Medication questions

Just Bill

My wife's medical journey began with lamotrigine for epilepsy 10 years ago. Then when she was diagnosed with EOD a year and a half ago she took aricept. Approximately 6 months ago she was very depressed, couldn't stop obsessing over death. The start of delusions and hallucinations. She took effexor and that really worked well. About 3 months ago she started sundowning real bad, that is when she started taking ambien. Now her hallucinations and delusions are completely out of control. So bad she is hiding all her stuff thinking kids are running around stealing. Every day we do the dementia Easter egg hunt: Where is my phone, wallet, laptop, remote, whatever she touches. That consumes hours of time per day. So here we are with seroquel. I gave her one last night before bed with ambien and aricept. This morning I gave her another one with her lamotrigine and effexor. She is out cold right now which isn't necessarily a bad thing. I am wondering since the seroquel knocks her out can I just stop the ambien cold turkey or should I wean her off or should I just leave well enough alone ? Thank you all again for your feedback on the seroquel. It is very comforting knowing you all are out there.

Ed1937

Bill, I checked for interactions from drugs.com. I know this doesn't answer your question, but it is good info. Here's what I found:

Interactions between your drugs

Moderate

zolpidem  venlafaxine

Applies to: Ambien (zolpidem), Effexor (venlafaxine)

Using zolpidem together with venlafaxine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

zolpidem  lamoTRIgine

Applies to: Ambien (zolpidem), lamotrigine

Using zolpidem together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

zolpidem  QUEtiapine

Applies to: Ambien (zolpidem), Seroquel (quetiapine)

Using zolpidem together with QUEtiapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

venlafaxine  lamoTRIgine

Applies to: Effexor (venlafaxine), lamotrigine

Treatment with venlafaxine may occasionally cause blood sodium levels to get too low, a condition known as hyponatremia, and using it with some anticonvulsants can increase that risk. In addition, venlafaxine can cause seizures in susceptible patients, which may reduce the effectiveness of medications that are used to control seizures such as lamoTRIgine. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. You should seek medical attention if you experience nausea, vomiting, headache, lethargy, irritability, difficulty concentrating, memory impairment, confusion, muscle spasm, weakness or unsteadiness, as these may be symptoms of hyponatremia. More severe cases may lead to hallucination, fainting, seizure, coma, and even death. Also let your doctor know if you develop seizures or experience an increase in seizures during treatment with venlafaxine. Additionally, because these medications may cause dizziness, drowsiness, and impairment in judgment, reaction speed and motor coordination, you should avoid driving or operating hazardous machinery until you know how they affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

venlafaxine  QUEtiapine

Applies to: Effexor (venlafaxine), Seroquel (quetiapine)

Using QUEtiapine together with venlafaxine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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No other interactions were found between your selected drugs. However, this does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

zolpidem  food

Applies to: Ambien (zolpidem)

You should avoid the use of alcohol while being treated with zolpidem. Alcohol can increase the nervous system side effects of zolpidem such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Taking zolpidem with food may delay the onset of sleep. For faster sleep onset, zolpidem should not be taken with or immediately after a meal. This will make it easier for your body to absorb the medication. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

venlafaxine  food

Applies to: Effexor (venlafaxine)

Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with venlafaxine. Do not use more than the recommended dose of venlafaxine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

lamoTRIgine  food

Applies to: lamotrigine

Alcohol can increase the nervous system side effects of lamoTRIgine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with lamoTRIgine. Do not use more than the recommended dose of lamoTRIgine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Rescue mom

Just FYI, I know many people who had issues getting off Ambien, and needed a couple of weeks of tapering down. Even tapering, they thought those 2 weeks were tough.

 My docs are hesitant to Rx Ambien to seniors, largely for that reason, they say. (None of these involves dementia, and I’m no expert. I have taken it myself, and others have told me the above)

But combined with Seroquel…I have no idea how that shakes out.

ImMaggieMae

My DH’s PCP didn’t want to prescribe Ambien because he said it could be habit forming for older people. This was when he had MCI, before any antipsychotics. I would check with her doctor before doing anything.

Just Bill

Therein lies the question: What are side effects and what are symptoms ? Dizzyness, confusion, drowsiness, difficulty concentrating, problems with memory ? She had all that before we started on this journey. It's the warning labels that makes me nervous. I would love to give her a multi vitamin and that's it. Her neurologist prescribed what she is taking, I am going to have a psychiatrist evaluate her and her meds, but this clearly is not an exact science. I also know I can't stop where this disease is taking her. All I am trying to do is make her last days as pleasant as possible for her. The only challenge is I am doing it with dangerous chemicals. It's a trial and error process hopefully more trial and less error plus it's a moving target the symptoms are dynamically changing pretty fast. I am lost. I believe in better life through chemistry but it seems to be a grey science not so much black and white. Thank you for the info Ed I appreciate it.

M1

Bill, the seroquel is going to be plenty to help her sleep in all likelihood.  Probably best to check with the doc who prescribed, but to be on the safe side I would taper the Ambien--if she's taking 10 mg, cut it in half for 3 days (fairly artibrary but based on normal half life of the drug), then give it every other night for the next week., then stop.  If she's taking 5 mg, same thing.  that's what I would do.

M1

FWIW, Effexor is the hardest to taper of the drugs you mentioned.  Really has to be tapered slowly, lots of side effects if withdrawn abruptly.

Just Bill

Thanks M1 tapering is the safest way to go. Every medication she takes is to relieve a specific symptom. The ambien was to help her with sundowning. I think if the seroquel helps with hallucinations and sleep, she can stop taking the ambien. Less chemicals the better.