Common Medications Prescribed for Dementia Patients

BRAND NAME VS. GENERIC NAME

Often when dealing with pharmaceutical products, we may come upon a specific drug and know it either by its brand name or its generic name. For example, AstraZeneca’s Seroquel vs.Quetiapineproduced by another laboratory.

These differences are related to the early life of a drug. It all starts with a pharmaceutical lab finds a molecule that will help treat a disease or a symptom. When the lab discovers the therapeutic importance of a drug, they can patent it and gain the right to name it. The process continues with the therapeutic effect and the safety of the drug being confirmed. Thereafter, the drug may be commercialized as a drug with a specific brand name. The patent comes with a limited time exclusivity in which the patenting lab is theonly one that may commercialize the drug.But once the patent duration expires, alist of the drug’s composition and the manufacturing method will be made available publicly. This allows other pharmaceutical laboratories to produce the same drug under their own name. The labs have to prove that the drug they are producing has exactly the same characteristics as the original one through rigorous and specific testing. Given the equivalency between the two drugs, the second one is considered to be a ‘generic’ version of the original one. The name of the new generic drug then will have to contain the name of the molecule, the dosage, and the pharmaceutical form. For example: Quetiapine Mylan, 25mg.

The only difference between Brand and Generic drugs are their names and when it was released to the market. However, since there is no innovation involved in producing the generic drug, the sale price of the drug is usually much lower. This is why generics are almost always cheaper than brand name drugs even though the quality and therapeutic effectsboth are exactly the same.


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PRN—Pro Re Nata

PRN is an acronym of “Pro Re Nata” – Latin for “as is needed”. It is a form of prescription where, for example, when an antibiotic has to be administered with a specific time interval in order to ensure its effectiveness. These intervals can be 8/8 hours, 12/12 hours, 24/24 hours, etc. There are some drugs that are only to be administered in specific situations or SOS situations. There is a limited amount that can be administered. For example, with an anti-inflammatory drug for muscle pain, it is to be taken only in the case of pain (SOS), in a maximum of 2 pills per day, with a 12h interval between dosages. If the pain stops after the first pill and there is no pain 12h later, the 2nd pill is not to be taken.

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DRUGS COMMONLY PRESCRIBED FOR DEMENTIA PATIENTS

Alzheimer’s Disease

While there is no cure for Alzheimer’s yet, there are treatments currently being used with the objective of treating or alleviating its symptoms and overall slowing down of the disease’s progression. The following are some of the most prescribed drugs for Alzheimer's:

Donepezil (Aricept)

DRUG NAME

SYMPTOM TREATED

DOSAGE

ADMINISTRATION

ADVERSE EFFECTS

Donepezil (Aricept)

Memory Loss

Diminished Concentration

Anxiety

Mild – Moderate Symptoms

5mg taken at bedtime.

Dosage may be increased as needed by your physician.

Dosage usually does not exceed 10mg per day.

Moderate – Severe Symptoms

10mg taken at bedtime.

Dosage may be increased as needed by your physician.

Dosage usually does not exceed 23mg per day.

Take at bedtime before sleeping

Can be taken with or without food

Oral disintegration tablets: dissolve on tongue before swallowing and follow with water

  • <10% of Cases:
  • Headache (3-10%)
  • Vomiting (3-8%)
  • Cramping (3-8%)
  •  Fatigue (3-8%)
  • Anorexia (2-8%)
  • Hypertension (3% )
  • Abnormal dreams (3%)
  • Hallucinations (3%)
  • Confusion (2%)
  • Syncope (2%)
  • >10% of Cases:
  • Nausea (3-19%)
  • Diarrhea (5-15%)
  • Insomnia (2-14%)
  • Accident (7-13%)
  • Infection (11%)

Rivastigmine (Exelon)

Memory Loss

Diminished Concentration

Anxiety

--Rivastigmine’s effects may lessen as the disease progresses and fewer cholinergic neurons remain functionally intact. No evidence indicates that acetylcholinesterase inhibitors alter the course of underlying dementia.

Rivastigmine is available in capsule, solution, and transdermal patch forms.

1.5mg two times a day.

Dosage may be gradually increased as needed and tolerated by your physician.

Dosage usually does not exceed 6mg two times a day.

Take with food

Oral solution may be swallowed directly from provided syringe or mixed with small glass of fluid (water)

<10% of Cases:

  • Decreased weight (3-8%)
  • Insomnia (PO 9%; patch 1-4%)
  • Anxiety (PO 5%; patch 3%)
  • Asthenia (PO 6%; patch 2-3%)
  • Vertigo (2%)
  • Fatigue (2%)

>10% of Cases:

  • Nausea (PO 47%; patch 21%)
  • Vomiting (PO 31%; patch 6-19%)
  • Dizziness (PO 21%; patch 2-7%)
  • Diarrhea (PO 19%; patch 6-10%)
  • Headache (PO 17%; patch 3-4%)
  • Anorexia (PO 17%; patch 3-9%)
  • Abdominal pain (PO 13%; patch 2-4%)

Galantamine (Razadyne, previously known as Reminyl)

Memory Loss

Diminished Concentration

Anxiety

--Galantamine’s effect may lessen as the disease progresses and fewer cholinergic neurons remain functionally intact. No evidence indicates that acetylcholinesterase inhibitors alter the course of underlying dementia.

Galantamine is available in extended-release (ER) daily dosing and in immediate-release (IR) form.

For Oral Dosage (ER Capsules)

8mg once a day with food.

Dosage may be increased to 16mg per day after at least 4 weeks, and then to 24mg per day after at least another 4 weeks.

Increases in dosage will have to be approved by your physician.

For Oral Dosage (Solution or Tablets)

4mg two times a day.

Dosage may be increased to 8mg two times a day after at least 4 weeks, and then to 12mg two times a day after at least another 4 weeks.

Increases in dosage will have to be approved by your physician.

Take with food

Conversion from galantamine tablets and oral solution to galantamine ER should occur at same daily dosage with the last dose of galantamine tablets/oral solution taken in evening and starting galantamine ER once daily treatment next morning

<10% of Cases:

  • Abdominal pain
  • Anorexia
  • Muscle cramp
  • Fatigue
  • Dizziness
  • Headache
  • Weight loss
  • Depression
  • Insomnia
  • UTI
  • Somnolence
  • Anemia
  • Syncope

>10% of Cases:

  • Nausea (20-25%)
  • Diarrhea (11-15%)
  • Vomiting (11-15%)

Rare Cases:

  • Bradycardia
  • AV block

Memantine (Nameda)

Nervousness

Restlessness

Cognitive Impairment

--Memantine is an N-methyl-D-aspartate (NMDA)-receptor antagonist. It works by blocking the excess activity of a substance in the brain called glutamate, which may reduce the symptoms associated with Alzheimer disease.

Immediate Release

Initial Dose: 5mg orally once a day, then titrated upwards by 5mg per week

Maintenance Dose: 5mg once a day up to 10mg twice a day

Maximum Dose: 20mg per day

Extended Release

Initial Dose: 7mg orally once a day, then titrated upwards by 7mg per week

Maintenance Dose: 7mg once a day up to 28mg once a day

Maximum Dose: 28mg per day

Can be taken with or without food.

Oral solution should not be mixed with any other liquid. The correct volume of oral solution must be withdrawn and slowly squirted into the corner of the patient’s mouth.

Major:

  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • Blurred vision
  • Dizziness
  • Headache
  • Nervousness
  • Pounding in the ears
  • Rapid weight gain
  • Slow or fast heartbeat
  • Tingling of the hands or feet
  • Unusual weight gain or loss

Minor:

  • Confusion
  • Anxiety
  • Back pain
  • Bladder pain
  • Bloody or cloudy urine
  • Change in walking and balance
  • Chills
  • Clumsiness or unsteadiness
  • Mucus-producing cough
  • Coughing
  • Diarrhea
  • Difficult, burning, or painful urination
  • Difficulty with breathing
  • Difficulty with moving
  • Discouragement
  • Dry mouth
  • Fear
  • Feeling sad or empty
  • Fever
  • Frequent urge to urinate
  • General feeling of discomfort or illness
  • Hyperventilation
  • Insomnia
  • Irritability
  • Joint pain
  • Loss of appetite
  • Loss of bladder control
  • Loss of interest or pleasure
  • Lower back or side pain
  • Muscle pain or stiffness
  • Nausea
  • Nervousness
  • Pain
  • Pain in the joints
  • Restlessness
  • Seeing, hearing, or feeling things that are not there
  • Shortness of breath
  • Sleepiness or unusual drowsiness
  • Sore throat
  • Tightness in the chest
  • Tiredness
  • Trouble with concentrating
  • Trouble with sleeping
  • Unusual tiredness or weakness
  • Vomiting
  • Wheezing

*List of side effects is not exhaustive. For a completely list or better understanding, please refer to your physician.

Levy Body Dementia

There is no cure for LBD yet. However, most of the symptoms presented are treatable. i.e., most of the drugs used in Alzheimer’s or Parkinson’s may have a positive effect on the symptoms.However, there are some drugs that are usually used in patients with severe mentalhealth problems, such as antipsychotics or neuroleptics that can be very dangerous for an LBD patient. It is possible that these drugs may worsen the symptoms and cause irreversible damage. This is why it is so important to correctly diagnose LBD.The following are some drugs used in the treatments of the symptoms:

DRUG NAME

SYMPTOM TREATED

DOSAGE

ADMINISTRATION

ADVERSE EFFECTS

Levodopa

Muscular Stiffness

--Levodopa usually is associated with other molecules that help it work better, such as Carbidopa or Entacapone.

250mg two to four times a day.

Dosage may be increased as needed by your physician.

Maximum dosage per day is usually no more than 8000mg per day.

Intake of high protein diets should be avoided

May be taken with food during the initial stages of taking this medicine. Once the body is accustomed to the medicine, it should be taken on an empty stomach for increased effectiveness.

If taking ER tablets, swallow the tablet whole without crushing or chewing, unless directed otherwise by your physician.

More Common:

  • Abnormal thinking: holding false beliefs that cannot be changed by fact
  • Agitation
  • Anxiety
  • Clenching or grinding of teeth
  • Clumsiness or unsteadiness
  • Confusion
  • Difficulty swallowing
  • Dizziness
  • Excessive watering of mouth
  • False sense of well-being
  • Feeling faint
  • General feeling of discomfort or illness
  • Hallucinations (seeing, hearing, or feeling things that are not there)
  • Increase in hand tremors
  • Nausea or vomiting
  • Numbness
  • Unusual and uncontrolled movements of the body, including the face, tongue, arms, hands, head, and upper body
  • Unusual tiredness or weakness

Less Common:

  • Blurred vision
  • Difficult urination
  • Difficulty opening mouth
  • Dilated (large) pupils
  • Dizziness or lightheadedness when getting up from a lying or sitting position
  • Double vision
  • Fast, irregular, or pounding heartbeat
  • Hot flashes
  • Increased blinking or spasm of eyelids
  • Loss of bladder control
  • Mental depression
  • Other mood or mental changes
  • Skin rash
  • Unusual weight gain or loss
  • Rare
  • Back or leg pain
  • Bloody or black tarry stools
  • Chills
  • Convulsions (seizures)
  • Fever
  • High blood pressure
  • Inability to move eyes
  • Loss of appetite
  • Pain, tenderness, or swelling of foot or leg
  • Pale skin
  • Prolonged, painful, inappropriate penile erection
  • Sore throat
  • Stomach pain
  • Swelling of face
  • Vomiting of blood or material that looks like coffee grounds

Clonazepam

Sleeping Disorders

--Clonazepam is a benzodiazepine. It affects chemicals in the brain that may be unbalanced.

Initial Dose: 0.25mg orally two times a day

Maintenance Dose: 1mg orally per day

Maximum Dose: 4mg orally per day

Swallow the tablet whole with a full glass of water

Not to be taken for more than 9 weeks in duration unless directed by your physician

Available as tablets, orally disintegrating wafers, oral solution, and injectable solution.

Common Cases:

  • Body aches or pain
  • Chills
  • Cough
  • Difficulty breathing
  • Discouragement
  • Dizziness
  • Ear congestion
  • Feeling sad or empty
  • Fever
  • Headache
  • Irritability
  • Lack of appetite
  • Loss of interest or pleasure
  • Loss of voice
  • Nasal congestion
  • Poor coordination
  • Runny nose
  • Shakiness and unsteady walk
  • Sleepiness or unusual drowsiness
  • Sneezing
  • Sore throat
  • Tiredness
  • Trouble concentrating
  • Trouble sleeping
  • Unsteadiness, trembling, or other problems with muscle control or coordination
  • Unusual tiredness or weakness

Less Common Cases:

  • Being forgetful
  • Bladder pain
  • Bloody or cloudy urine
  • Change in speech
  • Diarrhea
  • Difficult, burning, or painful urination
  • Frequent urge to urinate
  • General feeling of discomfort or illness
  • Joint pain
  • Nausea
  • Nervousness
  • Problems in urination or increase in the amount of urine
  • Shivering
  • Slurred speech
  • Sweating
  • Trouble speaking
  • Vomiting

*List of side effects is not exhaustive. For a completely list or better understanding, please refer to your physician.

Frontotemporal Dementia

There is no specific treatment for FTD and the treatments used for the other types of dementia are not effective in FTD. However, symptom severity can be decreased with the help of anti-depressants and anti-psychotics.

DRUG NAME

PURPOSE

DOSAGE

ADMINISTRATION

ADVERSE EFFECTS

Fluoxetine (Prozac)

Antidepressant

--Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant. The way this medicine works is still not fully understood. It is thought to positively affect communication between nerve cells in the central nervous system and/or restore chemical balance in the brain.

Initial dose: 20mg orally once daily

Maintenance dose: 20mg per day orally continuously or, 20 mg orally daily during the luteal phase of the menstrual system (the 14 days prior to the anticipated start of menses). The 20 mg daily dosage has been shown to be effective for up to six months of treatment. A 60 mg daily dosage has also been studied but has not been shown to be significantly more effective than 20 mg daily.

Maximum dose: 80 mg orally per day

Available as hard capsules and oral solution

Do not crush, chew, break, or open extended release capsules. Swallow it whole.

Oral solution should not be mixed with other liquids.

Common:

  • Decreased appetite
  • Hives, itching, or skin rash
  • Restlessness

Less Common:

  • Abnormal dreams
  • Breast enlargement or pain
  • Change in sense of taste
  • Changes in vision
  • Feeling of warmth or heat
  • Flushing or redness of the skin, especially on face and neck
  • Frequent urination
  • Hair loss
  • Increased appetite
  • Increased sensitivity of the skin to sunlight
  • Menstrual pain
  • Stomach cramps, gas, or pain
  • Unusual secretion of milk, in females
  • Weight loss
  • Yawning
  • Chills or fever
  • Joint or muscle pain

Rare:

  • Anxiety
  • Cold sweats
  • Confusion
  • Convulsions (seizures)
  • Cool pale skin
  • Diarrhea
  • Difficulty with concentration
  • Drowsiness
  • Dryness of the mouth
  • Excessive hunger
  • Fast or irregular heartbeat
  • Headache
  • Increased sweating
  • Increased thirst
  • Lack of energy
  • Mood or behavior changes
  • Overactive reflexes
  • Purple or red spots on the skin
  • Shakiness or unsteady walk
  • Shivering or shaking
  • Talking, feeling, and acting with excitement and activity you cannot control
  • Trouble with breathing
  • Unusual or incomplete body or facial movements
  • Unusual tiredness or weakness

Quetiapine (Seroquel)

Insomnia

--Quetiapine is an atypical neuroleptic that may act by antagonizing dopamine and serotonin effects. It is also used to treat insomnia.

50mg once a day in the evening, initially.

Dosage may be adjusted as needed by your physician.

Dosage usually does not excel 300mg per day.

Comes in extended release as well as immediate release tablet forms

Should not be crushed, chewed, or broken. Must be swallowed whole.

Can be taken with or without food.

<10% of Cases:

  • Abdominal pain (4-7%; dose related)
  • Dyspepsia (2-7%; dose related
  • Tremor (2-8%)
  • Back pain (3-5%)
  • Postural hypotension (2-7%)
  • Tachycardia (1-6%)
  • Pharyngitis (4-6%)
  • Rhinitis (3-4%)
  • Rash (4%)
  • Blurred vision (1-4%)
  • Arthralgia (1-4%)
  • Myalgia (2%)
  • Neck pain (2%)
  • Dyskinesia (4%)
  • Neutropenia (2%)
  • Hemorrhage (1%)

>10% of Cases:

  • Dizziness (1-18%)
  • Fatigue (3-14%)
  • Extrapyramidal symptoms (1-13%)
  • Increased diastolic blood pressure (41%)
  • Increased triglycerides (8-22%)
  • Increased total cholesterol (7-18%)
  • Increased appetite (2-12%)
  • Constipation (6-11%)
  • Dry mouth (9-44%)
  • Headache (7-21)
  • Somnolence (18-57%)
  • Rare Cases:
  • Priapism
  • Cardiomyopathy, myocarditis
  • QTC prolongation
  • Nightmares
  • Pancreatitis
  • Rhabdomyolysis
  • Palpitation
  • Leukocytosis
  • Epistaxis
  • Exfoliative dermatitis

*List of side effects is not exhaustive. For a completely list or better understanding, please refer to your physician.

Vascular Dementia

There is no treatment for VD nor for the devastating effects after an episode, which results in causing VD. The only option is to try and prevent another episode from happening by caring for the cardiovascular system. Sometimes, drugs used in Alzheimer’s may be effective to treat some symptoms.

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PRICING OF DRUGS USED IN DEMENTIA TREATMENTS

Below is a pricing list of the common drugs used in dementia treatments found in some of the leading stores and pharmacies:

 

Donepezil (Aricept)

Rivastigmine (Exelon)

Galantamine (Razadyne / Reminyl)

Memantine (Nameda)

Levodopa

Clonazepam

Fluoxetine (Prozac)

Quetiapine (Seroquel)

Health Warehouse

$8.10

$99.60

$78.00

$13.80

$404.40

 

$3.60

$7.20

Sam’s Club

Free with membership

$158.25^

$137.62^

$63.52

$335.85*

$7.36^

$6.27^

$4.00^

Safeway

$9.05*

$75.09*

$64.04*

$23.26*

$259.87*

 

 

$9.53*

Kroger Pharmacy

$11.55*

$75.59*

$65.54*

$23.76*

$234.29*

$9.82*

$5.61*

$9.85*

Target (CVS)

$11.90*

$88.14*

$74.37*

$25.45*

$229.26*

$12.36*

 

$11.53*

Walgreens

$13.33*

$98.00*

$78.19*

$31.76*

$176.36*

 

$7.63^

$12.83*

Publix

$13.36^

$199.06^

$129.37^

$332.72^

$335.85*

$9.92^

$7.63*

$71.89^

Walmart

$13.37^

$57.92^

$45.19^

$27.33

$335.85*

$7.36^

$4.00

$26.41^

Kmart

$41.32*

$101.96*

$92.35*

$59.43*

$323.91*

 

$3.00

$12.73*

CVS Pharmacy

$77.00*

$133.43*

$102.25*

$154.07*

$229.26*

 

 

$51.96*

Rite-Aid

$111.36*

$119.38*

$83.88*

$153.81*

$187.33*

 

$9.99

$55.45*

*with free coupon

^with free discount

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DRUGS ON TRIAL FOR DEMENTIA

Dementia affects mainly elderly people. As the population grows older and older, dementia is a disease that may eventually affect a large portion of the population. That is why there is an increasing number of drugs on trial for dementia treatment. Some of them are listed below:

  • Aducanumab
  • Allopregnanolone
  • Bisnorcymserine
  • Crenezumab
  • Growth hormone releasing hormone
  • Insulin
  • Itraconazole
  • Mesenchymal stem cells
  • Probucol
  • Rilapladib
  • S-Equol
  • Solanezumab
  • Telmisartan

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TIPS FOR ADMINISTERING MEDICATION TO PATIENTS

Importance of Timely Administration of Drugs

A drug’s efficacy is given by its capacity to treat or relief a specific symptom or disease. This is why is very important to administrate the drug according to the physician's prescription. In order for a treatment to be effective, the drugs must be administered at the prescribed time and dosage. This way, the blood concentration of the drug will ensure that its full effect.

What to Do When Loved One Won’t Swallow Pills

If your loved one won’t swallow pills there are some tips you could use:

  • Encourage your loved one to have a drink of water before taking the pills to ensure that their throat is not dry
  • Use cold water, so the pills won’t dissolve before reaching the stomach
  • Use carbonated water—this must be done after consultation with a physician to ensure that there will be no adverse effects to the patient
  • Make sure your loved one is relaxed

If none of the above works, you should talk to your pharmacist and/or your doctor to consider if there is a need for a change in the prescription, form, or dosage.

Medication Storage and Cutting for Correct Dosage

  • Use pill boxes or prepackaged pills
  • Use a pill slicer when cutting the pill is required
  • You can check out pillpack.com, a pharmacy designed to make medication storage and administration an easier task

It is extremely important for medicines to be well stored. Improper storage can damage or contaminate the medicines, which can result in reduced efficacy. Normally, medicines should be kept in a dry place, away from the direct solar light and in the original containers or a pill box.

Medication cutting should be avoided unless required by prescription or after consultation with a physician. The best thing to do is to buy the correct dosage from the pharmacy. There are some drugs that cannot be cut, chewed or dissolved. Be very careful, since the effect of the drug may be altered if improperly administered. For example when administering ‘slow release’ or ‘modified release’ pills, this can make a big difference.

What Happens To Medication Management When Loved One Is In A Care Home?

If your loved one is in a care home, medication management should be the caring home’s responsibility. However, you may have to buy the medication, depending on the type of caring service you hired. The caring home should be provided with all the information about the dosage and hours of every pill’s administration.

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ISSUES WITH MEDICATIONS – WHAT TO DO:

Depending on the situation, there are some issues that may come up. Some of them may be related to the characteristics of the drug, such as shape, color, smell, etc. If you think something is off, you should immediately talk to your pharmacist and try to report the case to the regulatory agency. Ask your pharmacist for help in doing so, or explain all the details so your pharmacist may do the reporting for you.

Sometimes there may be an issue concerning the administration of pills. In case you missed a dosage, read the prospect or ask your pharmacist about what to do. Some drugs are to be taken as soon as realize the missed dosage, while others are not supposed to be. In case of any doubts or concerns regarding the medication itself or its administration, always consult with either your pharmacist or physician to sort out the matter.

ADDITIONAL RESOURCES FOR MEDICATION INFORMATION

  • https://www.drugs.com/
  • https://www.goodrx.com
  • http://www.needymeds.org/coupons

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