Suggest Alternative Medication For Solian And Lexapro

Posted on Wed, 8 Apr 2015

Question: I am on the following meds: Lexapro 60 mg, Klonopin 2 mg, Solian (amisulpride) 100 mg and Keppra 1500 mg, for some OCD symptoms created, as i was explained here, by some dopaminergic activity because of agonism of 5HT7 and 5HT2b receptors. Even if symptoms decreased more or least 90 % (i feel bad looking at open windows in cars in the street, just that, but i'ts strange strange), they didn't disappeared. Since 60 mg of Lexapro is a very high dosage, my psychiatrist is now thinking another alternatives: maybe Zyprexa instead of Solian, or Vilazodone instead of Lexapro. Which alternative can be better? I am a poor metabolizer for cyp2c19 and mild for cyp2d6.
Thanks beforehand, XXXXXXX

Answered by Dr. Seikhoo Bishnoi (40 minutes later)

Brief Answer:
Olanzapine is a better drug for such symptoms and safer

Detailed Answer:
Hello thanks for asking from HCM for your health related queries

I can understand your concern. You are currently on Lexapro (Escitalopram) 60 mg per day, Clonazepam 2 mg, Solian 100 mg and Keppra 1500 mg (Levatiracetam) for OC symptoms. The symptoms didn't disappear completely completely so the doctors are planning to change the medicines.

Zyprexa is Olanzapine and the drug helps in psychotic symptoms, mood symptoms and in controlling abnormal OC symptoms. If we consider efficacy and safety of Olanzapine then Olanzapine is relatively safer as compared to Solian. The drug will help to control your symptoms more effectively as per my opinion. The cytochrome enzyme status will not have much effect on its doses and you can go with this drug if your psychiatrist is wanting to change.

Vilazodone is a new antidepressant and has been approved recently for MDD. The drug is relatively safer and in initial studies it is having almost same or more efficacy as Lexapro and is better tolerated. The drug can be given in your cytochrome enzyme metabolic states also. You are taking 60 mg of Lexapro and this is really very high dose. Even with such huge dose your symptoms are not remitting so I would also suggest you that there is need to change the medicines. Vilazodone should work in your case.

Thanks, hope this helps you. Please don't hesitate to ask again if you have more doubts or if you want to clear something from my answer.

Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (3 hours later)

Dear Doctor,
Thank you very much, your answer is very clear. My psychiatrist told me also that maybe he can try Brintallix (Vortioxetine), another new antidepressant. Can it work better than Lexapro for OCD symptom?
Thanks beforehand, XXXXXXX

Answered by Dr. Seikhoo Bishnoi (4 hours later)

Brief Answer:
Vortioxetine has comparable efficacy to Lexapro

Detailed Answer:
Hello again

Vortioxetine is a newer drug which is a serotonergic drug. In some studies it has been found to have good efficacy which was comparable to SSRI drugs like Lexapro for depressive disorder. As the drug is newer so not much studies are available for OCD but already Lexapro is not working at such high dose, so in such case the drug can be tried.

The drug will not have any bad effects considering your cytochrome enzymes states.

Thanks, still have more doubts please ask again. Take care

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar