What Causes Tremors And Imbalance Issues Inspite Of Being On Lamotrigine And Zyprexa?

Posted on Tue, 21 Apr 2015

Question: You had answered a health question for me before. In a similar vein, let me elaborate: My wife was discharged from a major university health center on a regimen of Zyprexa, 30 mg/day. Despite a continuing regimen of Lamotrigine, now 50 mg, she is experiencing worsening tremors, balance, difficulty in swallowing, nonspecific pains in her back and legs, and occasionally, some reality distortion symptoms. Could this be the result of a high Zyprexa dose, and if so, what dose would be recommended, and how would this new level be best achieved?

Answered by Dr. Seikhoo Bishnoi (42 minutes later)

Brief Answer:
These side effects can occur due to high doses

Detailed Answer:
Hello, Welcome to Health Care Magic

Thanks for asking again. Zyprexa is Olanzapine and the drug is a second generation antipsychotic drug. She has been prescribed 30 mg of Olanzapine and 50 mg Lamotrigine. As per my opinion the doses of Olanzapine are high. Though Olanzapine is a safe drug still in high doses it can cause such side effects. The symptoms like tremors, difficulty in swallowing (most likely due to dystonia), difficulty in balance could occur due to Olanzapine in high doses. It may cause problems of balance, distortions etc.

So yes Olanzapine is the possible reason for her side effects.

I usually prescribe Olanzapine in maximum 20 mg doses to my patients. But considering her past history doses can be increased in her case. To prevent her side effects like tremors, difficulty in swallowing medicines like Trihexiphenidyl or Benzotropine can be added. These medicines would reduce her symptoms and she would start tolerating the doses. Discuss with her doctor for proper evaluation again.

Thanks, Hope this helps you, if you have more doubts you can ask again

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

Follow up: Dr. Seikhoo Bishnoi (11 hours later)

Dr. Bishnoi
In the last day or so, her pacing has gotten incessant, and her swallowing has gotten worse. She is pacing so uncontrollably that last evening she fell. Today I try redirecting her to a couch for a few minutes in between strolls, but I doubt I can continue this supervision.

Is this also the result of high Olanzapine, and can this also be controlled by the two medications you indicated, trihexiphenidyl or benzotropine?

Answered by Dr. Seikhoo Bishnoi (56 minutes later)

Brief Answer:
Pacing and restlessness can occur due to Akathisia.

Detailed Answer:
Hello again

Her pacing could be occurring due to Akathisia which is also one of important side effect in high doses of antipsychotics. Difficulty in swallowing can occur due to dystonia. Yes these symptoms can occur due to side effects of high dose of Olanzapine.

Trihexiphenidyl or Benzotropine or even low dose benzodiazepines like Clonazepam can help to reduce these symptoms. Visit her psychiatrist again for her persistent symptoms.

Thanks.

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