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Tuesday, May 21, 2013
Drug Treatments and Side Effects
I give my 90 year old mother aricept 10mg at bedtime. She had restless nights so I changed to morning dose. She had very bad mornings, dizzy and restless, so I changed back to evening dose. The dreams and calling out has come back. She can call out 3 to 4 times through the night, which is hard going on the caregiver. She is very apologetic for calling. I never noticed this when she was on 5mg. Would it be better to change back to morning, or try going back on 5mg?
Also, she has been very happy since taking cipralex 5mg, but the consultant said she would benefit more by increasing the cipralex to 10mg, which she has been taking for 5 days, but I wonder was increasing the dose really necessary? Thank you.
Regarding the Aricept, on occasion we try 5mg twice a day to minimize peak effects. Aricept has a long half-life, so this is rarely necessary, but you could try it. If that fails, go back down to 5mg once a day or try one of the other cholinesterase inhibitors to see if it is better tolerated (Razadyne may have only modest effects on sleep).
Regarding the Cipralex, we have found that SSRIs such as this (Selective Serotonin Reuptake Inhibitors) are not only helpful for anxiety and depression, but also for irritability in dementia patients. Whatever dose provides adequate response in this regard is adequate. If you are satisfied with the response at 5mg, then it would seem reasonable to stay there. If not, go to 10mg.
David Q Beversdorf, MD
Assistant Professor of Clinical Neurobehavior and Neurology
College of Medicine
The Ohio State University