I took my DH for his appt with his neurologist today. The decicion is to wean him off both the razadyne and namenda. Also increase his risperdal and to change from lexapro to citalopram (I think that is what the prescription says). I am really nervous about this. I'm so afraid he will go downhill faster, but the Neurologist said that at this point it is not likely that the az meds are doing that much good. I do know it will save a lot of money on the prescriptions but what if he gets worse fast?
Was there a reason to wean him off the namenda? .. This does sound a bit odd, I understand your concern. Citropram is the generic of Celexa.. Changing all of those meds at once is unusual, because if he has a reaction, it's hard to know which drug he's having a problem with. Usually, they change one drug...wait a month..then change the next one...wait a month. So they can observe how your DH reacts to each drug. Is this, by chance, a new Neurologist? There's not much ahead of a Stage 6, where my husband is... just Stage 7. We never know.
I'd definitely question all those changes at once. My Dh's old Psych. Dr. reduced his 2 psych meds, and Artane, and added Trazadone all at once and said to watch in case of reactions. I asked how I'd know what they'd be and to which drug they were related. H didn't really answer. Sure enough reactions. Less than a week later first report--symptoms covered by Psych meds are breaking through. Restored to his full doses of those two. Next report tremors are worse and sleep is reducing to multiple short naps instead of enhanced longer sleep time. Restored the Artyane. Third call, He's sleeping 1.5 hours to 2 hrs. with lkess than 2 hours between, round the clock. Original response from Dr. was to increse the Trazadone. I questioned right back--He was sleeping 4-6 hours between 6-8pm and 10-2am. Then againn from 6-10-10;20 am and then from about 1-4pm. How is this little bitty naps any kind of quality sleep? The Office called back and said to stop the Trazadone., Took 2 weeks for his sleep to straighten out to his normal.
Could have saved a lot of grief if he'd tried these separately.
One thing I have learned from past experiences...and that was to err on the side of caution. I bet that even the pharmacist would agree that bringing on all the new drugs at one time is asking for trouble... as Carol just said. Incidentally, most pharmacists, (mine at CVS especially) are very willing to discuss the drugs with you..and they know more about them than most doctors know. Allison, my pharmacist, explains every little thing about the drugs we get from her as well as the ones we get from MEDCO. We usually begin a new drug with a 30 day supply, locally, and if it works, we go to the 90 days supplies at Medco.
I make sure she has ALL the drugs he takes in her computer. That's a safety net, since he has several doctors.
For about 6 years now I have been taking DH to Seattle to the University of Washington/Veterans Affairs Alzheimers Research Clinic for a yearly review. This April when I took him they basically said there is no reason to bring him back next year because there is "no memory to test". I asked about continuing Namenda and Razadyne. They said the research showed that maybe the drugs would not do much at this point but to ask his Neuroligist. The Neurologist is actually doing this in stages, but not a month at a time. First he is increasing his Risperdal from .25/.25/.50 mgs per day to .25/.50/.50 per day and that if need be I can increase it later. Then next week they are reducing the namenda from 10 mg 2x/day to 5 mg 2x/day. After a week of that the namenda is to stop. A week later the razadyne is to be reduced fm 12 mg 2x/day to 12 mg 1x/day. A week later the razadyne is to be discontinued. A week later I am to switch him from lexapro to citropram. N says to lexapro & citropram are closely related. (That change is to get him on a generic which is much less expensive). I guess I'll need to monitor is closely. The N did say that if I notice any negative reactions or other problems I need to call right away. DH hasn't had any problems with rage or anger. He is confused a lot and seldom knows who I am, just the one that takes care of him and that he it almost totally dependent upon. He already can't dress or undress or shower himself and has no idea of date, season, etc. I have to cut up his food and serve him only one food at a time, as well as change and clean him up when he messes the depends.He can no longer read or write. He watches a little TV but nothing with a plot. He is pretty docile. I think I am very fortunate that way. He does become quite agitated in the evening, wanting me to take him home, but I can usually talk him through that. I guess if he gets worse that way or if he starts with anger and/or abuse I'll need to get back to the N right away.
gmaewok - there is a thread here about when to take our LO off the meds. We will all have to make that decision but it sounds like the doctor is making that for you.
My husband has aMCI - not yet diagnosed AD, but my FIL was diagnosed about 25 years ago. He basically is a an empty shell that walks the hallways at the VA Unit he lives in. He doesn't talk, know anyone, does not interact other than smile, occasionally will feed himself, but is otherwise totally dependent on the staff. They have him on Namenda which my husband, his sister and I would like to see him removed from, but my BIL won't agree. Why, who knows cause he never goes to see him and he lives the closest (we are 3500 miles away). We could push it, but won't, but we feel it is time to stop the meds and let the disease take its course.
IMO - if you are not ready for this next step, tell the doctor you are not and ask if you can let him know when you are. They do say once they come off the drugs, they progress fast to where they would be if they had not taken it. You have to be ready for it. You need to let the doctor know if you need some time before doing it.
gmaewok, be prepared for going downhill. After you start with the reduction watch closely to see how it is effecting him. You can always return to the meds but with maybe some reduction in function. Some seem to go off them with little change. I don't think the Celexa change from Lexapro will bother him. My husband went from wellbutrin XL to Celexa and I didn't notice any difference.
It all boils down to "you have to make the decision yourself or go with the neuro". When my dh gets to a point the neuro thinks the meds aren'g helping him I will try the weaning off.
Razadyne/galantamine is another drug approved for mild to moderate AD. My hb is on it. For people who can't tolerate Aricept they will often try it - not so tough on the stomach (so they say).
The VA must get a better price on the galantamine because that is the first one they gave him, but he has to take an antacid due to stomach irritation. The first neurologist that said 'I guess early AD' put him on it. The second one at the VA thru OHSU said there is no signs of dementia yet, so I am not sure why she left him on it.
gmaewok, I have just been through the same experience. The dr told me with him on the highest dosage of the Razadyne and the Namenda, and the disease progressing a good bit faster now, that there is no point for continuing it. My hubby was on the Risperdol and develoed Parkison like symptoms so they took him back off the Risperdol and things have been a nightmare sice. He got very aggressive and just last night we had to place him in a place for them to adjust meds for a couple of weeks. So I hope your hubby does well. Best of luck to you!
I started today cutting the namenda from 10 mg 2x/day to 5 mg 2x/day. I am really nervous about it but we'll see. When DH was at the Alz research center last year they "decided" he has Parkinsonism and Lewy Body dementia as well as Alz. His risperdol has been increased from .25-.25-.50 to .25-.50-.50. I don't know if that is considered a small doseage but I actually never did see any change from the time we started it to the present.