Tuesday, July 10, 2007

Sundowners, Namenda, And Aricept

This post was originally going to be a comment response to suggestions made by reader Proud Progressive in the choking chicken post. But after I read it, I thought the info is worthwhile for everyone and I don't want anyone to miss it if it's buried in a comment. So here it is as a stand alone post.

First, thanks PP for the feedback and suggestions! And h/t to Fungjigirl on Flickr for the photo.

I don't think Mom's night time escapades are related to sundowner symptoms because that also happens sometimes. For those of you unaware, many Alzheimer's patients have an odd state of confusion when the sun begins to go down....hence "sundowner." It is always at sundown! Here in the Northeast U.S., in the winter it is about 4 o'clock and now in the summer months about 8. The script of those episodes with my mom revolve around who owns this house, where is she, she needs to go home, etc.

As I've mentioned in previous posts, I've cut back on her brain chemistry drugs in order to give the new Alzheimer's stuff a chance to work with a minimum of competing drug effects. I want to be able to say that the drug didn't work because it didn't work and not because it was interacting with the Paxil or Xanax. In light of these upsets in the middle of the night, it may be worthwhile going back to a half pill of Xanax before bedtime. Or, now that I think of it, maybe something less brain chemistry altering such as Tylenol PM.

She is tolerating the Namenda fine although not with much improvement in memory. I read on another blog that if Namenda doesn't work on its own that many doctors are prescribing Aricept as well and that combination works better for some.

Of course, I'm just saying what I'm looking into here and all people are different. Consult your doctor for your individual circumstances. Now that we have Namenda under our belt, I'll be asking our doctor about Aricept at our next appointment in early August.


Anonymous said...


Namenda normally works with doses of 10mg twice a day --and, you are right, we combine it with Aricept. We start with 5mg at bedtime for one month then we increase it to 10mg at bedtime. Aricept is normally recommended for mild or early stages of dementia. And Namenda for moderate to severe dementia.

Remember there is no cure for dementia but the medication tends to delay and improve some symptoms of the illness. Also all the benzos such as Ativan, Xanax, Valium, etc. tend to impair memory. And the antidepressant Paxil has an anticholinergic effect (including Tylenol PM which contains benadryl) which means it tends to also impair memory.

Personally, instead of prescribing Xanax, I like to prescribe Buspar that helps with anxiety and agitation. And I like to prescribe Zoloft instead of Paxil.

Take care. We miss you.
Dr. O
-typed my M ;)

Anonymous said...

Dad is now taking this cocktail, and we are keeping our fingers crossed. He seems to be tolerating it fairly well, but started him on a smaller dose to avoid the nausia side effect. I should have my mom get him a scrip for Xanax as well, if not for him, for her! :)

Anonymous said...

My husband, age 80, was diagnosed in May, 2005 with dementia/alzheimers. Dr.(neurologist) started him on Aricept and he is still on it. He tried Namenda (the doc) but suddenly my husband forgot how to
write. I read about Sundowners someone wrote about. I have noticed a change in my husband at night. He needs to take his meds
and go to bed earlier. He has crying spells. He has lost memory of where things are in the apt.
We will see neurologist l2/l8/08
and I will discuss. We have been
married 55 years and had just retired. I am thankful for the posts that I read,, as I don't have anyone to talk to much at this time that understands what both of us are going through.

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