Thank You. Basically I Just Want To Know If There

Posted on Wed, 17 Oct 2018

Question: Thank you.
Basically I just want to know if there is any mental health medication similar to olanzapine that does not put on weight.
My 48 year old Daughter has been on this medication for schitzophrenia for many years and now has multiple health problems, sleep apnea, heel spurs, pelvic cysts that continue to grow and a biopsy isnt possible as it may agrivate cancer if that is there. She has had 2 pulminary embolisims in the past and currently has blood clots in the lungs. She was on boold thinners warfarin but took herself off those even though the specialist thought she should stay on them.
Her weight is nearly 20 stone.
The olanzapine is putting on the weight but she is too scared to try another pill offered (aripiprozole) as sh is scared her mental health will decline. She has been sectioned into the mental health hospital on 3 previous occassions.
IS there anyhing aas successful as 7.5 ml olanzapine or are there injections that dont put on weight please?
We live in New Zealand.
Lois Hudson

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
Haloperidol or Aripiprazole can be tried.

Detailed Answer:
Hello thanks for using ask a doctor service

I can understand your concern. Olanzapine is second generation antipsychotic drug. The drug has great efficacy but causes weight gain. If weight gain is an issue then other option is Aripiprazole.

Have she tried this drug?

Aripiprazole doses are gradually increased and once she is getting adequate doses like 20-30 mg then her symptoms will be under control. The drug is metabolically safe and you can give her this drug without worries.

First generation antipsychotic drugs like Haloperidol are metabolically safe and has no serious effect. This can be kept as option. The drug is known to cause EPS side effects so should be used cautiously. You can talk with her doctor for this.

Thanks and Take care

Please don't hesitate to ask again if you need more help.

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

Follow up: Dr. Seikhoo Bishnoi (55 minutes later)

Thank you.
Will intramuscular injections be less weight gaining than oral meds please.
What are EPS side effects please.
Is Aripiprozole better than haloperadol and what is the difference between first and second generation drugs please

Answered by Dr. Seikhoo Bishnoi (8 hours later)

Brief Answer:
Second generation drugs are newer drugs.

Detailed Answer:
Hello again

I am sorry for replying late.

Paliperidone injections which are long acting can be kept in options. The drug is metabolically safer than Olanzapine and is available in long acting injections too. The weight gain is less compared to Olanzapine and oral formulations.

EPS is extrapyramidal side effects. In EPS side effects like tremors, Parkinson's like side effects as rigidity, tremors, slowness, salivation etc, dystopias or painful muscle contractions, akathisia or acute restlessness etc are seen. These side effects are more common with older or first generation antipsychotic drugs.

Aripiprazole is a good drug and has good efficacy. If its better than Haloperidone that can't be commented, but yes Aripiprazole is definitely safer than Haloperidol.

First generation drugs are older drugs that act by DA blocking, while second generation drugs are newer drugs and act by acting on 5-HT3 receptors. There are more differences but that are pharmacological difference. Recent days psychiatrists prefer second generation drugs like Olanzapine, Risperidone, Paliperidone, Aripiprazole etc than first generation drugs like Haloperidol, Chlorpromazine etc.

Second generation drugs are safer but has more metabolic side effects like weight gain, sedation, hyperglycaemia etc.

I hope this helps in understanding, but still something is not cleared then please contact again.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Yogesh D