New drugs are appearing all the time and you may need to ask your doctor what type of medication is being prescribed. The generic name is given first, followed by some of the common proprietary (trade) names. This list includes the names of many (but not all) of the different medications available.
Sodium valproate (Epilim also Valpro) Carbamazepine (Tegretol).
However, in higher doses these cholinesterase inhibitor drugs may occasionally increase agitation and produce insomnia with nightmares. Evidence suggests that these drugs also have slight beneficial effects on behavioural symptoms, particularly apathy (lack of drive), mood and confidence, (and in people with dementia with Lewy bodies) delusions and hallucinations. Taking cholinesterase inhibitor drugs may therefore reduce the need for other forms of medication.
It is important to address these factors in the first instance before resorting to medication. By minimising distress and agitation it is usually possible to avoid the use of drugs altogether. If, after trying non-drug treatments, drugs are considered to be necessary remember:.
Before any of the drugs mentioned on this page are prescribed it is essential to ensure that the person with dementia is physically healthy, comfortable and well cared for.
This may be irreversible, but is more likely to disappear if it is recognised early and the medication causing the problem stopped. If taken for long periods some of these drugs can produce a side-effect called tardive dyskinesia, which is recognised by persistent involuntary chewing movements and facial grimacing. Antipsychotics (see above) are often used for severe or persistent anxiety.
If the person does wake up during the night despite sedation, increased confusion and unsteadiness may occur. If excessive sedation is given at bedtime, the person may be unable to wake to go to the toilet and incontinence may occur, sometimes for the first time.
Researchers around the world are working to develop effective treatments for dementia, and eventually to find a cure. Much of this work is focussed on Alzheimer’s disease, the most common form of dementia.
Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Reminyl) Memantine (Ebixa).
Amisulpride (Solian) Chlorpromazine (Largactil) Escitalopram (Lexapro) Fluphenazine (Modecate) Haloperidol (Haldol, Serenace) Moclobemide (Auroix) Olanzapine (Zyprexa) Promazine (Promazine) Quetiapine (Seroquel) Risperidone (Risperdal) Sulpiride (Dolmatil, Sulparex, Sulpitil) Trifluoperazine (Sazine) Zuclopenthixol (Clopixol).
In the early stages they are usually a reaction to the person’s awareness of their diagnosis. Symptoms of depression are extremely common in dementia. In addition, both types of depression can be treated with antidepressants, but care must be taken to ensure that this is done with the minimum of side-effects. In the later stages of the illness, depression may also be the result of reduced chemical transmitter function in the brain. Simple non-drug interventions, such as an activity or exercise programme, can be very helpful.
Some studies have suggested that sudden death may be a rare complication of giving older antipsychotics to people with dementia with Lewy bodies or Parkinson’s disease. Side-effects can include excessive sedation, dizziness, unsteadiness and symptoms that resemble those of Parkinson’s disease (shakiness, slowness and stiffness of the limbs). If such a person must be prescribed an antipsychotic, it should be done with the utmost care, under close supervision, and should be monitored regularly. Some antipsychotics are particularly dangerous for people with dementia with Lewy bodies or Parkinson’s disease, being very likely to cause severe stiffness.
Generic names are used in this information sheet – at the end you will find a list of drugs in common use, giving both the generic and proprietary names. All drugs have at least two names – a generic name, which identifies the substance, and a proprietary (trade) name, which may vary depending upon the company that manufactured it.
Many of the drugs commonly prescribed for people with dementia can cause excessive sedation during the day, leading to an inability to sleep at night. Hypnotics are generally more helpful in getting people off to sleep at bedtime than they are at keeping people asleep throughout the whole of the night. Increased stimulation and activity during the day can reduce the need for sleep-inducing medications (hypnotics) at night. They are usually taken 30 minutes to one hour before going to bed. Sleep disturbance, and in particular persistent wakefulness and night-time restlessness, can be distressing for the person with dementia and disturbing for carers.
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Anticonvulsant drugs, such as sodium valproate and carbamazepine, are sometimes also used to reduce aggression and agitation.
Continuous treatment in excess of two to four weeks is not advisable because dependency can occur, making it difficult to stop the medication without withdrawal symptoms. Short-lived periods of anxiety, for example in response to a stressful event, may be helped by a group of drugs known as benzodiazepines.
However, while there is some indication that atypical antipsychotics such as risperidone and olanzapine can be beneficial, it is important to balance the potential benefit against possible side effects, which may include increased risk of stroke and death. A new generation of antipsychotics called atypical antipsychotics may be less prone to produce troublesome side-effects.
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Whichever drug is used, treatment with antipsychotics should be regularly reviewed and the dose reduced or the drug withdrawn if side effects become unacceptable. Excessive sedation with antipsychotics may reduce symptoms such as restlessness and aggression at the expense of reducing mobility and worsening confusion.
Lithium carbonate (Lithicarb, Quilonum).
The long term use of benzodiazepines for neuropsychiatric symptons is not recommended, but they have a limited role in the short term treatment of agitation in people with dementia (Woodward 2005). There are many different benzodiazepines, some with a short duration of action, such as lorazepam and oxazepam, and some with longer action, such as chlordiazepoxide and diazepam. All of these drugs may cause excessive sedation, unsteadiness and a tendency to fall, and they may accentuate any confusion and memory deficits that are already present.
Whenever possible, the person should be helped to lead an active life, with interesting and stimulating daily activities. Behavioural and psychological symptoms of dementia can often result from unreported pain, other illnesses, drug interactions and environmental factors.
Memantine is the most recent antidementia drug to be developed. It works in a different way to the anticholinesterase drugs and is the first drug approved for those in the middle to later stages of Alzheimer’s disease.
The use of such drugs should be regularly reviewed by the doctor. Hypnotics are often best used intermittently, rather than regularly, when the carer and person with dementia feel that a good night’s sleep is necessary for either or both of them.
For these reasons their use by all age groups is in decline and they are not recommended for use in people with Alzheimer’s disease except when they have found to be the only effective treatment for previous depressions in that individual. They might also cause a dry mouth, blurred vision, constipation, difficulty in urination (especially in men) and dizziness on standing, which may lead to falls and injuries. Tricyclic antidepressants, such as amitriptyline, imipramine or dothiepin, which used to be widely used to treat depression, are likely to increase confusion in someone with dementia.
The new generation of cholinesterase inhibitor drugs (donepezil, galantamine and rivastigmine) were originally developed to improve memory and the ability to carry out day-to-day living activities in people with Alzheimer’s disease.
What may occur is that mental function is slowed in people with dementia who take antipsychotics so that they appear to have deteriorated, though this deterioration may be reversible if the drug is ceased. Some studies have suggested that antipsychotic use may be associated with faster cognitive decline in people with dementia, but this finding is controversial and not supported by some other research.
Newer antidepressants are preferable as first line treatments for depression in dementia. Drugs such as fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram and escitalopram (known as the selective serotonin re-uptake inhibitors) do not have the side-effects of tricyclics and are well tolerated by older people.
Drugs will be more effective if they are taken exactly as prescribed by the doctor, in the correct dose and monitored regularly for side-effects. If symptoms are difficult to control, the GP may refer to a specialist for further advice.
Where an individual has used benzodiazepine drugs for a long period prior to the development of dementia withdrawal may be difficult, but the decision about whether to continue their use or to slowly reduce the dose should be addressed with the doctor treating the person with dementia. In addition, benzodiazepines are associated with a range of side-effects that make them particularly problematic for older people and should not be recommended other than for very short term use.
Antipsychotics (also known as neuroleptics or major tranquillisers) are drugs that were originally developed to treat people with schizophrenia. The use of antipsychotics in people with dementia remains controversial and clinical trials are in progress to better determine their effectiveness.
Anxiety states, accompanied by panic attacks and fearfulness may lead to demands for constant company and reassurance.
There is some evidence that memantine has a positive effect on mood, behaviour and agitation.
They can produce headaches and nausea, especially in the first week or two of treatment. Moclobemide is well tolerated by people with dementia and was found to be helpful in one large study of individuals with depression and cognitive impairment. There is very limited information about the use of other newer antidepressants such as mianserin, mirtazapine and venlaine in people with dementia.
Once started, the doctor will usually recommend prescribing antidepressant drugs for a period of at least six months. In order for them to be effective, it is important that they are taken regularly without missing any doses. Antidepressants may be helpful not only in improving persistently low mood but also in controlling the irritability and rapid mood swings that often occur in dementia and following a stroke. Improvement in mood typically takes two to three weeks or more to occur, whereas side-effects may appear within a few days of starting treatment.
Amitriptyline (Endep) Citalopram (Cipramil, also Celapram, Ciazil, Talam, Talohexal) Dothiepin (Prothiaden, also Dothep) Doxepin (Sinequan, also Deptran) Fluoxetine (Prozac, also Lovan, Auscap, Fluohexal, Fluoxebell, Zactin) Fluvoxamine (Faverin, also Movax, Luvox, Voxam) Imipramine (Tofranil, also Tolerade) Mirtazipine (Avanza, Axit, Mirtazon, Remeron) Nortriptyline (Allegron) Paroxetine (Aropax, Paxtine, Oxetine) Reboxetine (Edronax) Sertraline (Zoloft, Xydep, Eleva, Concorz) Venlaine (Efexor).
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