My mother (see the Doppelganger thread in the Alzheimer's category) is now taking her meds. There are dosage and potency issues. Any advice?

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My mother (see the Doppelganger thread in the Alzheimer's category) is now taking her meds. There are dosage and potency issues. Any advice?

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When the psychiatrist originally prescribed an antidepressant and a medication to treat mood swings, she refused to take them. More recently, however, I have succeeded in convincing her to. I was concerned about her taking pills that may be losing potency--the prescription was filled mid-October--and she got strangely belligerent yesterday and I thought she might have taken a second dose (she took a first dose of the pills hours early). But the expiration on both meds is about a year from now...

Alzheimer's & Dementia Medications

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My Mom's sister had in fact insisted I should hand her the pill to take. But when I did that my Mom angrily threw the pill on the floor. She has not taken one since. The doctor told me over the phone, later, I should try to put the medication in her food. How I will do this when she is sitting there (and always facing the plate or bowl) I do not know.

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Dougie; Can't you place the bowl on the counter in front of you, out of mom's sight? And then bring it to the table?

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Please keep in touch with the psychiatrist. You should be able to call him/her with concerns. Maybe the drug he prescribed is causing her problems. When I as in my thirties I had antidepressants that gave me thinking, concentration and memory problems. Just imaging those drugs with an older brain.

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If your mother goes to the hospital and is an inpatient for 3 nights, she'll be eligible for Medicare-paid rehab. Once she's there, you explain to discharge planning that it's becoming impossible for you to get mom to be compliant with meds and that she is unsafe at home.

They will work with you to find a placement and to apply for Medicaid if that's needed.

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I will need support from family members and even the lawyer (ref.: the key) before I can do this.

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If she gets sicker, you will call 911 and have her taken to the ER. I think she needs a higher level of care than you can giver her at home.

Have you thought about a care facility?

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Hope you're feeling OK, Dougie.

I wonder if other people on this forum might have ideas about how to convince your mom to take her meds. I'm wondering if it's possible to tell a fib and say it's a vitamin or....?

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I have had the thyroidectomy--because the gland became cancerous. She does not know the gland was removed or that it had cancer--she developed breast cancer in 1988 and she had a mastectomy. But what I am concerned about is that she will continue to refuse to take the medication and that the infection will spread...

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Aww, i am sorry to hear this, Dougie! How are you holding up? How is your health these days?

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The matter has taken a dramatic--and unfortunate--turn. My mother started complaining about a pain in her mouth...because of my own preoccupations (including an MRI of my own) I was delayed in contacting her dentist's office. As it turned out, she did not have a toothache and was referred to her physician's office and that of an oral surgeon. She refused to fill out the forms at the oral surgeon's office, and now will not take the antibiotic (amoxicillin) prescribed by the physician. In fact she threw that capsule I handed her to the floor.
She is not scheduled to return to her dentist's office (where an oral surgeon is scheduled to treat her) until Wednesday next week.

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I saw an entry on Wikipedia about Quetiapine, that it should NOT be given to patients with dementia. My mother was originally diagnosed, after a series of tests in a hospital (including an MRI), as having "unspecified dementia." She has been taking the 25-mg. tablets daily--first one, then two, then three, at the doctor's direction. Since March of this year.

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Hmm, did she explain why she took 2 last night, and 1 this morning, not all 3 at night together as the doctor prescribed?

I think since she can't reliably follow instructions like this, you have to give her the correct number of tablets, hand her some water and watch her swallow them. The poor lady seems to be too prone to confusion to be trusted to take her meds correctly, consistently.

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Update: The psychiatrist has written a new prescription, with directions for my mother to take THREE Quietapine tablets--same potency--per night. I set them out for her last night; she took two last night, and one this morning; all as I was watching. (Her sister said I should watch to see that she IS taking the meds; I have never had any reason to believe that she has disposed of them any other way.)

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No your meds are fine. I imagine the mood was your mom just adjusting to finally having some needed meds in her system. Oh boy, no one could get my mom to take her meds! Then she’d take too many, she’d always hide them and I never did get them all together to work out a schedule for her. That’s just one reason she’s in AL now.

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Glad to hear this, Dougie!

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Since that last item she has apparently continued to take the pills with no problem. Last night, when she was going through an episode of apparent "Capgras delusion"--waiting for my "clone" to return--I gave her a glass of water and the pills. She accepted the glass of water; swallowed the pills without batting an eye; then took a drink of the water. Apparently whatever disdain she had for the medication she has no longer.

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I must retract my last statement: She did not take the medication at all last night... She asked me an unintelligible question before retiring for the night, about "doctor" and "25"; I waited for the rest of the sentence, but she got annoyed that I did not answer her and walked away in a huff. Later on last night I saw an empty vial for another medication (with "25" anything not indicated anywhere on the label) set out on the table in the kitchen, near where the regular meds are kept.

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Is your mom less agitated these days, Dougie?

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I asked her own physician, who said it doesn't really matter if she takes them in the morning, but I try to avoid letting this happen. Also, the psychiatrist who prescribed the medications has advised me to have her take two of the 25-milligram Quietapine tablets, instead of just one, per night. So far she has done this twice in as many days, again without argument.

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She takes the pills, but I often cannot get her to do so at night before she goes to bed--usually within an hour or so after dinner. So I put the pills on a Kleenex and set them on the counter in the bathroom, next to a glass of water; I figure that sooner or later she'll have to use the bathroom and see the pills and take them, during the night. But what usually happens is that they are still there in the morning, with the water. I bring them to her, and she takes them then. Does this matter?

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Situation out of the ordinary: My Mom usually takes the pills, as mentioned above, sometime shortly after dinner, because she retires for the night so early. Last night she went to bed very early and did not take the pills at all. I left them on a Kleenex in the bathroom as a reminder, knowing she gets up at odd hours to use the bathroom. This morning she had not touched them; but after I got up she approached me, where I was sitting near the water cooler, with the pills and an empty glass. I got the message. I filled the glass with water; she took the pills and drank some water. Better late than never, I suppose.

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I must point out that she had been to the psychiatrist twice after he prescribed the medications, without her having taken them; and to at least two appointments with her own doctor, who also urged her to; and also a visit to the ER in a hospital when she had a strange crying episode ("I wanna die...") and they ran a series of tests on her, including an MRI, resulting in the "unspecified dementia" diagnosis. The ER doctor also urged me to get her to take the medication. When the urine test indicated a urinary tract infection and her doctor issued a prescription for it, I considered this the perfect lever to get her to take the other medications as well.

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Dougie, please make sure that your mom does not have access to these meds other than the prescribed dosages.

It's very important that you tell the psychiatrist that she only started taking them in midMarch, not when prescribed in October. The second med you mentioned is the generic version of Seroquel which is an atypical antipsychotic. It can be a miracle drug for some folks with depression.

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She was quite passive today, unlike yesterday. She did not try to take the medication early...the UTI medication ran out yesterday and no refills were indicated. She does not have an appointment with the psychiatrist until Saturday, April 7. I intend to continue to get her to take the medications--Mirtazapine and Quetiapine fumarate--in the evening...she has a tendency to go to sleep shortly after dinner, in her chair in the living room. She may wake up, not too long after that--maybe within a couple of hours--and return to her bedroom. She drinks other things, including coffee and milk, during the day.

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I do hope you realize Mirtazapine is supposed to be taken shortly before bedtime. If your mother likes to read when she climbs into bed then she should take it when she climbs into bed, not earlier. I will presume she was put on 7.5 mg as an intro dosage, as the doctor will increase after eight weeks of usage. Please tell the doctor she has resisted taking the drug up until now.

In reference to Cipro and Bactrim you need to make certain she has 6 8oz glasses of water a day at a minimum, as Bactrim can cause kidney stones or renal impairment which will make your mother loopy. Flush her kidneys well as she can get dehydrated.

My Mom got real loopy and Sundowners after her UTI Drugs, very common!

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Mirtazapine.

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Dougie,

What antidepressant did your mother start taking?

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Yes, two doctors, at the same facility and in consequence of her same visit.

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Dougie; Did two different doctors prescribe the two diff. meds?

Sundowning, at least for my mom, was really never about what time of day it was. We just noticed that she was different in the early evening when my SIL visited after work. She would insist that she had a terrible communicable disease, etc. When I would call her in the AM, nothing was wrong.

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The episode was in mid-afternoon, here in Gardena, CA. Yesterday (Saturday). The Bactrim was 6 pills, the Cipro 14. (Correction: just after 5 p.m.; but sunset here is just after 7 p.m. what with Daylight Saving time.)

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What do you mean "very limited amount of each in the prescriptions?" She was taking BOTH Bactrim and Cipro?

Sundowning is a behavioral issue that affects people, mostly those with dementia. In the late afternoon/early evening, they appear to have delusions/hallucinations that are not present during the daylight hours. Can you Google "sundowning"?

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My mother (see the Doppelganger thread in the Alzheimer's category) is now taking her meds. There are dosage and potency issues. Any advice?

36 Answers

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