Questions about the drugs

RanchersWife

I need some advice from people who’ve maybe seen this. I’ll lay out the timeline and see if you all think my plan makes sense. Mil is solid stage 6 and slipping steadily. 

1) 3 months ago hospice nurse suggested we discontinue Donepezil and Mementine. 

2) We did and she declined. She slept more.

3) 2 months ago we started those drugs again. She become much more active and agitated after we resumed drugs. We started Celexa and then Seroquel about two weeks after that. After a week on all the drugs she fell. (Probably related to the Seroquel.) 

4) Her behavior is just getting worse and worse. She yells, cycles emotionally, hits, was treated for an UTI...

5) Now hospice says it might be time for Xanax and/or Avitan as needed.

I’m thinking we need to discontinue the Donepezil and Mementine again before we add more “as needed” drugs 

Another factor in this is she doesn’t like caregivers other than my husband and me. A few days with me and she’s better. (I’m not better. Thus, the caregivers.) These caregivers are expressing concern about her behavior and how hard it is to deal with. (She used to be easy.) I would rather she be more subdued natyurally due to lack of medication than due to more...

So, the question is: does it make sense to try a week free of Donepezil and Mementine before we add more drugs? I know people say they have little effect at this stage be we do see an effect. Hospice nurse said it probably won’t make a difference but is fine with whatever we decide. Any experience or opinions based on what you know about how these drugs work? 

mommyandme (m&m)

I am removing drugs slowly. During a time of less cognition she wasn’t getting her meds correctly for a few days, chewing, refusing blah blah blah.  I saw a decline. My mom has been on Galantamine  and Memantine for what feels like a long time, a few years at least.  

After observing what I could, I took her off Galantamine (as it doesn’t need to be titrated down) and kept Memantine on board. This experiment is about a week old. I see her as being more awake and aware and she’s in there. As long as she gets enough rest she’s doing well without the Galantamine. I’m happy with this decision.  Physically she’s weaker and less confident (only because of dementia and age, not med related) but her mind is “ok” relatively. 

Her hospice nurse is great about my med questions and supports my decisions 

towhee

There are so many moving parts when it comes to understanding our loved ones behavior. You had medication changes, UTI that can cause agitation, antibiotics for the UTI which can cause agitation, environmental stress in the form of caregivers, etc. Sigh. You have done a really good job of thinking about this and laying it out. I understand you not wanting to add medications which might add to her fall risk.  One question, did you titrate her medications back up when you added them back, or did you add them back at full dose? Two suggestions, one- try to work with one medication at the time if possible, two- consult your neurologist, who would be most familiar with these medications. You might want to ask which of the two medications might be more likely to have caused agitation when added back, and which of the two is considered more of a fall risk. 

Many doctors prefer ativan to xanax, it is less likely to build up in the system.

mommyandme (m&m)

We also use Ativan as needed, which is just .5 mgs in the evening.  

I was going to ask if there was a titration down with Memantine as it should be slowly removed. 

jfkoc

Makes sense to me....add/remove slowly ... one by one.

RanchersWife

We discontinued Mementine and Donepezil. This coincided with Sunday - a happy, busy day with a shower (not happy) and a trip to church. Today is calm so far. She’s walking her loop but not upset. Next caregiver comes tomorrow evening for 3 hours. We will see how she is.