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Vraag

Ik heb 15 jaar geleden de diagnose schizoaffectieve stoornis gekregen, en ze konden me moeilijk instellen, daarna toch gelukt. Ik ben ook stabiel, na 15 jaar nog. Maar vraag me toch af of er nu wat medicatie afkan.

Ik slik seroquel - prozac - buspiron - oxazepam - topiramaat. Is dit niet een beetje teveel, ik ben hier ook 30 kilo van aangekomen, heb er ook last van. Maar de psychiater wil niet minderen, hij durft het niet aan. Ik moet toegeven dat ik er behoorlijk vanaf ben geweest 15 jaar geleden, en moeilijk instelbaar met medicatie. Nadat hij met een farmacoloog samen heeft gesproken. kwamen tot deze cocktail, en mijn leven is daardoor wel positief veranderd, met enkele slechte dagen.

Wat vind u van de hoeveelheid medicatie is het overdreven veel, of normaal, zou ik kunnen minderen, of moet ik echt naar de psychiater luisteren?

 

Antwoord

Als ik het goed begrijp gebruik je in combinatie de volgende middelen:

  • Prozac (fluoxetine)
  • Seroquel (quetiapine)
  • buspirone
  • verapamil
  • oxazepam
  • topiramate
  • levothyroxine
  • pravastatin
  • Acetylsalicylic Acid (aspirin)
  • dipyridamole

Dit is een hele lijst.

En in farmacologische termen is dit niet echt rationeel te noemen. Je hebt zoveel dat het niet meer mogelijk is te voorspellen wat het effect op het brein zal zijn en of dat nog therapeutisch dan wel toxisch zal zijn.

We zien in de psychiatrie wel vaker dat mensen die moeilijk reageren op medicatie op het laatst een hele waslijst aan middelen hebben waaraan vervolgens niemand meer iets durft te veranderen uit angst dat het weer slechter zal gaan.

Het kan dat het nu relatief goed met je gaat dankzij de medicatie. Maar het is ook mogelijk dat het nu goed met je gaat ondanks de medicatie. Niemand die het weet.

Het probleem is nu dat niemand kan voorspellen wat er zal gaan gebeuren als je bijvoorbeeld gaat minderen met de buspirone, of met de oxazepam, of de prozac of welk middel dan ook.

Het is iets wat je zelf zult moeten beslissen. Minderen met de medicatie betekent dat je een chemische verandering aanbrengt in het brein die gevolgen kan hebben - en welke gevolgen dat gaan zijn kan ik niet voorspellen.

Als je gaat besluiten te minderen moet je de volgende regels in acht nemen:

1. Begin met het middel waar je het minst vertrouwen in hebt dat het iets bijdraagt.

2. Bouw langzaam af, vooral aan het einde. Bijvoorbeeld stapjes van 10% elke 2-4 weken.

3. Laat je monitoren door iemand.

4. Vindt een psychiater die creatief is, meedenkt, en begrijpt dat mensen willen experimenteren vanuit het principe van "dignity of risk".

5. Spreek met een ervaringsdeskundige op dit gebied. Bijvoorbeeld in PlusMinus.

Hieronder heb ik voor jou en je psychiater een lijst gemaakt van de te verwachten interacties tussen alle geneesmiddelen. Iets om de gaten te houden denk ik!


Interactions between your drugs

Major

topiramate QUEtiapine

Applies to: topiramate, Seroquel (quetiapine)

Topiramate can cause increased body temperature and decreased sweating, and these effects may be worsened when combined with medications like QUEtiapine. Heat stroke and hospitalization may occur in some people, especially in warm weather and during vigorous exercise. Children are particularly susceptible. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should drink plenty of fluids during warm weather and when exercising, and seek medical attention if you have decreased sweating or a fever. You may also experience drowsiness, dizziness, or lightheadedness when taking these medications together. Therefore, avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Major

busPIRone FLUoxetine

Applies to: buspirone, Prozac (fluoxetine)

Using busPIRone together with FLUoxetine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

FLUoxetine QUEtiapine

Applies to: Prozac (fluoxetine), Seroquel (quetiapine)

Using QUEtiapine together with FLUoxetine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

busPIRone QUEtiapine

Applies to: buspirone, Seroquel (quetiapine)

Using busPIRone together with QUEtiapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

verapamil QUEtiapine

Applies to: verapamil, Seroquel (quetiapine)

Verapamil may increase the blood levels of QUEtiapine. You may be more likely to experience side effects such as dizziness; drowsiness; dry mouth; constipation; increased appetite; weight gain; increased blood sugar and cholesterol or triglyceride levels; cognitive and motor impairment; involuntary muscle movements involving the face, tongue, or other parts of the body; difficulty swallowing; low blood pressure (especially at the start of treatment or after a dose increase); blood pressure increases (reported in children and teenagers); irregular heart rhythm; and seizures. Let your doctor know if your condition changes or you experience increased side effects. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

oxazepam QUEtiapine

Applies to: oxazepam, Seroquel (quetiapine)

Using oxazepam together with QUEtiapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

FLUoxetine topiramate

Applies to: Prozac (fluoxetine), topiramate

Using FLUoxetine together with topiramate may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

busPIRone topiramate

Applies to: buspirone, topiramate

Using busPIRone together with topiramate may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

oxazepam topiramate

Applies to: oxazepam, topiramate

Using oxazepam together with topiramate may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

dipyridamole FLUoxetine

Applies to: dipyridamole, Prozac (fluoxetine)

Using FLUoxetine together with dipyridamole may increase the risk of bleeding. The interaction may be more likely if you are elderly or have kidney or liver disease. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

aspirin FLUoxetine

Applies to: Acetylsalicylic Acid (aspirin), Prozac (fluoxetine)

Using FLUoxetine together with aspirin may increase the risk of bleeding. The interaction may be more likely if you are elderly or have kidney or liver disease. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

verapamil FLUoxetine

Applies to: verapamil, Prozac (fluoxetine)

FLUoxetine may increase the blood levels and effects of verapamil. You may be more likely to experience serious side effects such as irregular heart rhythm, fluid retention, swelling, heart failure, and excessively low blood pressure. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should seek medical attention if you develop dizziness or fainting; sudden, unexplained weight gain; swelling of the hands, ankles, or feet; chest pain; or difficulty breathing during treatment with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

verapamil busPIRone

Applies to: verapamil, buspirone

Before using verapamil, tell your doctor if you also use busPIRone. This can cause drowsiness, feeling light-headed, uneven heart rate, depressed mood, unusual thoughts or behavior, or lack coordination. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment if you take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

verapamil aspirin

Applies to: verapamil, Acetylsalicylic Acid (aspirin)

Before using verapamil, tell your doctor if you also use aspirin. This combination may cause unusual bleeding or bruising, headache, dizziness, or weakness. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or need your blood pressure checked more often. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Minor

FLUoxetine levothyroxine

Applies to: Prozac (fluoxetine), levothyroxine

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

For clinical details see professional interaction data.

No other interactions were found between your selected drugs. This does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

oxazepam food

Applies to: oxazepam

Alcohol can increase the nervous system side effects of oxazepam such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with oxazepam. Do not use more than the recommended dose of oxazepam, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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Moderate

verapamil food

Applies to: verapamil

You may take verapamil with or without food, but take it the same way every time. You should avoid consuming grapefruit or grapefruit juice as much as possible during treatment with verapamil. If you have been regularly consuming grapefruit or grapefruit juice with verapamil, do not increase or decrease the amounts of these products in your diet without first talking to your doctor. Grapefruit juice can increase the blood levels and effects of verapamil. Contact your doctor if you experience sudden, unexplained weight gain; swelling of the hands, ankles, or feet; chest pain; or difficulty breathing. Avoid driving or operating hazardous machinery until you know how the medication affects you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

busPIRone food

Applies to: buspirone

You should avoid the use of alcohol while being treated with busPIRone. Alcohol can increase the nervous system side effects of busPIRone such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Patients receiving busPIRone should preferably avoid the consumption of large amounts of grapefruits and grapefruit juice. If this is not possible, the busPIRone dose should be taken at least 2 hours before or 8 hours after grapefruit or grapefruit juice. Large amounts of grapefruit and grapefruit juice may cause increased levels of busPIRone in your body. This can lead to increased adverse effects such as drowsiness. Talk to your doctor or pharmacist if you have any questions or concerns.

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Moderate

dipyridamole food

Applies to: dipyridamole

Caffeine may interfere with the effects of dipyridamole in dilating the arteries. You should avoid caffeine-containing products for at least 24 hours before an imaging procedure involving dipyridamole given by injection. However, no special precaution is necessary if you are taking dipyridamole orally for maintenance.

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Moderate

FLUoxetine food

Applies to: Prozac (fluoxetine)

Alcohol can increase the nervous system side effects of FLUoxetine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with FLUoxetine. Do not use more than the recommended dose of FLUoxetine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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Moderate

levothyroxine food

Applies to: levothyroxine

The timing of meals relative to your levothyroxine dose can affect absorption of the medication. Therefore, levothyroxine should be taken on a consistent schedule with regard to time of day and relation to meals to avoid large fluctuations in blood levels, which may alter its effects. In addition, absorption of levothyroxine may be decreased by foods such as soybean flour, cotton seed meal, walnuts, dietary fiber, calcium, and calcium fortified juices. These foods should be avoided within several hours of dosing if possible. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

When levothyroxine is given during continuous enteral nutrition (tube feedings) for more than 7 days, the tube feeding should be interrupted for at least one hour before and one hour after the dose of levothyroxine. You may need more frequent blood tests to monitor levothyroxine levels.

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the \'Central Nervous System (CNS) Drugs\' category to be taken concurrently is usually three. Your list includes five medicines belonging to the \'Central Nervous System (CNS) Drugs\' category:

Prozac (fluoxetine)

Seroquel (quetiapine)

buspirone

oxazepam

topiramate

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication

Psychotropic agents

Therapeutic duplication

The recommended maximum number of medicines in the \'psychotropic agents\' category to be taken concurrently is usually three. Your list includes four medicines belonging to the \'psychotropic agents\' category:

Prozac (fluoxetine)

Seroquel (quetiapine)

buspirone

oxazepam

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication

Tranquilizers

Therapeutic duplication

The recommended maximum number of medicines in the \'tranquilizers\' category to be taken concurrently is usually one. Your list includes two medicines belonging to the \'tranquilizers\' category:

buspirone

oxazepam

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

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Beantwoord door: jim van Os op 2 september 2019
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