Hi doctor,
Thank you for the reply,
I hope you remember my consultation with you on the health of my sister. Based on your inputs and my follow-up with the doctor treating her, these are the latest medicines she takes:
(a) Joykem (Sulphide) 200 mg two times a day in the morning and night.
(b) Azep (Clonazepam) 1.5 mg in the morning daily.
(c) Clozapine 100 mg 1/2 (half) tablet in the morning daily.
[b and c were reduced after my last consultation with you one medicine at a time. Around a month has passed since then].
(d) Quetiapine 300 mg 1/2 (half) tablet in the night daily.
(Quetiapine dose was cut to half before my previous consultation with you due to low urine output).
Since about a month back tablet Azep has been reduced from 2 mg to 1.5 mg and Clozapine has been reduced from 100 mg to 50 mg.
Bowel movement has improved a lot since the earlier consultation and now it is almost on alternating days. Now she can pass stool with lower effort. Her condition is stable and even better as her anxiety levels (irritating mood) have come down. The only point is sometimes her thoughts wander on her hallucinations before she gets back to her senses once again.
I am unable to attach any blood report as she refuses to take blood tests. Kindly understand it.
Now my concerns are as follows:
I suspect that there is fluid buildup in the stomach and urine output is also lower in the morning even though she passes urine with ease at night. She weighs 132.2 lbs and her stomach looks bulgy suggesting fluid retention. She also feels thirsty especially while taking food almost frequently. She takes sufficient water. Please advise on this.
She feels sleepy. For that, I understand tablet Azep should be tapered out gradually. Our previous efforts to cut down tablet Azep were not successful as she had relapse syndrome. (At that time she also took Quetiapine 300 mg; urine output was low and she regularly felt abdomen pain). Now I understand that her relapse is principally due to a reduction in the tablet Azep. This time I want to cut it very gradually. Please advise on dose reduction and frequency.
I also want to know whether this tablet can be tapered first or if any other tablets should be tapered beforehand before tapering tablet Azep. In the evenings I take her for a regular walk out. She walks very slowly. I want her muscle movements to be better. Please advise. The last time when we went for an eye check up ophthalmologist told me that her eyesight is weak. Do any tablets she takes exert an influence on her eye health? I also want to taper one tablet at a time and wait for around 20 days before attempting another one. In this way, I hope I can better observe her and take corrective steps.
Thanks.