I know ren. BTW, I did try to look up the doses etc for benztropine in 'my' copy of the BNF (well more precisely, the NHS's, but decided to liberate it from its captivity and rehome it, to a loving owner, after I was in hospital once and had been treated THOROUGHLY like utter shit. They deserved to compensate me for the suffering THEY forced upon me, that was not a product of the reason I went in to the hospital. But was directly and utterly due to their denying me my prescribed and most certainly requisite medication. They just told me 'we don't give more than 10mg morphine, 20 at most', for example, and didn't bother with any haste whatsoever, but took DAYS to give me even THAT. And to me, who has been taking pain meds, and the anticonvulsant chlormethiazole, which they do, definitely have available for dispensation when required to do so, because I know it for a fact they do, for several times I've been in and they have done this, not being in the least bothered by the needs of the patient, only by the absolute number of miligrams. Yet when LEAVING the place, after days to a week of solid unbearable agonising misery and suffering, leaving me, pretty much, to stew in my own juices and to rot, without the giving of so much as a fuck.
Yet leaving? given two STOCK bottles, not just a few days of the meds as I had requested, until I could contact my own doctor to obtain my meds as I SHOULD have had them, of the chlormethiazole. Not script sized portions for a patient, but the kind of big pharmacy dispensary supply bottles they dip into to dole out pills/capsules in the case of the chlormethiazole, to patients when they do decide to bother giving a shit. Hell the bastards didn't even bother feeding me for two-three sodding days, not so much as a single, miserable, miserly pissing bite, for days,when they already knew I had had nothing, because at the time I simply had not any money to buy anything, because my money had not yet been paid into my bank since the last lot. So I'd already gone hungry for two days, maybe a third, possibly even a fourth.
I mean..jesus thats just not on. They couldn't even call it drug seeking, or anything else, not that they did in the case of my known to be legitimately prescribed medications, they just couldn't be arsed to give me any food. Walked on right by me with trays of chow for people, and kept telling me some was on its way. Was it? no. It was not. Hours and hours of begging got me nothing. They all but tied a meal to a stick and waved it in front of my nose only to pull it away when I would reach. Not quite that, in the physical sense, but in every other sense they teased and tormented me with the promise of food and relief. But nothing came. And to someone with a tolerance equal to a minimum of 200-300mg of IV morphine and a maximum of about a gram and a half (thats about as much, the upper limit I would feel safe with as a single IV bolus dose, of morphine sulfate alone, not counting my other meds mind you, but with or without them, about 1.25-1.5 grams of MS is what I would consider the maximum I could safely accept without fear of coming to physiological harm, itching or histamine release causing wheals if extravasated to any degree not counted as harm, merely annoyance)
Ren, WHY the very devil do you use a butyrophenone, and haldol the most beastly toxic, in a physical sense (the metabolite HPP and HPP+ are mitochondrial toxins which ARE thoroughly KNOWN to cause irreversible neuronal death and destruction of dopaminergic neurons, and long term to result in frank cerebral atrophy, in lieu of ALL/ANY of the other APs?
It truly does utterly make me sick and if I am honest, ANGRY. Not, not at all with, at you ren, thats not where the anger is directed, but at the medical establishments, who continue to use this poisonous and dangerous old AP, or its close relatives. There are many of them, both typical and atypicals, even, for truly recalcitrant, treatment resistant, frank and full blown severest of schizophrenia, clozapine (highly effective in many of even these cases, but in the UK, patients must be mandatorily enrolled upon a named-patient basis to receive this last-resort AP drug, due to the danger, which must be explained to each patient, and they must also be made aware of the signs to look for, before it can be prescribed to them, due to clozapines capability to cause agranulocytosis, a blood disorder which can be fatal if it occurs)
It just does not make sense that this most dangerous of drugs is acceptable whatsoever. It isn't as if it is even anything special in the world of neuroleptics. Its got that tox issue, the severest of modes of toxic action, actual, irreversible cell death, which is not recoverable naturally, although brain tissue transplants have been done in cases of poisoning of certain people due to a botched synthesis of a batch of a pethidine analog, MPPP, resulting in the much more immediately, instantly and horrifyingly awful chemically induced parkinson's, after they shortcutted the synth, causing the MPPP intermediate in one stage of the reaction to overheat, ending up causing the expulsion of a molecule of propionic anhydride, and a dehydration to 1-methyl-2,3,4-tetrahydropyridine, that itself, is then once it gets into the brain, is uptaken via DAT (dopamine transporter) into dopaminergic neurons, particularly within the substantia nigra, of the nigro-striatal tract, this little bit of the brain contains most of the dopaminergic neurons of the type
that are responsible for inhibiting uncontrolled, unrequired motor activity, so the result, once this population of DAergic nerve cells uptakes this tetrahydropyridine, MAO-b then oxidizes it to the corresponding methylphenyltetrahydropyridinium cation, which is therefore charged, as an ionic species and cannot leave the cells it has been taken into, so they cannot expel the poison, which goes on to quite literally cook the substantia nigra. Fries the nerves, literally fries them. Cooked in their own brain-juice. Poor rotten fucking bastards, they didn't deserve THAT to happen to them, no matter WHAT anybody's opinion of recreational drug use is. They were not even, to my knowledge of this heartrending case, dealing it to others. There were two of them, a couple, guy and his girlfriend who liked opioids, searched the lit, and decided on this pethidine analog, and created a reverse ester variant, they just didn't KNOW about the byproduct, that was created when the temperature was permitted to rise above that which was needed. IIRC the reaction must be done at very cold temperatures, and kept cold during the esterification step with propionic anhydride. They had no idea about this dehydration, or what MPTP would do if it did get ingested.
Bang, instant parkinsons of such dreadful severity that they could barely twitch a muscle, paralysed and if they had not been seen, they would both have starved to death slowly, at least if dehydration did not supervene and kill them a little more quickly. But still, jesus fucking christ on a cunting paedophile's HIV-ridden kitten-microwaving bicycle! A slow, drawn out end of the most terrible and most shocking cruelty would have been theirs.
As it was, they were initially treated with the usual parkinsons type regimens, L-DOPA plus carbidopa (a peripheral dopamine decarboxylase inhibitor is needed to allow L-DOPA to pass into the brain where it may then exert its effect, if this isn't done then DA-decarboxylase will just turn L-DOPA into dopamine in the periphery before it can cross into the brain, and DA itself is just chewed up and gozzed out again by monoamineoxidases LONG before it could be of use, other than via injection in hospital settings as an emergency pressor drug in cases of hypotension severe enough to warrant pressors, as its very short acting, and has certain differences in clinical practice, with adrenaline.)
But as is wont to happen in parkinsonian patients, L-DOPA loses its efficacy with time. Other drugs were tried, I forget which now, but all to some eventual failure or other, and in the end, I don't know by memory what happened to the girlfriend but the guy was treated with brain surgery and a tissue graft. I seem to remember this did help him some, mercifully.
But to me, any drug which bears a similarity even if the acute toxicity is of a less potent nature, not milder, less potent. The mode of action is exactly the same, with the toxic haloperidol metabolite, it should be abandoned and thrown away to languish with the likes of many of the treatments in my old antique medical books, such as arsenic (with the exception of tryparsamide, an old, POSSIBLY still used, anti-trypanosomiasis agent, although superior drugs like pentamidine are now available and have been for quite some time, these were used to treat sleeping sickness, african trypanosomiasis, the deadly disease spread by the bite of the african tsetse fly. It was, or if still ever used, is, considered acceptable despite its nasty side effects, its toxicity, its being an arsenical compound, and the lengthy and painful mode of treatment, IIRC it was given by intraperitoneal injection, deep through the wall of the abdomen, in a series of shots, deposited into the abdominal cavity between the stomach and the outside of the body. Very painful and the drug required a lengthy and multiple shot regimen. I have, once, had to have an I.P injection, and it was most unpleasant. It was not anything to do however with either arsenic based drugs or to do with trypanosomiasis, it simply doesn't occur here, nor thankfully does the noxious tsetse. In my case IIRC it was something to do with blood clotting),
wolfsbane, treating teething children with mercury and chalk paste (known by the name grey mass), similar to the blue mass, and blue pill, both again mercurials, again,common as dog muck in those days.
Although I do not blame them in case of sleeping sickness, for if it is untreated, there is only one outcome. And it is a most final one, after a long, slow decline once the neurological phase begins, it may even be protracted over years, when the subject lapses into a coma, having first become insomniac, intractably insomniac via night and unrousably, sleeps during the rest of the time, becomes demented, and eventually wastes away and finally, the Reaper takes that which is his due. Most unpleasant. The similar disease called in africa 'nagana' which afflicts cattle, and in the duly named Tsetse-belt, that portion of africa where the Tsetse flies occur and carry oftimes the trypanosome responsible for the disease in both cattle, people, and africans.
is due to the same protozoan parasite. Or rather, parasites, Trypanosoma gambiense, and T.brucei, I forget which way round but one of the two takes a much more rapid course than the other. But both of them
Thought you worked in a fast food joint couldbe hun? or have you finally changed works, and got shot of that bell end boss? (or preferably got your bell end boss shot of course:P)
