Any experience with olanzapine and gabapentin?

LaneyG

DH was discharged from hospital with these olanzapine/zyprexa and gabapentin replacing alprazolam and risperidone. He seems calmer, in some ways more lucid. Doesn’t smile as much tho. Delusions and paranoia are still there especially at end of day. And there are issues where anger and agitation are still quite problematic - driving and tricking him into going to that awful place, the hospital. I struggle thinking the anger is well placed. Anyway, interested in dosage and time of day. Thanks so much.

ImMaggieMae

Laney, it was a hospital psychiatrist/pharmacist who first put my DH on Risperidone a couple years ago and it was a wonder drug for him. Calmed the agitation and definitely made him seem more lucid. But the dosage had to be increased a bit over time. He was never angry or aggressive, but the agitation was over the top. He never stopped moving. Very unpleasant not only for me, but for him. He had that “deer in the headlights” look. He had no ability to listen to reason or calm down without the medication. We often have to adjust dosage and timing on the Risperidone. Too much can make him drowsy. And it changes from time to time. Both the hospital psychiatrist and later his neurologist (when we finally got into one) works with me on adjustments within set perameters. Those perameters can be changed when needed with a visit, but so far the drug prescriptions are adequate and permit enough leeway. We are very fortunate to have a great neurologist who takes adequate time to advise as well as listen and believes in “boots on the ground” in caregivers participation.

Alprazolam is a great anti-anxiety drug that works quickly but also wears off quickly, like in about 5 or 6 hours. So it has a high potential for becoming addictive. I’ve also been told that it can cause cognitive problems in people with dementia.

He took Olanzapine for a few days in the hospital in early days, but they switched to Risperidone. Not sure exactly why, so I can’t comment on that. I know it’s another antipsychotic which seems to be one of the few effective types drugs for delusions and hallucinations, according to people on these forums and in many other printed studies. My DH doesn’t have either as far as I know, just the sometimes extreme agitation.

My DH has taken Gabapentin for years for neuropathy in his feet and legs, caused by a chemo drug about 14 years ago. The cancer never came back, but cramps in his feet and legs at night were a result. 300mg of Gabapentin helps a lot. It also causes drowsiness so he takes it along with 6mg of melatonin right before bed. He always sleeps soundly through the night, about 9 hours and lately sometimes more. I asked the neurologist’s office about Gabapentin for sundowning after trying trazadone for about a month which didn’t seem to have an effect. They prescribed 100 or 200mg of the Gabapentin as needed, which helps quite a bit if given right around the time sundowning starts by making him a bit drowsy. Still experimenting with that but it seems to be working.

The thing is, that changes have to be made slowly and each change needs at least a couple weeks to see how it’s working. And there are good days and bad days regardless and that has to be taken into consideration. I hope my comments help. Feel free to msg me if I can be of any more help.

LaneyG

Yes. Thanks MaggieMae

M1

Interesting choice with the gabapentin, I've not seen it used frequently in this context. Was it explained to you? I personally would want to know their rationale......it is typically used for neuropathic pain and for seizures, but not to my knowledge as a sedative--there is a very wide dose range. The Zyprexa/olanzapine is more commonly used but also tends to have more side effects that some of the other antipsychotics. As I mentioned on your other thread, if you are not satisfied that his behaviors are controlled I'd take him back to the hospital in a heartbeat. Were the social workers of any help to you, or not?

mrahope

Hi, Laney,

My DH takes gabapentin (recently prescribed) at night for severe Restless Legs Syndrome (a lifelong problem for him). FWIW, I have noticed no changes at all in any of his dementia related behaviors. The only benefit is that he used to take an opioid for this condition for many years, but is now being successfully withdrawn from it. Just sharing. YMMV

M1

Laney out of my own curiosity I dug a little about the gabapentin. I would ask his docs about this, as there does not appear to be strong data supporting its use. I found this in a 2023 article:

Especially in older adults, gabapentin and pregabalin are prescribed to treat behavioral and psychological symptoms of dementia (BPSD). A systematic review analyzing 24 relevant articles found that the use of gabapentinoid agents significantly decreased BPSD in patients with Alzheimer’s disease, suggesting a possible benefit. However, 15 papers were original case series/case reports, and the remaining 9 papers were solely reviews. There were no randomized trials.

This means that it's never been shown to be better than a placebo control.

LadyTexan

Hi Laney.

My DH had EOAD. Sometime during his illness, DH was prescribed Gabapentin by his psychiatrist who was very knowledgeable about his Alzheimers. If I remember correctly, it was prescribed for his agitation or possibly neck pain resulting from head trauma he encountered in his 20s. Or maybe the agitation was caused by the neck pain.

Here's the weird part. DH took Gabapentin with good results for several years. It helped his pain and agitation. Later in his disease DH abruptly stopped taking his meds which eventually led to a stay in the psych hospital.

As DH was slowly titrating back onto his multiple meds, he developed a rash on his face. The face rash was alarming because it was considered a serious side effect for the Gabapentin. The psychiatrist stopped the gabapentin immediately upon hearing about the rash.

I always thought it odd that the Gabapentin worked very well for a long while and then DH developed a side effect serious enough that the gabapentin was discontinued.

I have no experience with the olanzapine.

Ernie123

A number of years ago my DW was prescribed Risperidone for delusions and agitation. It worked well at first but after a number of months and dosage increases it lost its effectiveness. The Geriatric Psychiatrist switched her to Olanzapine and within a few days she was calm and relatively happy. He said it is usual to have to experiment a bit with meds and dosage as what works for one person will not necessarily work for another. Also patients must be monitored and meds adjusted as the disease progresses. So my advice would be to be sure your LO is being monitored by a competent Geriatrician and don’t expect anecdotal evidence from others experience to necessarily apply to him.

She has been on Olanzapine and Escitalopram for three years now with Trazadone at night. Seems to be a good mix for her keeping her emotionally content and sleeping well. She is now in Stage 7 of the disease.

mpang123

I take olanzapine for schizophrenia and gabapentin for anxiety, sleep and nerve pain. They work for me.

Quilting brings calm

My mom takes gabapentin for her neuropathy. She takes sertraline and mitrazipine for anxiety and depression. Her psych resident once commented to me that gabapentin also has some anti-depressant benefits. I haven’t seen that benefit in her case.

Joydean

I take gabapentin for lower back pain caused by nerve damage, it has never made me sleepy (I wish it did) . I take 600mg. And have taken it for several years.