Advice please(6)

Jeanne123

Hi all, my mom is in a memory care facility.  She was aggressive and combative for a while.  The doctor prescribed zyprexa.  Since she’s been on it (6 months now) she has become so restless and  can’t sit still.  Also zombie like.  However she is no longer aggressive.  She also lost 6lbs in a month.   It’s hard to see her so restless and I wonder if we tapered back zyprexa or discontinue it, would she still show signs of aggression? Any advice?  I’ll be taking her to the doctor this week for a checkup.

​fesk

Hi Jeanne - sorry you are going through this. 

Restlessness is a side effect of this medicine and, unfortunately, the zombie like condition is likely the result of the medication too. Weight loss is not. Usually one gains weight with Zyprexa. 

You didn't mention what dose your mother is on. There are medications to treat the restlessness, but I would discuss with her doctor to see if you can lower the dose. The side effects should lessen on a lower dose. The medicine will need to be tapered very slowly and carefully and you can then watch for any signs of aggression reappearing. The goal should be the lowest effective dose. You never know, you may be able to stop it eventually with the doctor's guidance but your mother may also need to stay on the medication or be on a similar medication.

Jeanne123

Thank you so much Fesk.   I really appreciate the knowledge and guidance.

She’s on 10mg.  Last December we trained to go to 5mg but she wouldn’t take her meds and we were afraid for the bad behaviors starting.  She’s at a wonderful MC facility and I felt we were so close to being evicted and our nerves were frazzled.  She had been on seroqule (spelling?) prior but that didn’t help the combativeness.    Do you know what the lowest dosage is for zyprexa? 

I’ll talk to her doctor.  Thank you again, you made my day.

Jeanne123

 Thank you so much Fesk.   I really appreciate the knowledge and guidance.

She’s on 10mg.  Last December we trained to go to 5mg but she wouldn’t take her meds and we were afraid for the bad behaviors starting.  She’s at a wonderful MC facility and I felt we were so close to being evicted and our nerves were frazzled.  She had been on seroqule (spelling?) prior but that didn’t help the combativeness.    Do you know what the lowest dosage is for zyprexa? 

I’ll talk to her doctor.  Thank you again, you made my day.

caregiving daughter

What kind of doctor? If at all possible, I would suggest involving a psychiatrist. They could listen to your concerns and make suggestions on treatment plans.

Jo C.

Jeanne, I am sorry for what is happening and can imagine how stressful the situation is for you.

One question:  Who has prescribed the Zyprexa?  Is it a primary care physician or is it a dementia specialist such as a Neurologist who sees dementia patients or a Geriatric Psychiatrist?  That can make a difference.

Zyprexa is an atypical antipsychotic med.  It is most often used in treating schizphrenia and bipolar disorder, but can also be used for some in treating severe behavioral issues in dementia that lesser interventions have not been able to help.  Other atypical antipsychotics used to treat such issues are Seroquel and Risperdone which are the two most often prescribed.  

If a person is having significant side effects to a drug, usually that drug will be discontinued BUT with any med, the change needs to be ordered by the doctor and directions followed as some meds cannot be stopped abruptly.

It would be best to have a dementia specialist be the one to prescribe especially when there are such issues.  NOTE:  You do not mention other meds your mother may be on, that too is important as sometimes the negative effects are caused by interactions between different drugs.

It is good your mother is being seen by the doctor this week for a checkup. Ask to have full labs done to see if there are any other conditions that may be affecting her behaviors that as yet have not been diagnosed. Also be certain that she is checked for a "silent" urinary tract infection.  Those UTIs are called, "silent," because there are usually no physical signs of infection, but there will often be a huge change in behaviors to the highly negative side of he ledger and it can be quite dramatic for some.

If this is a primary care MD who is seeing your mother and is the one who has prescribed the other meds, it may be a good idea to have her seen by a dementia specialist to manage her dementia meds considering her reactions to them.

There will be a spot in which your mother will be able to be helped without being completely knocked out; a specialist may be more likely to find a better approach with meds.

Let us know how it is going, we will be thinking of you and so hope that you will be able to find a good answer for your mother; she is certainly blessed to have you by her side as her loving and caring daughter who is also an excellent advocate on her behalf.

J.

​fesk

Hi Jeanne - you have a lot of good advice. I agree that, if your mom's doctor is not a specialist, it would be best if a geriatric psychiatrist or specialist review all medications.  This doctor can then give you guidance and manage either trying to reduce the Zyprexa to lessen the side effects or perhaps try a similar medication that would have less side effects. If the Zyprexa is managing her symptoms well, it may make sense to try lowering the dose before changing medications. All of this needs to be done very carefully under the doctor's supervision because there can be other issues when lowering/discontinuing/changing this type of medicine. I am not certain of all the forms Zyprexa comes in but I think 2.5mg may be the lowest dose. However, the goal is for the medicine to be at the lowest - effective - dose so that may mean 2.5mg for one person, 5 or 10 for another. 

I wish you best of luck at the appointment. Please let us know how everything goes.

Jeanne123

Thank you for the advice all!  It truly helps.

I have my mom seeing a psychiatrist nurse practitioner and her primary doctor.  I have an appointment with the psychiatrist nurse practitioner next week, however today she lowered the dose on zyprexa from 10mg to 5mg. And see how she does.  I’m also seeing her primary doctor tomorrow and will have a full blood work, urine test done.  

The psychiatrist nurse practitioner said she believes this is dementia and not zyprexa.  But she’s willing to see how she does as we lower the dose.    My gut has me feeling it may be both, but if the drug is not needed any more for the combativeness , it may be better to take her off.  But she may need it…. 

We had her on seraquel but that didn’t help the combativeness.

Thank you