My roommate's psychiatrist prescribes 6 mg daily of an antipsychotic for her to take. She takes 2 mg instead each day, and she's really doing better. She tells me she's afraid to tell the doctor. What should we do?
Take your medication exactly as prescribed.
One of the most common problems I encounter is with patients who want to change how they take their medication without speaking to their doctors. I often tell patients they are their own best doctor. But, what this means is that you watch for side effects and monitor the medication's effectiveness, but never change the dosage on your own.
For example, a doctor will write for an antibiotic with directions to take one tablet four times a day for ten days. Some patients have decided taking two tablets four times a day for five days will give the same result. There are many reasons this doesn't work. First, and most important, is that by doubling the dose you may be increasing the medication to toxic levels.
Another reason is that many times medication has to be taken for a certain duration of time. By decreasing the length of time you take an antibiotic you may cause some bacteria to survive, and this bacteria that survives may become resistant to the antibiotic.
Many times I'll be asked the question why is my dose higher than his; he is a lot sicker than I am. Always remember that in most cases the dose of medication are individualized for each patient. For example, the normal blood pressure is 120/80. It is not uncommon to have a patient with a pressure of 180/110 respond to 5 mg of a certain medication. Yet, we will have another patient with a blood pressure of 150/120 who needs 20 mg of the same medication to lower his pressure.
Medications like Zyprexa, Risperdal and Seroquel work by binding to and blocking both serotonin and dopamine receptors. Some patients will respond to 5 mg a day to get the desired effect; others will need 40 mg a day to get the same effect. Remember the dose is not always an indicator of how sick a patient is.
Remember also, that in many chronic conditions like diabetes, high blood pressure and schizophrenia dosing is individualized for each patient. In many cases it took a long time of trying many different drugs and doses until the desired effect was achieved.
Schizophrenia is a very complex illness that presents particular challenges in patients. Never alter your dose without first speaking to your doctor, pharmacist or other health care professional.