Mom went into a nursing facility on May 15, 2008. Prior to this she was at home and on the following meds:
Lexapro 10mg in A.M. (depression/anxiety)
Omeprazole 20mg in A.M. (acid reflux)
Clonazepam .5mg in A.M. (tremors/anxiety)
Melatonin 6mg in P.M. (sleep/sundowning)
And things were on an even keel.

With the environment change, she was not sleeping at night. Her family physician prescribed an additional .25mg Clonazepam in P.M. without success. So we flip-flopped and gave her the .5mg Clonazepam in the P.M. and .25mg in the A.M. She slept great but had increased tremors and agitation during the day with the decreased A.M. dosage. So the dr upped the dose to .5mg in A.M. & P.M. with today being the 10th day of this dosage. She seems to have increased confusion, agitation, has become more unstable on her feet and has fallen several times. She keeps thinking she has a chair behind her and sits down anywhere. In addition, she has lost 15 lbs. in 1 month.

So strange that .75mg wasn't enough but 1mg is too much.

The facility requested an order from her physician to restrain her during times when the staff is dealing with other residents. My dad approved it as we don't want to deal with injuries/broken bones on top of the AD.

We're confused as to what direction to go with a med adjustment -- although she has been seen by the same GP for 30 years, he's not an expert in geriatrics or dementia. She has seen a neuro twice in 4 years. The Director at the facility has recommended a psychiatrist but mom is not able to verbalize anything so I don't really see the point. Our other option is the geriatric psychiatric ward at out local hospital.

In addition, mom is extremely sensitive to meds. She was not able to tolerate Aricept or Namenda. When she first entered the facility, she was given 25mg of Hydroxyzine for insomnia and it knocked her for a whammy -- very lethargic for 3 days.

Any input/experience on drug combos or what route to go with a med adjustment would be greatly appreciated.

THANKS!

The problem is the Klonopin (Clonazepam)

This is a benzodiazapine med. These meds cause sedation (risk of falls) and lose the therapeutic effect over time. They are strongly anticholinergic, meaning they reduce production of the neurotransmitter needed for thought. The result is increased confusion. Benzodiazapine meds are on the Beers list of meds that are inappropriate for the elderly. (and they are worse for people with dementia.)
Rule number 1 of dementa care, do not use meds that are anticholinergic, and especially, do not use Benzodiazapines. Because they are inappropriate for the elderly, medicare part D will not pay for them.

Benzodiazapines work on the same part of the brain and in the same way as alcohol, hence the agitation.

Your mother needs to see a neurologist who is an expert in dementia.

A dementia doctor would get her off the Clonazepam. Most will use trazadone to iniate sleep. If maintaining sleep is a problem, they might resort to Ambien, which is not a benzo.

If the antidepressant Lexapro (approved for generalized anxiety disorder) is not enough to handle the anxiety, a dementia doctor would add in Buspar.

If tremors are a problem to the person, a different seizure med should be used.

THANKS!!! a million Norbert. I had hoped you would respond.

The problem is that mom's neurologist is the one that initially prescribed the Klonopin. I am going to call the local Alzheimer's chapter today to see if there is a recommended dementia neurologist in our area.

Your response makes absolute sense.
Thanks again!

I agree. Lose the Clonazepam. We had a horrible expreience with it.

Put her on Razadyne. When the SNF took my mother off Razadyne by mistake, all hell broke loose.

I don't know the acid reflux med she takes. We are using Prilosec.

SNF's always recommend a psych consult - about as helpful as an dermatologist....and most likely harmful.

Elderly have the opposite reaction to sleep meds so it is just so difficult to help them.

Have heard varying reports on Lexapro at low doses. Was going to look into it for my mother but we haven't had success with that class of drugs historically.

Pat

Has anyone had any experience or have any information on this...

Alzheimer's Agitation Eased by Use of Synthetic Marijuana

"Alzheimer's patients exhibit reduced agitation when they use a synthetic version of the active ingredient in marijuana, according to researchers at Monmouth Medical Center in Long Branch , New Jersey .

In turn, say the researchers, family caregivers also benefit from the effects of the synthetic drug which contains dronobinal because their Alzheimer's afflicted loved ones are calmer.

"Our results show dronabinol ( also known as Marinol ) is an effective treatment for behavioral agitation in patients with Alzheimer's and may ultimately help reduce the stress often experienced by caregivers," lead investigator Dr. Joel S. Ross sa id in a statement announcing the findings. The findings were presented at the American Society of Consultant Pharmacists' 34th annual meeting earlier this month in San Antonio .

Ross added: "While difficult for the patient, the effects of agitation can greatly impact the emotional and physical health of family members and caregivers. By reducing patients' agitation, caregivers are able to focus more time and energy on their patients' overall well being."

Dronabinol, which is marketed as Marinol, is synthetic delta-9-tetrahydrocannabinol (delta-9-THC). Delta-9-THC also is a naturally occurring component of Cannabis sativa L (marijuana). Dronabinol has been approved by the Food and Drug Administration (FDA) for the treatment of anorexia in patients with HIV/AIDS and for the treatment of nausea and vomiting associated with cancer chemotherapy. Recent clinical tests also have examined dronabinol's potential to relieve symptoms of multiple sclerosis.

An estimated three out of every four Alzheimer's patients are affected by agitation, which is cited as the most common behavioral problem in Alzheimer's patients. As a result, the behavior of Alzheimer's patients is often marked by physical or verbal abuse, pacing, restlessness, screaming and repeated requests for attention. These traits take a toll on family caregivers who are closest to the patient.

In fact, most family caregivers - nearly 80% -- report their own high stress levels and depression, according to the Alzheimer's Association. It is thought most of these afflictions are caused by caregiving for the Alzheimer's patient.

The results derived from a multi-center, open label, randomized, parallel-group study of 54 patients conducted by researchers at Monmouth Medical Center , an affiliate of the Saint Barnabas Health Care System, a 527-bed community teaching hospital located in Long Branch, New Jersey . "

http://ww2.caregivershome.com/news/article.cfm?UID=347

Pat

I am 58 and taking both Razadyne and Klonopin. My specialist has taught me to pay attention to the times I am withdrawing from the meds as well as when they take effect. Your mother can be watched for this withdrawal time, late afternoon for meds taken at bedtime. That might explain the dosages and when they're needed. A short time in a hospital that will fine-tune this might be worthwhile.

OK, I finally feel we are on the right track. Were fortunate enough to get Mom in to a neurologist in Mpls on a cancellation. Not a dementia specialist on such short notice but seems to know his stuff. He reduced her klonopin by 50% over the course of the next 2 weeks and then will again cut it by 50% for 2 weeks after that. In addition, he put her on trazadone for sleep which is working great!

We have been to hell & back the last 3 days with her ... hyper, running, no appetite, agitated, etc., etc. Withdrawal symptoms, I'm sure. Finally by late afternoon today she has settled down, ate all her dinner and is somewhat lucid.

That klonopin had an EXTREMELY adverse effect on her.

Norbert you are my HERO!!!!

TRY THE MEDICATION TEGRETOL OR DEPAKOTE IT HELPS STALIZE THERE MOOD joyce559@juno.com