When my husband was in the hospital they gave him Seroquel to stop the combative behavior. The Nursing Director at the place he is staying after he was dismissed, doesn't like Seroquel, so they didn't give it to he. They were going discuss giving him Ativan instead. After last night being so combative, the doctor has prescribed both. Surely they won't give him both...now my question is what is best Seroquel or Ativan???? After last night, I am strongly thinking that I will bring him home. Take him to Daycare thru the day and bring him home to shower & sleep. I am not getting much sleep being at the Nursing Home calming him or worrying they are going to call me in the middle of the night. Any thoughts? I trust this group's opinion more than the Care Center. They are with them about 8 hours not 24. I think you guys know more about Dementia from experience. Please help.
I know that Seraquel has helped my husband. LOTS. Doseage adjusted as needed. The only thing I know about Risperadal (as I was on it myself one time as an antidepressant) is that it is notorious for weight gain...I've heard more than 60lbs in a year.....wouldn't that just add to depression? I stopped taking it!
My H gets 50mg of Seroquel three times a day and 0.5mg of generic Ativan three times a day. This has been keeping him calm and manageable for the last six months. The doctor's instructions say I can give up to 1mg of the ativan three times daily, so I can adjust as needed. We are all a lot happier with this arrangement.
kadee maybe you can try the doctors orders and see how it works. if its too much you can chose just the ativan or seroquel individually ifyou think hes overdrugged. as you see others are using both together so it must be common scripts by drs. you can adjust as needed thru the dr. its important to do what it takes to keep him calm and safe. ihope the meds work. divvi
Seroquel and Ativan are different. Seroquel is an anti-psychotic drug. The nursing director probably doesn't like it because it comes with all sorts of warnings that it should not used in dementia patients because it can cause heart problems and death. Many of us and our doctors feel that if the behavior is that bad that it needs seroquel (or risperdal), then it is better to be on it. To be blunt, AD is a terminal disease. This is purely my own opinion, but I would rather have my husband calm with a better quality of the life he has left, than raging and screaming all of the time.
Yes, they do prescribe both Ativan and Seroquel. Ativan is an anti-anxiety drug that can be used in combination with Seroquel as an added "help" for the behavior.
I have an aquaintance whose husband was completely uncontrollable. Seroquel helped, but did not completely alleviate his symptoms. The doctor added Ativan to the Seroquel, and now he is calm, and she was able to keep him home, and attending Day Care 5 days a week.
Discuss the situation with his doctor, including the information I have given you, and then you can make an informed decision.
First of all, why is the nursing director making med management decisions!!!!! Secondly, Seroquel and Ativan as mentioned above can work beautifully together, if at the correct dosage. Jim takes 100mg of Seroquel each morning and 150 mg at bedtime. He also take 0.5 mg of Ativan for anxiety 4 times daily. We've had great sucess. Please talk to you Doctor!
Kadee, this subject is also under discussion at the moment on the AA site. You might want to follow this link to the specific forum and especially read comments by JAB (our Sunshyne when she was posting here). There are definitely differences of opinion on these drugs.
I have a friend whose AD wife (now deceased) used to become very violent, take swings at him, didn't recognize him and was frightened by him. When nothing else worked, she was finally given Zyprexa, and it made a significant difference.
Firstly, thank you to everyone who responded to my message. I called the Care Center this morning. P. slept the whole night. He came out of his room around 9:30 with a smile on his face...until they tried to change him, he was soiled both ways & was adamant that he would not allow them to change him. As soon as I could dress I went over there, he broke into a big smile when he saw me. At first he didn't want me to change him, however, he finally did with no problem. I cleaned him up, changed his clothes & walked him to the dinning area. He was fine. I decided last night that I would take him to Daycare 7 days a week & bring him home at night. That way I could shower him. And maybe he would remember to use the toilet at times. Also, talked to the Neurologist. She really couldn't understand why the Nursing Director had a problem, he is only on 1/2 of 25 mg of Seroquel every 6 hours & Ativan 1 mg of Ativan every 6 hours as needed. Even the day nurse told me that there are 3 other residents that are taking Seroquel with no problems. He would'nt eat breakfast there, however, he did eat lunch for me. He is now asleep. I will be giving him the Seroquel every day. As everyone here has said, when discussing medication for behavior problems, this is a terminal disease. I also agree it if makes him calmer it will be better for him & me. Thanks again, you guys are the best.
Kadee, My dh would never let anyone but me change him. The aides could wash him and shave him but when it came to changeing his diaper, he would fight them every time. They alway called me into the room to help them. I think it was a modesty thing.
Joyce, I think you are exactly correct, we have been told not to expose our private parts most of our lives. He really doesn't like me changing him, however, he will finally agree.
I finally tried to "do something" (other than worry about when I would next run by the ALF to see Jeff,) so I went to yoga.
So I got the call, right as I was starting to drive home, telling me that he'd gotten a little difficult, was moving furniture around in someone else's room, and behaving a bit obstreperously, not quite combatively, but moving that direction.
He had calmed down a bit by the time I got there, but was still in crazy mode...I could see it in his eyes and attitude, and of course there was the fact that he asked me if I had an Uzi.
I talked to the staff before I left. Typically, they would give him an Ativan if talking techniques weren't quite doing the trick, but as we do not have a standing Rx for that, they can't do it tonight. Hopefully when I go in in the morning I can get that underway, so he'll have a PRN Rx for that or something similar.
Did I ever mention that I really don't think Alzheimer's is a very good disease?
Emily For what it is worth my two cents. Our primary Dr had prescribed Ativan four times a day for my wife and that helped keep her calm and anxiety free for several months. Then hospice Dr came and wanted to take her off the Ativan and put her on seroquel, well to make a long story short is was a disaster she became very distraught and upset so I contacted our primary Dr and he told us to switch back and if necessary give her two at bedtime and we did and she became quiet again. My advice would be to follow the orders of the Dr who has the most knowledge of the patient and not necessarily those of the attending. The primary Dr. usually knows the patient more intimately than an attending and that is the Dr. that I would trust with my loved one. But again this is just my opinion and you need to do what is best for you and your loved one. May God help you to make the decision which works best for you. Bruce D *
Thanks Bruce. He has not been prescribed any sort of anxiety or psychotropic med before, so anyone will be shooting in the dark. Since we've started with the visiting gerontologist who comes to his ALF, I guess the best move will be to go with that guy's recommendation and let him adjust as necessary.
The behavior though, is something I was starting to see before he moved to the ALF. I guess it's not surprising to see some escalation, whether due to new environment or simply disease progression. This looks like it would have been an inevitable step wherever Jeff lived.
I am assuming you left the Uzi at home? Sorry, not funny, but I did have to chuckle. Lord the things they have trapped in their minds....
I think you are right, at home or in his new home, medicines to help curb behaviors are often inevitable. I hope they quickly find what will help soothe Jeff the best. ((hugs))
Thanks Nikki. Yeah, I didn't bring the Uzi. The weekend before he moved though, he spent most of Sunday talking about how we'd all need to arm ourselves because the Japanese were attacking. He also talked about Winston Churchill a lot that day. Think there was a theme? Funny thing is, he was born in '47, so didn't experience WW2 himself.
When hb went to care center the last time in October, he was ok (in his way), but began going in people's rooms. Long story he was given resperdal, small dose. Eventually began to do nothing but sit w/head down and drool. I asked that dose be cut, whatever it was. Doc did that; staff recommended it to him, also. About 3 weeks ago he was admitted to hospital totally unresponsive. All meds removed, IV antibiotics and fluids. Within 6 hrs he was sitting up and being fed pudding and soup. After a week was back in care center. He's continuing w/no drugs. Behavior change is remarkable, eats, participates in some activities, walks w/a shuffle, is much more "clear-eyed." Staff has commented on the change. He wasn't staying in bed; so now they put him to bed after everyone else is in bed and he does better staying there. Probably hears/sees no activity so doesn't think he has to investigate or is missing out on something. I believe the resperdal made him sit w/head down, drooling. Maybe build-up caused unresponsiveness; don't know. He's still somewhat stubborn, but he was that w/o "somewhat" in past years. Staff is happy with him; so am I.
Zibby-I'm sure it was the risperdal. After 1 small dose of Risperdal my husband didn't recognize me, had to be led by the hand when he walked, started shuffling and his hands had tremors. His head dropped when he was sitting and was out of it. They stopped the Risperdal and he was fine.
Well, we'll be starting a small dose (I think that's 25mg) of Seroquel tomorrow morning. Morning or night? I suggested morning, as he seems to be calm enough when he wakes up at night that he can be guided back to bed. The paranoia and agitation are generally issues from late morning through early evening.
Of course I've read many back-threads on the subject of Seroquel. I can see that for some it was a big help, others not so much. Seems worth a try though.
It will be good if his mood smoothes a bit, because I think lunch out now and then might improve his outlook.
emily, I told the woman this morning at the ALF about DH and his H and P, she said if he gets too agitated they would check with the doctor about giving him Ativan but only as needed. I hope it doesn't come to that but if it does I certainly hope it works.
That is what I was told at first too, that they would want an Rx for Ativan on hand for an as-needed thing. But because it would be hard to administer is he's quite agitated, and because he has ongoing hallucinations, off and on paranoia, and mild agitation much of the time, the doctor thought a low level systemic dose of Seroquel would be better to start with.
emily, DH has been on Seroquel for quite some time, he now takes 75mg in the evening. I have written 2 letters to his neuro and I'm still waiting for an answer. His hallucinations and paranoia have been going on for over 3 years, maybe even closer to 4 which is why I just can't take anymore. I hope the doctor at the ALF can do or prescribe something that will help him.
I saw a bumper sticker on a car parked next to mine and it said : "remember the person you wanted to be". A friend on another message board said "make your decisions based on the person you want to be".
Well, the person I want/wanted to be would not have neglected yoga, but I have. So, your message resonated. H is still at home and as the situation progresses, I will likely be the one to leave.
Anyway, I can picture you, 2800 miles away, driving home from that class and getting that call. A few years ago, I was driving home after picking up my new, at that time, components for wireless. I was happy. Okay not really giddy but almost. Then I got the call; from a neighbor, "the ambulance has been called to your house and ___ was transported". He was seen outside and there was an incident while he was checking the mail.
So, if what I took from what you posted is that there was a moment of contentment, and it was taken from you, I kind of understand.
No tears. On to ativan. I really like this med. I take it as does H. Short acting, easy to customize the dose. It affects me much more strongly than it does him. I don't really understand the why of that difference but it seems to really blunt his anger.
General N recommends respirdol (sp) instead of seroquel for H but not while he is home.
He started Seroquel this morning. I don't know how long before one would really expect to know the results, but he was in a better frame of mind this morning for whatever reason. I was going to take him out, or go for a walk, but he was too busy reading messages, so I'll check later. Today's "Googles" (which he reads off the floor, his pants, etc,) mainly involved the other three Stooges trying to get in touch with him to find out where he is. Apparently he is the missing 4th Stooge (aka Effie-poo) and they're looking for him. So I got out my iPhone and said I'd text them and let them know he was right here in town. He thought that was a good idea.
I noticed improvements with Lynn right away. His dose did have to be increased as the disease progressed, but now he isn't on it at all. If the delusions continue this strongly, they might try to increase Jeff's dose. Emily, I know you aren't kidding, it is tragic, and I am so sorry. You have such a compassionate heart. How sweet of you to offer to text the "other 3 stooges" when I am sure you just wanted to fall apart. ((hugs and more hugs))
We had inconsolable crying. (Which got her thrown outta her daycare) The Ativan worked but wore off too quickly. To last any time she need 2 mg (or more) and it destroyed her speech to complete gibberish.
Added Celexa - 2 weeks later she still had crying at her new daycare. They were not happy. This was even with 1 mg Ativan given shortly before leaving in the morning. Added Seroquel - it has now been one week and the crying is under control. She had Ativan 0.5 mg before leaving the last 2 days (insurance) but hopefully we may be able to stop that. Two more days in this week and if she can do daycare without crying, I will be satisified with the Celexa/Seroquel combo.
We had unbearable sundowners syndrome. So bad that she was literally out of control. Dr prescribed Seroquel and it helped tremendously, but, her insurance went in the donut hole on the second month and I had to pay $800.00 for a months supply. When I told her Dr about it, he gave me a form to fill out for the manufacturer and then it only cost me $25.00. The company is Astra Zenica and they were wonderful/
Steve was on Seroquel for 4 years and it really helped--the initial dosage was 25 mg, went up from there. After 4 yrs the effect wore of, he was inpatient in geripsych ward for 2 wks, switched to Zyprexa. Worked several mos before needing second geripsych stay, still on Zyprexa with a handful of other meds in the cocktail, still working fine. Some trial and error is inevitably involved, as m-mman's post illustrates.
If there is financial need, I understand some drug cos. will provide meds at cost.
Not certain if the assistance Dean received from Astra Zeneca was from this or not, but I have seen television ads for the following. Might be a place to start for assistance with Rx costs. Or, perhaps google drug company name and the phrase "help with prescription costs."
Emily: Go to the Astra Zenica website and they will have the form there. Just fill it out and you will hear back from them. The form says that there is a maximum income allowable, but, our Dr said that they don't pay any attention to it. They just approve everybody. My experience was 2.5 yrs ago so they might have changed their policies or procedures since then.
The Dr gave me Seroquel to give DH if he gets really bad sundowning...Dr said to give it to him around 3pm before the sundowning gets too bad..Some days SD seems to start from the morning, so do I give it to him in the morning, and will that last him through the day After the bad reaction he had to Risperadal, I've been too scared to give it to him, I've just been trying to see each day out as best I can..
Julia: Seroquel is a good drug and is very effective most of the time for what it is prescribed for. Your situation sounds a lot like mine was except my SD experience was every day. I ended up giving my DW more doses in order to solve the problem. I mean that the Dr said that I could. I wouldn't give any more than the Dr said was safe.
This can be a dangerous drug, but, my experience is that the benefits out weigh the risks. We didn't have any side effects.
When we used Seroquel I had to work out the timing for best effect. For us, a dose between 3-4 pm would calm him and he'd go to bed around 8;30-9. IfI waited until 7, it wasmidnight or later.Not ore meds...just when.
My husband was given risperadal first for his agitation and constant pacing. It made everything worse. He was then placed on seroquel and that has helped. Give it a try. You can always stop it.
Emily, I am very glad to hear this and will keep my fingers crossed you continue to see more improvements. Lynn stayed at 25mg for over a year. Then we upped it to 50, then to 75 right before he was placed. They had to up it to 275mg!!, but it was only for a short period of time. Then he was brought back down to just the 25 again, now nothing. It worked very well for him and I am grateful we tried it.
On a side note, there is a resident at the nursing home who needs medication badly. She was placed last November, I have yet to see one visitor. She cries all the time, just breaks my heart!! She paces excessively in her highly delusional state. Her family has said no to the meds because of the "black box warning". It just really ticks me off that they are letting her suffer so. Of course, they don't have to see it so it isn't bothering them.
The kids and I have "adopted" her. They bring her little gifts for the holidays and visit her when they come. She just eats up the attention! I visit with her every day. She waits for me, sometimes I find her asleep in Lynn’s bed! (I told the staff this was fine) She pulls on my shirt sleeve when she is ready to go for a walk. What am I to do? So I take her for walks with Lynn. I must make quite a sight pushing his long lounge chair type Broda chair with one hand and holding onto her with the other. I am getting pretty good at one hand "driving"
I have told the DON I would be more than happy to talk with the "family" about the black box warning versus the quality of life this poor woman has. So far I haven’t had any feedback. Her doctor there is the one I fired, sooooo no point in trying to talk to him! <wink> It is just so heartbreaking when you know medications could make her life much better.
thats a very sad story nikki. so many appear to be abandoned by family once in a facility it seems. injustices dont fly well by me either- the weak, young, old and animals, sets me off without mercy. :) good for you to try to help her. i am sure it makes a difference.
I like to think it makes a difference. I have "adopted" quite a few of the abandoned. Of course, this opens my heart to more heartbreak when we lose one of the dear souls. *sigh* Is all I can do to keep from speaking my mind when the "families" come in for the bedside death vigil. I do a lot of tongue biting!
I think when our journey is over, and I have had time to heal, that I will continue to visit. I have seen firsthand what the one on one attention can do for some of these people.
Thanks for the reply everyone.. Risperidal was not good, Dh was going to self harm with a big kitchen knife. All morning he kept hiding the house keys..checking over and over to see if doors were locked, all the door locks are working themselves loose with all the checking.... I will start him on Seroquel , just can't go on like this every day, it's just a small dose. I guess it all a matter what time to give it to him, morning or afternoon. Like Deb said i can always stop it. So comforting to know it has helped a lot of your spouses...
OK, I had enough, if I had handcuffs I would have cuffed him to a chair....didn't sit still for 2 mins all day. Gave DH a Seroquel at 3pm, within an hour he was asleep in the chair. So, is it OK to only give it when he needs it, or do I now need to give it to DH every day? Just 25mg, I really don't want him zonked out all the time.. thanks so much for your help...
Julia, so far (even though it has only been a couple days,) I'm not seeing that it zonks him. Maybe that's the effect after excessive agitation and activity because it finally let him relax and his natural response was to fall asleep.
Julia, when I started my DH on Seroquel I gave it to him in the evening to help him sleep. If I am not mistaken it takes a while for it to get into their system to be effective all day to some extent. He started on 25mg in the evening over a year ago & he is still on that same dose. I think it calmed him down altogether. It was either that or just the progression of the disease. I’m not sure but at this point I’m not going to fix something that ain’t broken!
Emily, ElaineH, yes, it could have been that he was on the go all day, he finally relaxed and fell asleep, after dinner he was ready for bed by 7pm, so I can't complain about that. I think I was surprised that it worked so quickly and had that effect on him,scared me a little...but I'll carry on with it and hope after a few days it will have a calming effect for most of the day. I'd be happy with that. Thanks so much
Nikki--in our state, there is a ombudsman program that exists to provide advocates for people in nursing homes. It's done on a voluntary basis. If they have something like that where you live, perhaps later on you can give it a whirl. You could probably write a training manual for them with all your advocacy experience!
Marilyn, they do have that program here too. I hadn't thought about it yet, but that is a pretty good idea. It could put a little "weight" behind my visits. Excellent food for thought, thank you ♥
Julia, I am wishing you the best of luck with the Seroquel. It is a pretty small dose, the same Lynn was started on, and it did not cause him to sleep that quickly. However it did have an instant calming affect on him that only got better with time. I am hoping for the same results for you and your DH. ((hugs))