so many have had to send their spouses to units to iron out the medications for aggressive behavior. many of you have found that miracle combo that has agreed with your spouse and has them on an even keel for the time being. if your spouse has had aggressive issues and is now compliant and easier to manage what meds did the trick or are working? we may can find a relative number of meds that crop up over and over. this could be a starting point for those who follow to know which ones seem to work or not. we know its a hit or miss with many but having a starting point may bring them around alot faster if we knew which ones maybe to suggest to our doctors. and yes we know more than most doctors! :)
post your input please and doseages if possible. mine is non aggressive but if hes anxious or ansy i used .5mg of ativan or generic lorazepam. works like a charm and makes him smiley and very easy going.
DH was on Seroquel for about 1 1/2 years. It suddenly stopped working one day, with terrible results.
Here is what dh is on now:
Donepezil, 10 mg, 1 X day at bedtime Risperidone, 1 mg, 1 X day at bedtime Citalopram, 10 mg, 1 X day
I call these his "happy pills." So far, they've been working for almost a year. Of course, he has other pills he takes daily, but the above pills are to keep his anger problems at bay.
DH is on generic Aricept 10mg.1 x AM,1 x PM. Namenda 10 mg. 1 x AM,1x PM., Zoloft 50mg. AM,(just cut back from 100mg) and Seroquel 25 mg. at bedtime (he was on 50 mg.for a time until he improved and I cut back to 25mg) the seroquel he just went on 6mo.ago,the others for several years.
Good thread Divvi. I have quite a bit to contribute--will do it later, when I have time. We have to remember that each patient is different and there is no magic formula. That said, even just knowing the drug names is helpful because people can ask their docs about them. Steve is on a cocktail of many things, some not even developed for dementia--but it's workingl
When my son was first dx incorrectly and was put on multiple medications that had harsh side effects I used a web site called Crazymeds.
I learned that many brain disorders were treated with the same meds and that I could learn from people or caregivers from multiple brain illnessness. At the time my DS couldn't tell me and I couldn't tell what was the illness and what was the medication side effects. For example I learned that many addictions are treated with antipsychotic medications like Seroquel and that persons with addictions could tell the rest of us what they were experiencing from the meds. So..even though the site is edgy and full of modern humor you might want to give it a try after you learn from others what meds they are on. There is a list that describes all the real life side effects of every medication that is RXed to people with every possible brain disorder. The site has forums were you can post question. Best Regards, TD
Thanks divvi. I found it helpful when MarilyninMD mentioned that Steve was on Trazadone, so I asked Rich's doc if that would help him sleep and she prescribed it and told me that it was a good suggestion. So I think this thread will be helpful for all with the basic caveats. I just want to state that Rich was dx'd at 58 with FTD (behavioral variant) and is now 62 and has had a history of agitation, aggression and occassional violence (before he was on meds). He is currently on:
300 mgs generic seroquel -100 mgs 3X/day 300 mgs generic neurontin - 100 mgs 3x/day 300 mgs generic trazadone at night .5 mgs ativan as needed for agitation
Since he was one of the spice who had stays in geripsych units, they did try several combinations of meds before we got to this combo which is still working. They tried depakote, risperdal, klonopin, celexa, lexapro and xanax.
It is useful if you can know if one symptom is driving everything else. I believe that many symptoms are fueled by my wife's anxiety. That should help put the drugs I mention in context.
Xanax was a helpful drug pre dx but we thought it was a bad mix with brain injury and dementia so we cut it back greatly. At night replaced it with Trazadone, as with LFL's LO. Later introduced Trazadone in middle of day to help with anxiety.
Lamictal for depression. We think it helps.
Paxil as a mood stabilizer. It was the first drug she took that helped in the 90s. Eventually stopped working but after being off of it for many years started working again. Some doctors feel that Paxil a. FTD is a poor mix but it works for her.
Xanax at 2pm to help with anxiety and as needed. Also if she has trouble sleeping.
Sonata as needed for sleep. Usually go weeks without using it.
She had tried seriquel in 2007 and it didn't help her but made he very hungry.
Those of you who trust in your PCPs, know that they do NOT always know what works with dementia patients, and feel free to request/suggest various things. Doctors today are used to people asking to have all kinds of meds that they have seen advertised on TV.. and sometimes willing to go along with patient recommendations. In the case of dementia patients, where YOU are the one observing (closely) the reactions, many seem to be willing to listen to you. Do recognize that you are assuming some responsibility here, of course.
Lorazepam helped the most, the best, @ 1mg tid. During the final weeks he started to metabolize it very fast. He always was a fast metabolizer but this med was the most helpful.
Generic aricept @10 mg daily. He had a bad reaction to the 23mg.
I will cast a vote against depakote, which has been helpful for many but provoked delusions in H. The dosage was the lowest but I don't recall, or can check, what it was.
He was ftd, his dx is indeterminate, but at about 47.
Dx was AD; agitation and sleeplessness were the main issues being treated. This combo has been working well for over a year now. "Steve's Cocktail" --Anti-psychotic: Olanzapine 2.5mg (this is generic Zyprexa; Seroquel was the original, but effect wore off after 4 years) --Anti-depressant: Citalopram 40mg (generic Celexa) given since dx, over 7 yrs. --Amantadine 100mg: This is a Parkinson's med, sometimes helps AD patients --Benztropine 2.5mg: Olanzapine caused a bit of dystonia (leaning towards one side). This drug offsets that. --Prazosin Hcl 1 mg: This is an interesting one--helps empty the bladder which stays a bit full due to BPH (enlarged prostate). A partially full bladder can cause agitation in dementia pts. Standard prostate meds (i.e. Avodart and others) caused delirium due to AD. --Fosinopril 20mg--for high blood pressure. --Namenda 10mg--given twice a day for AD, practically since dx. At this late date may no longer be effective in helping functioning, but believed to help with agitation. --Trazodone 100mg--Anti-depressant used to help with sleeplessness --OTC Vitamin D and Senna
Aricept was discontinued last year because it was slowing his heart rate too much, and he had already been on it for 7 yrs.
Lloyd takes Keppra (anti-convulsant) 1ml 3x a day. That is equal to 300mg per day. He takes 4-5ml Neurontin at bedtime. He still takes 1- 10mg Namenda once a day. I've tried to stop the Namenda but he gets worse without any. And he gets a fourth of a 100mg Trazadone at bedtime. He was taking 1 2.5 Marinol 2x a day, but the effects of that wore off after about 8 months and we could not afford to pay cash for the 5.0mg (over $500 per month). My theory is "less is better".
Our MD says you know your DW and what's going on. He gives me dose instructions, not to exceed. Other than the Namenda and Aricept (g) the dose depends on what's going on any given day Namenda 2xday Donepezil 1 x day at bedtime ( less GI side effect) Ativan 1 Mg. up to 4 mg a day as nec for sun downing Melatonin 3 mg 1 or 2 tab late afternoon sundowning Ambien 1 mg. . 1/2 - 1 tab at bedtime Organic Marinol with music works better on many night than Ativan
Well our problem continues to be crying. Constant inconsolable crying and whining. I am more than thankful that it is NOT screaming and violence but quiet would be nice once and a while. (I am also very fortunate that after the sundowning she does sleep at night). She also has typical outbursts in public. Anyway we have prescriptions to: (all generic versions/daily doses listed)
And with all this I really don’t see much of a change. Because of the Clonoazepam (a valium) she does fall asleep in a chair about 4 hours after each dose (3 times a day).
She has been on this for about 4 months now and I am thinking of cutting her back but I donno, ya hate to have the behaviors get worse . . .
When H was newly admitted to ALF I contracted with a palliative care-hospice care specialist MD.
They cut out the generic aricept right away.
They kept stable the generic keppra which I failed to add above.
They kept stable the generic lorazepam and generic zolpidem.
H's condition was severe and he could no longer swallow, so I think they had some meds to help with that.
To be honest, one doc told me the choice was between less sedation and more awareness and more tranquilization and less awareness. H had already said what he wanted in an executed document so I followed that in clear conscience.
Hmmm, my dh is on very few, but they are most helpful. He started out with Aricept - it only gave him gastrointestinal (aka Poop Patrol) issues and nothing more; Namenda made him instantly very aggressive (trashed that one pretty quickly). So, today he takes 40 mg/day Celexa 50 mg/night Trazadone .25 mg/day Lorazapam (more if he gets overly anxious) And that's it for AD symptoms. He hums along mostly very good naturedly on this cocktail. His cognitive skills decline daily and much more rapidly this year than last. And, even more rapidly since my emergency trip to hospital for Sepsis - seems to have sent him closer to next stage.
I don't think this has been mentioned about meds. Of course, best to always check with your dr. for complete instructions on how to decrease or increase the medications.
Only once did I have a problem with my dh's meds. And, it was very unusual that he became very upset...really agitated. I started out medicating him with the smaller dose the dr. had prescribed and then gradually increased the medication...it took hours to get him calmed down. When the hospice nurse came he told me I should have started with the HIGHER dose and decreased the medication as he got calmer.
I mention this so that some of you that are using the drugs to calm your spouses, you may want to check to see what is the highest dose you can use and ask your dr. about starting high and then decreasing. I think many of us, including me, are afraid to give them the highest dose possible.