Drug Induced Dementia: Proceed with Caution David M. Angaran, MS, FASHP, FCCP Clinical Professor University Florida College of Pharmacy Angaran Associates, LTD
Presentation Objectives • Explain how and when this may happen. • Present examples of drug caused conditions and symptoms that worsen dementia. • Provide drug examples that can worsen dementia • Describe how to reduce the chance of this happening.
Dementia • Mental condition which represents a deterioration from previous function in at least three of the following functions: • Language, understand what you are seeing, memory/reasoning and emotion • Includes: • Alzheimer’s, Mild Cognitive Impairment, Lewy Body, and Vascular
But First a Reminder“The SUNNY side” Medications can be vital to a better life for the caregiver and patient • Slow progression and relieve symptoms of dementia • Treat diseases that worsen dementia • Depression • Pain • Anxiety
Drugs make Dementia Worse:How? • Direct acting on the brain • Delirium Dizziness • Agitation Hallucinations • Memory Loss Depression • Indirect acting on the body • Constipation Blood sugar • Urinary retention Dehydration
How often does this happen? • No ONE really knows • Patients with mental changes • 10-30% thought to be drug induced. • Adverse drug effects emergency room visits for >65 yr. (Gurwitz JH et al. JAMA 2003;289:1107-1116) • Dementia related • Neuropsychiatry 5% • Falls, dizzy, 8.5% • If it happens to you or a loved one it is 100%.
Who is at greatest risk? • Already demented or brain injury • Frail elderly, the older the more susceptible. • Has other disease states • Taking more drugs • Taking drugs unknown to physician or pharmacist • Prescription (another Dr, another Pharmacy) • Over the counter (OTC) eg. Sleep meds. • Herbal
When can it happen? • When a new drug is started. • >65 yr. Go low and slow • When the dose is changed. • When another drug is added, stopped, or changed • When a drug is stopped • Treated condition can get worse • Withdrawal side affects eg. Valium, antidepressants
What Can YOU Do To Help?“Talk with your Dr. and RPh” • Must know every drug the person is taking. • OTC: Benadryl • Herbal: St. Johns Wart • Home remedy • Nutritional supplements eg. Ephedrine • Alcohol • Must know HOW the drugs are being taken. • How much • How often • How regular • How long
What Can you Do to Help?“Be Informed” • Keep a Drug log. Name, Use, Directions. • Do NOT stop, start or change drug regimen without consulting your Dr. or RPh. • Know what trouble looks like and what to do. • Side effects • What action to take • Ensure the drugs are taken as prescribed. • What to do if you miss a dose. • Ask for a “Medication Review” at regular intervals.
Drugs that MAY worsen Dementia • Anti Cholinergic Alternative • Elavil- antidepressant Paxil • Benadry-allergy Claritin • Demerol-pain Percocet • Mellaril-antipsychotic Risperdal • Anti anxiety • Valium Xanax • The list goes on and on……….
Nursing Home Do NOT use list Pentazocine (Talwin): Confusion, hallucinations, dizziness, lightheadedness, euphoria, and sedation Long-acting benzodiazepines(Librium): Sedation, drowsiness, ataxia, fatigue, confusion, weakness, dizziness, vertigo, syncope, psychological changes Amitriptyline(Elavil)Anticholinergic and sedating properties, which can result in confusion, delirium, or hallucinations Doxepin(Sinequan):Anticholinergic and sedating properties, which can result in confusion, delirium, or hallucinations Meprobamate(Equanil): Highly addictive and sedating, which can result in drowsiness and ataxia Lisi DM. Medscape Pharmacotherapy 2000;2 www.medscape.com adapted
Nursing Home Do NOT use list(cont) Digoxin(Lanoxin): Toxic signs include headache, fatigue, malaise, drowsiness, and depression Methyldopa(Aldomet) May exacerbate depression Chlorpropamide(Diabenese) Hypoglycemia, which can result in altered mental state (confusion, amnesia, coma) GI antispasmodics(Bentyl) Highly anticholinergic properties, which can result in confusion, delirium, or hallucinations Barbiturates(Seconal) Highly addictive and sedative, resulting in drowsiness, lethargy, depression, severe CNS depression
Nursing Home DO NOT use list(cont) Muscle relaxants(Robaxin): Anticholinergic properties, which can result in sedation, weakness, confusion, delirium, or hallucinations Antihistamines(Chlortrimeton): Anticholinergic properties, which can result in confusion, delirium, or hallucinations Reserpine: Depression, sedation Diphenhydramine(Bendaryl) Highly anticholinergic, which can result in confusion, delirium, or hallucinations Indomethacin(Indocin) Headache, dizziness, vertigo, somnolence, depression, fatigue Disopyramide(Norpace): Strongly anticholinergic properties, which can result in confusion, delirium, and hallucinations
Drugs that May worsen Dementia(cont) • What is IN that over the counter (OTC)? • DON’T trust the name: Excedrin/Excedrin PM • Unfamiliar contents: Ask and let them know why you are asking. • Cautions on the labels are NOT enough. • Heavy machinery and driving cautions • Sedation and excitement
Mental status has suddenly gotten worse;what will your Dr. Do? • Drug related questions: • Could it be caused by a drug? • What are ALL the drugs the patient is taking? • Has any drug been started, stopped, or changed? • How are they TAKING these drugs? • Actions that may take place. • Medication review • Stop, substitute, increase/decrease dose
Getting Help • Your Pharmacist • Consultants for nursing homes and assisted living homes. • Drug needs at ONE pharmacy • Complete drug profile • Get to know you and your situation • Rx medication information sheet NOT written for people suffering from dementia • Web sites • www.medscape.com Medscape • www.intelihealth.com Harvard Medical School
REMEMBER • Medications can be VERY beneficial for you and your loved one. • Keep all your healthcare providers informed about what and how drugs are used. • Keep a record of all the drugs. • Know what “trouble” looks like and what to do about it.