Help Question about the SN bible

[cecaris]

Hey,

I've tried asking this in private suicide discussion already but didn't really get an answer so I thought I try it here.

In the SN bible, some Antipsychotics are listed as viable replacement for Antiemetics. One of them is Clozapine. I'm prescribed Clozapine anyway and I'm planning to ctb with SN, which I already have. I can't really get Meto though, so I wanted to ask for reassurance that Clozapine will work as well. An explanation as to why it supposedly works as a replacement for antiemetics would also be appreciated.

 

[gentarouhongou]

Hi,
I'm not a doctor, please what I say with a grain of salt.
Hope you're doing well. I actually hadn't noticed that Clozapine was in the SN bible, and now that you mention it I'm pretty surprised. While yes, what they claim about the majority of antipsychotics acting similarly to the antiemetics listed (such as Metoclopramide) is true, Clozapine is an exception.
To understand this, we need to digest how antiemetics really work (no pun intended), at surface level at the very least. The antiemetics needed for the SN method are specifically dopamine receptor 2 (D₂) antagonist, which means they bind to said receptor in the chemoreceptor trigger zone (which is where the brain controls all the nausea stuff) and do not allow dopamine to come and "trigger" the receptors in this "zone", hence donned an antagonist, which prevents the brain from receiving the message that it needs to throw up so to speak. Many first generation antipsychotics also bind to the D₂ receptors, and Clozapine, does the same. HOWEVER, unlike said first generation antipsychotics and antiemetics, Clozapine is known to bind VERY loosely to these receptors and will detach very quickly, meaning the receptor is very likely to be triggered while you ctb. Why does Clozapine act this way? Put simply, Clozapine as an antipsychotic differs from other first generation antipsychotics that may only target one or two receptors with strength in the brain such as dopamine, while Clozapine spreads out its efficacy throughout a wide variety them.
While ctb with SN without use of antiemetics is possible, it is not recommended. I know you seem unable to access metoclopramide, but I'd personally recommend Domperidone. Especially with all the other recommended antiemetics crossing the blood-brain barrier having strong interactions with antipsychotics, domperidone is manageable and mainly works in your gut so it's relatively safe.
I hope everything works out <3

 

[cecaris]

Thank you so much for your detailed response!

I wonder why Clozapine was listed there then, but anyways, could you tell me whether Olanzapine is also not an option? I'm asking because Olanzapine is also listed there and I used to have an Olanzapine prescription, so that might be more accessible than prescription antiemetics like Domperidone.

Idk, I might even attempt without any antiemetics if that also doesn't work. Though I'm not even sure if I could get a prescription for Olanzapine anymore. I really hoped that the info was accurate and Clozapine would work.

 

[gentarouhongou]

Thank you so much for your detailed response!

I wonder why Clozapine was listed there then, but anyways, could you tell me whether Olanzapine is also not an option? I'm asking because Olanzapine is also listed there and I used to have an Olanzapine prescription, so that might be more accessible than prescription antiemetics like Domperidone.

Idk, I might even attempt without any antiemetics if that also doesn't work. Though I'm not even sure if I could get a prescription for Olanzapine anymore. I really hoped that the info was accurate and Clozapine would work.

You're very welcome! And yes, Olanzapine works very well. In fact, it's extremely powerful and would be much more effective than antiemetics like domperidone and metoclopramide.
Cheers!