Various med changes....

[Benjammin69]

Hi all,

I have been for a medication review and these are the changes we are making to my schedule :-

Decrease mirtazapine to 30mg to take in the evening
Maintain quetiapine 200mg in the evening
Increase quetiapine to 100mg from 50mg in the morning.
100mg hydroxyzine PRN
10mg diazepam PRN

What's everyone's view on these changes?

The idea is to get anxiety under control now the depression has dipped off...

[panic_down_under]

What's everyone's view on these changes?

Well, if it was up to me you wouldn't be on any of them, and especially not 3 sedating antihistamines all doing the same thing, but if the combo works for you then cool.

Just two questions, how old are you and what is your general state of health, particularly heart health, i.e do you have high BP, cholesterol, etc?

[Benjammin69]

Well, if it was up to me you wouldn't be on any of them, and especially not 3 sedating antihistamines all doing the same thing, but if the combo works for you then cool.



Just two questions, how old are you and what is your general state of health, particularly heart health, i.e do you have high BP, cholesterol, etc?



Hi thanks for your response PDU,

No blood pressure is fine, heart rate is fine, cholesterol is fine, bit over weight but was before meds, had full bloods checked and they are fine - so unfortunately it's just my head :-(


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---------- Post added at 07:44 ---------- Previous post was at 07:03 ----------

Oh and I'm 32 :-/


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[panic_down_under]

No blood pressure is fine, heart rate is fine, cholesterol is fine, bit over weight but was before meds, had full bloods checked and they are fine - so unfortunately it's just my head :-(

The reason I asked is that mirtazapine, quetiapine and hydroxyzine may each affect the electrical system of the heart in some circumstances causing prolongation of the QTc interval (https://www.nps.org.au/australian-prescriber/articles/drugs-and-the-qtc-interval) segment of the beat. This is not usually an issue unless there are specific preexisting heart conditions, but the more QTc prolonging meds are taken the greater the potential for adverse events. Unfortunately, other often taken medications such as antibiotics can also affect the QTc so common illnesses could further increase the number of such meds being taken (the drug list at the above link is incomplete, CredibleMeds (https://crediblemeds.org/index.php/drugsearch) maintains a more complete drug list for the FDA).

You are probably not in any danger, but I would ask for an ECG/EKG just to be sure.

[Benjammin69]

The reason I asked is that mirtazapine, quetiapine and hydroxyzine may each affect the electrical system of the heart in some circumstances causing prolongation of the QTc interval (https://www.nps.org.au/australian-prescriber/articles/drugs-and-the-qtc-interval) segment of the beat. This is not usually an issue unless there are specific preexisting heart conditions, but the more QTc prolonging meds are taken the greater the potential for adverse events. Unfortunately, other often taken medications such as antibiotics can also affect the QTc so common illnesses could further increase the number of such meds being taken (the drug list at the above link is incomplete, CredibleMeds (https://crediblemeds.org/index.php/drugsearch) maintains a more complete drug list for the FDA).



You are probably not in any danger, but I would ask for an ECG/EKG just to be sure.



Blimey last thing I need is my ticket to stop ticking or tocking!

Hopefully reduction of mirt goes well and I can get off mirt within 10 weeks so I will just be on quetiapine.

Hydroxyzine is a PRN and have not used yet, they wanted to give me something other than diazepam as I have been using Diaz for 3/4 times a week for last 3 weeks so they don't want me using that more.


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[panic_down_under]

Hopefully reduction of mirt goes well and I can get off mirt within 10 weeks so I will just be on quetiapine.

You should not have significant difficulty getting off mirtazapine as quetiapine (and hydroxyzine) hits most of the same significant receptors with about the same binding potency.

Mirtazapine: H1: 1.6 Ki, 5-HT2a: 69.0 Ki, D2: 1000 Ki
Quetiapine : H1: 6.9 Ki, 5-HT2a: 118. Ki, D2: 500. Ki
Hydroxyzine:H1: 2.0 Ki, 5-HT2a: 50.0 Ki, D2: 378. Ki

Note, the lower the Ki value the more potent the binding potential and if the Ki is over about 125-150 the effect is insignificant.