antipsychotic meds question (Seroquel and Zyprexa)

Yanne

Advice requested: My dad is entering 7th week of Memory Care. In the last two weeks he has had 3 physical outbursts that have threatened his roommate and caregivers. Because of the last one, he was taken to ER and given Seroquel (without our permission). The facility took him back the next day (yesterday) after one dose; he missed the afternoon one, took this morning's. He had another outburst and we were told they were calling 911 to remove him again, but then we got a call back saying he was asleep and it was rescinded. I called tonight and was told the facility made a request with his insurance to add Zyprexa as a regular 2nd med rather than for just when he has an outburst. I said we weren't consulted and NO; this is to be now discussed Monday. The advice requested is about the two meds; does anyone have experience with (a) how long it might take to find out if Seroquel isn't working as it should and (b) taking both together?

harshedbuzz

Yanne-

I am sorry for this situation.

The MCF has to take steps to keep their residents and staff safe, so I am not surprised that he was turfed to the ER when things turned physical. You will need to get a handle on this or he may be asked to leave.

Were you at the ER when he arrived? Since MCF residents do not have someone from the facility ride along in the ambulance, it's important for a family member/POA to be at the ER not just to advocate but to help keep the PWD calm. Hospital delirium is real and can't cloud the situation for those prescribing.

That said, Seroquel can be a great medication for a PWD who is agitated, or hallucinating, or aggressive. It allowed my dad to be cared for at home until the end stage. For PWD it is given at low doses; dad took 25mg 2x daily but there's room to go up if needed for a time. Zyprexa is a similar medication.

In your situation, I would suggest getting dad in with a geriatric psychiatrist. We did this outpatient about a year before MC and continued with the geripsych affiliated with the MCF who saw him there. Your situation is more emergent. In your shoes, a brief hospitalization (about 2 weeks) in a geripsych unit for medication management might be the best option. I'm kind of surprised the ER didn't initiate that plan.

Seroquel can be used 2 different ways. Sometimes, it's prescribed "as needed" to calm a person down. I feel it's better to be proactive with the anxious/angry feelings that drive the behaviors by prescribing on a daily basis. Many people see an immediate improvement around sleep if that's an issue, but full effects of the drug will take weeks to be seen. Most prescribers like to take a start-low/go-slow approach to psychoactive meds, so it can take some time to get to the appropriate dose.

HB

M1

Second everything HB said. He may well benefit from some time in the hospital to get this settled. I would not start two meds simultaneously, especially in the same category; if there are side effects, it will be impossible to tell which drug is implicated and leave you worse off than when you started. Seroquel is usually very well tolerated, especially at the doses used in dementia patients--worth realizing that while most dementia patients might take 25-200 mg, doses of up to 800 mg are used in schizophrenia, so there's a very wide range.

Zyprexa is similar, but has more frequent and wider range of side effects. I would argue strongly not to start it until you have time to see how the Seroquel is going to work; dose escalation if needed can happen pretty quickly. I would ask if there is a geriatric psychiatrist affiliated with your facility and ask to speak to him/her directly. It is going to be a tightrope, and I would go into this meeting on Monday with a plan--because if you don't have one, you may be asked to remove him, and getting him in somewhere else will be all the harder.

It is very difficult on all sides. I agree that it's not good practice that you weren't consulted by the ER, but they did the right thing, so I wouldn't come down on them too hard. No MC facility has the capacity to deal with an aggressive resident; they are short staffed as it is. Let us know what happens.

jfkoc

When ever a new drug is suggested it is a good idea to check it out with your pharmacist and on an online site like drug.com. Understand the drug and so enter everything and selectt interactions.

Please have someone with your father any time he needs the ER or is hospitalized. Yest this does mean 24/7. Neither the ER nor the floor staff is trained to care for patients with any kind of dementia.

I agree...start one and then then the other and perhaps increase the first instead of adding a duplicate.

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vanlinks99

Mom is on quetiapine for 4 or 5 weeks. She has less crying but way agitating and hallucinations. She mentioned a lot of people dying so I really wonder is this the right path?

Malka

My dad is on Serequel, 25 mg, for a little over a year. He was having some delusions and he was getting aggressive with his aide who lives with him. She didn't want me to get the doctor to give it to him. I think even though it made him a little more tired, the aggressiveness went away. He has been on it for a little over a year and I think it's time to get a bit of a larger dose because he has become more paranoid, and I see him making faces behind the aide's back. Again, she tells me that she knows how to calm him down, but sometimes she is on her weekend off. I am still going to approach the doctor again for the increase to have. The aide can score the pills so he can have the 25mg dose, but there will be the other half just in case.

Hope65

How did this all turn out? Im interested to know, as my mom will likely be going to MC within the next couple of months.

My mom takes seroquel at night for very minor hallucinations, which have decreased significantly. She also takes an antidepressant, but it's not Zyprexa. Both are taken daily. One was prescribed by her gerontologist & the other by a geriatric psychiatrist -- not st the same time. Meds can be so much based on individual cases, so what may be great for one may not be for another.