My mom lives with me and is in the mid to late stages of AD. Her outbursts and tears are getting harder and harder to control. Last night nothing seemed to work. Normally my mom is asleep by 8:30 and sleeps deeply for 14 hours. It took till 1:15 a.m. before I could get her asleep. That was after 2 mg of Haldol, 4 mg of Ativan and 10 mg of Ambien. Any thoughts or suggestions?

If this is a continuing problem, you might want to ask her doctor about different meds. Seroquel or Risperdal work for a lot of people.

I second Seroquel. It's very commonly prescribed by doctors with expertise in treating people with dementia who are highly agitated. And it doesn't tend to zombify them or cause other problematic side effects, unlike Haldol in particular.

It's often given in combination with an antidepressant like Celexa, which also has very few side effects in most people.

Dear Angela L,
Hello and Welcome to the AD Message Boards.

I'm sorry to hear about the problem with your Mom. Please, contact her doctor for a medication evaluation and check-up. This sometimes needs to be done fairly often when a person is not stable on their meds.

I know it is difficult. If you need immediate assistance, please call the 24/7 AD Helpline @ 800-272-3900.

Again, welcome. You are NOT alone. We're here!

It seems alot of meds that would knock an ordinary person out cold have little or no effect on an AD patient.
My dad walked through -Haldol-Ambien-Ativan-Risperdal. I felt like I needed a tranquilizer gun for elephants sometimes.
I never tried Seroquel but that would have been my next choice.
All I had was a guy who still wanted to walk and TRY. Those were some bad nights.
Definetely talk to your Doc and find what will work for him..

2 mg of Haldol, 4 mg of Ativan and 10 mg of Ambien.

OMG
You need to have your mother under the care of a doctor who has expertise in treating dementia. Please call your local Alzheimers Chapter and get names of dementia experts in your area.

My MIL had no relief with Xanax, Ativan or the sleep aid Ambien...they had the opposite effect most of the time...in the beginning of the AD and she couldn't sleep, her GP recommended Benedryl...DO NOT use it...way, way, way bad...

She ended up on Seroquel and it allows her to sleep through the night...over time the dosage has gone up...as soon as she starts getting more agitated than normal and not sleeping again and it lasts for more than a day or two, it's time for her to see her neurologist for a "tune up".

don't wait until she's out of control...I did that with MIL and it was soooo awful...I thought I could handle it or it would get better but she would have been admitted to the gero psych unit if there had been a bed available.

Good luck.

My god,,,thats alot of drugs for anyone to be on. Ambien works the opposite for some people that have AD,,at least it did with my Mom.

I would strongly urge you to call your Mom's dr and request something else,,such as Risperdal of Seroquel,,to help with her anxiousness,,and it will help her to be more relaxed and able to sleep,,without looping her out.

If this is a new behavior,,yet seems to be suddenly an ongoing behavior,,have her checked for UTI. I hope that you can get things straightened out and both your Mom and you can get some rest. Peace

Norbert reacted the way he did is because ...

Ativan recommended dose in AD patients is 0.5 mg 1 to 4 times a day. Ativan should be prescribed for short-term (e.g., 2-4 weeks) use only -- continuous long-term use is not recommended for anyone, including healthy young adults. The effectiveness in long-term (more than 4 months) has not been assessed by systematic clinical studies. The physician should periodically reassess the usefulness of the drug for the individual patient. Adverse reactions include amnesia, memory impairment, confusion, disorintation, depression, and suicidal thoughts. Paradoxical reactions, including anxiety, excitation, agitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, and hallucinations may occur. They are more likely in the elderly; and should they occur, use of the drug should be discontinued BUT see below.

Ativan produces increased CNS-depressant effects when administered with other CNS depressants such as antipsychotics (haldol) or sedatives/hypnotics (such as Ambien). Use, both alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression. Ativan causes dependence. Abrupt discontinuation should be avoided -- the list of withdrawal symptoms is very long -- and a gradual dosage-tapering schedule followed after extended therapy.



Haldol is an older, first generation antipsychotic. The starting dose is usually 0.125 mg., with a maximum of approximately 1-2 mg. Debilitated or geriatric patients, as well as those with a history of adverse reactions to antipsychotic drugs, may require less haldol than younger or healthier patients. This drug is best used for acute situations needing immediate control. It should not be used for long-term purposes. It can affect your ADLO's memory, and may have serious side effects such as extrapyramidal symptoms, tardive dyskinesia, and dystonia, which are likely to occur more frequently and with greater severity at higher doses.


Ambien is indicated for the *short-term* treatment of insomnia. The recommended Ambien dosage is 5 mg in elderly and/or debilitated patients, to decrease the possibility of side effects. These patients should be closely monitored. Impaired motor and/or cognitive performance after repeated exposure or unusual sensitivity to sedative/hypnotic drugs is a concern in elderly and/or debilitated patients. Side effects include depression, confusion, agitation, anxiety, decreased cognition, emotional lability, hallucinations, nervousness, and panic attacks. There is evidence from dose comparison trials suggesting a dose relationship for many of the adverse reactions associated with Ambien use -- the more you use and the longer you use it, the more likely the side effects will appear. The emergence of any new behavioral sign or symptom of concern requires careful and immediate evaluation.

Careful consideration should be given to the pharmacology of any CNS-active drug to be used with Ambien. Any drug with CNS-depressant effects (see both of the drugs above) could potentially enhance the CNS-depressant effects of Ambien.

Patients can become dependent on Ambien. It should NOT be stopped abruptly. Withdrawal signs and symptoms following abrupt discontinuation range from mild dysphoria and insomnia to a withdrawal syndrome that may include abdominal and muscle cramps, vomiting, sweating, tremors, and convulsions.

mom was on haldol then resperdol before she came to me. she was put on seroquel from 25mg sequentially thru increases to the current 200mgs. i love the fact that she wakes up happy and alert. it important that you be proactive on the behalf of your mom. i suspect she would wish to be minimally medicated as i believe my mom told her neurologist.

Angela...One of the most frustrating parts of this disease for us was finding the right combination of meds to give my husband some relief and be able to sleep. He did not respond typically to ANY medication and the ones that did have effect came with warnings against using them for dementia.

I have to agree that the combination and dosage your mom is on is unusual but knowing what we have gone through I would be the last person to recommend one drug over another. This combination of drugs is not working for your mom so it might be time to explore other options that have previously been mentioned.

I know how frustrated you must feel and hope that you find the right combination of meds for your mom so you can both get some relief.

JAB,

Thank you for posting your excellent write-ups on these three meds. Sometimes, when I see the same medical issues over and over, it is hard to summon the energy to generate a full, detailed explanation.

One of the most compelling problems with Haldol, is the development of IRREVERSABLE
tardive dyskinesia, that can occur after even a single dose. The longer the treatment, the more likely it will occur.

Angela L.

The problem here is, if the caregiver goes to the doctor with suggestions for more appropriate medications, and if he takes suggestions from the lay caregiver ("I have a medical degree and she gets advice from the internet"), he would most likely use wrong dosages and take months adjusting doses trying get it right. But the symptoms in Alzheimer’s change quickly, and an inexperienced doctor is unlikely to ever hit this rapidly changing target with appropriate treatment.

You also mention crying as a significant problem, but no antidepressants are prescribed. Your mother is in emotional distress that is not being addressed (regardless of whether this is caused by or increased by the inappropriate medications). This is quite simply, a form of medical abuse. Sorry to be so blunt. Depression in dementia is another issue that Family Doctors are not equipped to handle effectively.

Yeah, I know what you mean, Norbert. It is extremely upsetting how many caregivers struggle with unqualified doctors on top of everything else.

You cut directly to the chase: Angela's mom needs to see a neuro who is very experienced in treating dementia patients. As Kirsten says, it's not up to us to recommend what meds she should be taking, but we can point out that the current doctor simply doesn't understand the issues.

I just thought Angela might need a little further clarification as to why.

So. Even if Angela's mom is being seen by a neuro, it may not be the right neuro. They specialize, and those who specialize in migraines (like my husband's now-ex neuro did) or epilepsy, etc, typically don't know enough to treat someone like Angela's mom. In my experience, the best place to find a qualified doctor is an AD research center or a memory disorder clinic at a major research hospital or university med center. Whereabouts do you live, Angela?

Thanks for all of your helpful information. I did not mention in the original post that Mom has been in Hospice for the last six months. Most of her medicine decisions are made by a Hospice nurse whose primary goal is to make Mom comfortable in her "final days." There are two problems with that. One, Mom doesn't seem to be in her final days and secondly, she's not comfortable at all. She is anxious, irritable or agitated about 80% of her waking hours. About the only time she's at peace is when she's eating. She used to be on an anti-depressant (Lexapro) but the Hospice nurse discouraged its use because she is now taking Ativan. The nurse wanted to take her off Seroquel too but I really fought that because generally her 25 mg dose does seem to help her sleep at night. In recent weeks we have even upped her Seroquel to another 25 mg pill in the morning. I must add that I did not want Mom to be in Hospice but was strongly encouraged by the Alzheimer's Association to pursue a connection with them.

I think it is way out of line for a nurse to be making decisions about medicines, especially ones like these that can have the exact opposite effect.

I'd insist on speaking with the doctor, preferably a neuro who understands these meds. As you said, the goal is your mom's comfort, and that goal is obviously not being met. Maybe also talk to the supervising RN about a nurse making decisions such as these.

If you don't get *immediate* help that way, consider switching to a different hospice provider. There are usually multiple organizations offering hospice in any given location, unless you're in a tiny town. Some are better than others.

When my father was on Hospice,,,the "nurse" never decided on what "medications" he should have,,other than a liquid laxative,,the rest of medicating was up to my "Dad's Dr" who was in contact with Hospice at all times.

Once a Hospice Dr came to the house just to meet my Dad,,not long before he passed away,,and that was one time too many,,,she was and absolute idiot! Told my Dad how great it was that he can "die at home" in front of the tv,,,,

I was so mad,,,I escorted right out the door and told what an absolute ass I thought she was to say such a thing as she said to my Dad,,and I informed here that since starting Morphine,,he didn't watch the tv,,it distorted how things looked,,,probably like LSD from the 60"s.

Anyhow,,your Dr can still oversee your LO,,,,so either tell the nurse no more of her prescribing medications,,or you will have to call another Hospice and request someone that allows a "real Dr" to do the prescribing. Peace