Hospital prescribed Zyprexa for agitation and combativeness...am I wrong to be Pis*ed off?

Holly H · January 23

I am POA and while my mom is in hospital, dr prescribes Zyprexa after my mom became combative when they tried to bathe her. Nobody told me they were doing it. They now have her on a regular dose of 5mg and she's been on it for 2 days. She's a totally different person than when she went in. No words are making sense and she can't even lift a fork to her mouth (which were not problems 4 days ago). I am reading about Zyprexa and dementia and I'm horrified at what I'm reading. Warnings that it is not approved for dementia and could cause stroke and death? I am getting her from hospital today and taking her directly to new placement in MC. Can we just stop with the Zyprexa and hope she returns to her baseline? They are writing an RX for it but I am thinking I don't want to give her it once she's out of the hospital. I hate hospitals!

Marta · January 23

Was she in hospital for behavioral issues or another reason?

when you admitted her, you signed a consent for treatment.

Marta · January 23

I found your earlier post.

I strongly advise you to not take your mom out of the hospital until she is stable on medication. MC will send her right back.

No, when one is admitted to hospital, permission from the POA is not typically sought when treatment decisions are made. You gave permission when you signed her in.

If you read widely on these boards you’ll learn that Zyprexa, Risperdal, and Seroquel ( atypical antipsychotics) are commonly prescribed for our loved ones when their behaviors put themselves and/or others at RISK. The association of these medications with increased risk of stroke or death is not cause and effect, it is an association: start with the fact that the person is elderly (increased risk of death), add to that advanced state of dementia ( increased risk for death) and whatever co-morbidities pre-exist (often multiple in the elderly so increased risk for death) - and what do you have? Increased risk of death overall, whether they get the antipsychotic or not.

Yes, it would be nice if these decisions were discussed with POA first. In the real world, that’s just not possible.

I’m sorry that you and your Mom are at this stage of this most egregious journey.

M1 · January 23

Please Holly, as on your other thread: she needs to go to geri-psych for stabilization first, or she'll land right back in the ER, and then the MC might not take her back. All of the atypical antipsychotics carry that "black box" warning about vascular events, but the risk is actually quite low. Of the three (Seroquel, Risperdal, Zyprexa) I think Zyprexa is the most likely to cause side effects. Seroquel and Risperdal are more commonly prescribed and are usually well tolerated.

jfkoc · January 23

Hi Holly...

Good for you for your advocacy. It is so important.

The black box warnings are frightening but sometimes the risk is worth it.

Can you stop the Zyprexa? Yes but it might be important not to do that cold turkey. Please talk with the Dr before you take your mother out of the hospital.

harshedbuzz · January 24

@Holly H

This class of medications is often used off-label for agitation behaviors in dementia. Dad was on Seroquel for a couple of years, I can appreciate the gut-punch when reading the warnings that come with the medication. This medication was a game-changer for us; it relieved dad of the powerful anxiety he couldn't process or understand that was driving his agitation and aggression. It allowed my mom to keep him at home with her 2 years longer than she otherwise could have. When the time came, it also helped him transition into my first choice MC fairly easily and remain there until he passed.

I would encourage you to speak to her care team. Sometimes meds needs to be tweaked to get a good result with minimal side effects. Perhaps she'd do better on a smaller dose or maybe another choice from that class of medications-- Risperdal or Seroquel perhaps.

If it is very important to you that dementia is an indication with FDA approval, there is a newer antipsychotic on the market that does have this called Rexulti. It does come with the same risks and as well as with an eye-watering price tag. (~ $1400.00/30 tabs)

I would also encourage you to get her to a point where she's calmer and more able to transition to MC successfully. Where I live, most MCFs will not accept a new resident in the condition in which you are describing your dear mom. While these MCFs will allow a PWD to age-in-place, they require the person to be ambulatory (or independently use a non-motorized wheelchair) and able to self-feed. It's important to understand that LTC don't operate like hospitals--it's like the difference between a private and public school in the U.S.-- MCFs don't have to accept all who apply and they can/will ask a resident to leave if the PWD has behaviors. In some cases they may take a PWD back after a successful geri-psych stay, but not always.

HB

clever_bear · January 25

I second much of what was said in above comments.

Are you allowed to be upset/angry that your mom is experiencing side affects from the medication? Absolutely! Does that mean you should immediately remove her from the hospital? Probably not. Any reasonable medical team would be happy to hear your concerns, and would have options to offer such a different/lower dose, a different medication etc. Just like not everyone responds well to one anti-depressant, not every medication to help manage agitation will be successful.

I urge others to please also consider the cause for agitation in mom in this situation. Mom is in a strange place with strange people who are trying to do something that involves no clothing, likely mom is cold or uncomfortable, and may not entirely appreciate the circumstances. I would be agitated in her position too. It's possible that once mom has a set routine some where, the agitation may disappear and iether the medication may not be needed, or a leser dose will do the same thing.

I work in mental health and I'll second again that the black box warnings are not a direct cause and affect by any means. The risk is generally low, but it's a way to remove liability for pharmaceudical companies, or so I suspect. Reagrdless, the risk to your mom and others is likely judged to be higher without the medication than with it.

i'm continually struck by a story of when my step-dad was dying of canger. He went into the hospital to have an infection treated, if I'm remembering correctly. When he came out, he was far weaker and short of breath constantly. When they went to his next pulminolgy appointment, my sister out right told the doctor "He can barely walk from the car the few steps to the door of the house without immediately needing to sit down. What's causing this?" The doctor asked, "You mean he wasn't like this before?" She was flabbergasted. But I think we all underestimate how little doctors actually know their patients as far as what's normal/usual for them. It's important to speak up whenever you notice a side affect or change for the worse.

Hang in there, and keep us updated if you can. Please be good to yourself.

jfkoc · January 25

clever_bear....such a good post about meds and a hospital experience....A dose of reality.

Holly H · January 25

https://alzconnected.org/discussion/comment/195651#Comment_195651

She's never been aggressive. clever_bear nailed it above. Hospitals and their lack of respect for dementia patients caused her agitation. I wanted to punch a few people there myself. I am appalled at what doctors are doing to these precious souls when they are inpatient. She is now in memory care and doing amazingly well.

M1 · January 25

Glad it's gone well so far, good news.

Hospital prescribed Zyprexa for agitation and combativeness...am I wrong to be Pis*ed off?

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