Restraint should be used when medicating Alzheimer’s patients

It is very common for patients with Alzheimer’s disease to take medications for other health problems, such as high blood pressure and bladder incontinence, in addition to treatment for their symptoms of Alzheimer’s. However, taking multiple medications at the same time can increase significantly the risk of adverse negative effects, which in Alzheimer’s patients is often exacerbated. Therefore, it is important to consider which drugs to avoid or use as sparingly as possible when they are prescribed or given to patients with the disease.

It is vital for the caregivers and the health providers to keep in mind that in general patients with Alzheimer’s disease are more sensitive to the side effects of any given drug. For this reason, the rule of thumb for these patients is always to prescribe or administer an additional drug only if it is truly deemed necessary and most importantly always to use its lowest possible dosage. By following this principle, we will keep at bay or at least minimize as much as possible some unwanted and potentially serious side effects.

Here is a list of some common drugs that needs special attention before administering to an Alzheimer’s disease patient.

Antidepressants
Certain antidepressants, such as amitriptyline (Elavil), nortriptyline (Pamelor), and imipramine (Tofranil), can worsen cognitive function and cause sedation. These drugs have anticholinergic effects, meaning that they can further suppress the activity of an important substance that is produced by our body and the brain called acetylcholine. The reason is that in patients with Alzheimer’ disease the activity of this chemical is already significantly reduced. Therefore, the subject taking one of those antidepressants could experience serious side effects beside the worsening of cognitive function such as dizziness, dry mouth, difficulty swallowing, vision problems and severe constipation. To avoid these side effects and for low mood and irritability in Alzheimer’s, antidepressants such as citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) may be more appropriate.

Sedatives and sleep aids
Certain sedatives or hypnotics, such as benzodiazepines and barbiturates, can cause drowsiness, confusion, increased cognitive impairment, slowed reaction time, and worsening balance, leading to falls. Sleep aids can also have similar effects. Examples of sedatives to avoid include diazepam (Valium), temazepam (Restoril), triazolam (Halcion), and sleep aids zolpidem (Ambien) and eszopiclone (Lunesta).

Antipsychotics
Antipsychotics, such as haloperidol (Haldol), risperidone (Risperdal), and olanzapine (Zyprexa), are sometimes used to treat behavioral symptoms in Alzheimer’s patients, including agitation, aggressiveness, and hallucinations. However, these drugs can cause serious side effects, such as severe sedation, confusion, and even motor problem such as slow movements, tremor at rest, muscle rigidity (Parkinsonian-like symptoms). For these reasons, they should not be used routinely, and if needed, the minimum effective dose should be used for the shortest possible time, under the supervision of an experienced clinician.

Over-the-counter medications
Alzheimer’s patients should also be cautious when taking over-the-counter medications that contain diphenhydramine (Benadryl), an antihistamine used as an anti-allergy medication. However, this drug can cause drowsiness and may lead to confusion and worsen cognitive function. It is important to remember that diphenhydramine is very frequently found also in sleep aids and in “nighttime” or “PM” versions of several popular pain relievers, as well as cold and sinus remedies.

In conclusion, Alzheimer’s patients are particularly vulnerable to the side effects of various medications. It is important to consult with doctors and pharmacists to learn about the benefits and potential adverse effects of any new treatment therapy, including seemingly benign over-the-counter remedies.