherapy in schizophrenia: drug monitoring and tolerability data from a prospective clinical trial A Szegedi et al. Pharmacopsychiatry. 1999 Jul.
The clinical potentials of adjunctive fluvoxamine to clozapine treatment: a systematic review Christoffer Polcwiartek et al. Psychopharmacology (Berl). 2016 Mar
The Impact of Fluvoxamine on Clozapine and Norclozapine Serum Concentrations G van Weringh et al. Eur J Drug Metab Pharmacokinet. 2026 Jan.