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Thursday, December 5, 2013
Multiple Medications and Alzheimer's Disease
I am currently caring for my grandmother (age 78), who is in the mid to severe stages of Alzheimer`s Disease. She is currently taking Exelon, Namenda and Zyprexa. After researching these meds on the internet, I see that most sites suggest that Zyprexa should not be used for behavioral problems with older adults with dementia, and has other cautions regarding older adults with dementia. My question is, does my grandmother really need to be taking all 3 of these medications everyday? And is Zyprexa helping or hurting her? I can provide more information if necessary. Thank you.
In most Alzheimer's disease patients in the moderate to severe stages, we definitely feel that Exelon and Namenda are both useful. Exelon has been approved for moderate stage disease and Namenda for moderate to severe stage disease. These medications are designed to slow the clinical decline of cognitive (memory, word finding, ...) symptoms and slow the loss of functional abilities. Both should be taken twice a day every day or they will not be useful. They work in different ways and are thought to be additive in their effects. We suggest taking both to our Alzheimer's patients.
Zyprexa is designed to be helpful for behavioral symptoms of suspiciousness, false beliefs, hallucinations, and aggression. If your grandmother does not have these symptoms, or they have improved and are no longer present to any significant degree, then I would ask her doctor to see if she would be a candidate to taper off Zyprexa. Although there can be side effects and problems associated with the use of Zyprexa (increased sugar or triglycerides and other issues) or any of the other atypical antipsychotic class of drugs, there are very few to no better alternatives if patients have the behavioral symptoms mentioned above.
Douglas W Scharre, MD
Clinical Associate Professor of Neurology
Clinical Associate Professor of Psychiatry
College of Medicine
The Ohio State University