Q. My wife has late stage Alzheimer’s disease. She is now in a memory care facility. They often give her sedatives to calm her agitation.
I have read that such drugs are dangerous, especially for older people with dementia. Is there anything that might be safer?
A. You are right that strong sedatives such as aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) come with scary warnings:
“Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.”
It doesn’t get any more stark than that. Death is the ultimate side effect.
Such powerful antipsychotic drugs have a long list of other side effects as well. Some people have referred to antipsychotic drugs as “chemical straitjackets.” They can cause drowsiness, dizziness, headache, walking difficulties, impaired judgement or thinking, uncontrollable muscle movements, restlessness, agitation, uncontrollable urges to move or pace, anxiety, tremor, blurred vision, diabetes, depression, and suicidal thoughts. That is only a partial list, but you get the idea.
The Classic Double Bind of Alzheimer’s Disease:
Given the list of side effects above, you might assume that such strong sedatives should never be given to someone with dementia and we would not disagree with you. On the other hand, caregivers, whether family members or nursing staff, are faced with a terrible dilemma. Someone with Alzheimer’s disease can become quite agitated and say or do things that are self destructive or challenging for those trying to help. It can be very tempting to try a medicine that might calm an agitated dementia patient, even if it could have terrible side effects.
Another Potential Option:
A new study offers some hope for calming agitation without such dire consequences. Investigators gave 220 people with Alzheimer’s disease either placebo or a combination of quinidine and dextromethorphan (Nuedexta).
Both drugs have been used for decades. Dextromethorphan is the active ingredient in many OTC cough medicines (the DM in Robitussin DM, for example). Quinidine is prescribed for irregular heart rhythms. It has been used for decades, though its roots could be traced back to the 18th century and the bark of the cinchona tree. It was first used to treat atrial fibrillation over 100 years ago.
The new study involving Nuedexta for Alzheimer’s disease patients demonstrated a significant drop in agitation and aggression (JAMA, Sept. 22/29, 2015). This is an off-label use of Nuedexta. That means the FDA has not yet approved the drug for patients with dementia. Any decision to consider such treatment needs to be undertaken carefully under medical supervision and only after a thoughtful review of side effects and potential interactions with other medications.
