My Mom has been on the same medication for her Alzheimer’s for several years. Should her medication be changed at some point during her treatment?
Currently, there is no medical consensus for if, when, or how to discontinue the main drugs used to treat Alzheimer’s. It was once thought that taking patients off these drugs, called cholinesterase inhibitors, would see their condition decline rapidly. For those in the early stages of the disease, this is still true.
However, the medical community is now considering if those in the later stages of Alzheimer’s should be taken off the medication. There’s also discussion of whether Alzheimer’s patients can or should be taken off anti-psychotics.
Any change of medication should be discussed with your parent’s doctor. Yet, after giving their guidance, many physicians will leave the decision in the family’s hands. Without medical consensus, it’s up to you to weigh the benefits and costs of discontinuing Alzheimer’s drugs. Here are some of the factors you should consider.
Consider the Window of Benefit
1. Cholinesterase Inhibitors
Some dementia drugs called cholinesterase inhibitors, including galantamine (Razadyne), are designed to stall certain symptoms of Alzheimer’s. Once your parent has developed those symptoms, they may no longer benefit from the drug.
In the words of Medscape’s Dr. Ren: “These drugs are designed primarily to treat short-term symptoms and to forestall some of the acute changes of Alzheimer’s disease, so once someone is impaired enough, it is probably worth a trial with the prescriber.”
2. Anti-Psychotic Medications
The same can be said for anti-psychotic medications, which are usually prescribed for behavioral problems. These symptoms generally stop in the later stages of Alzheimer’s, and so the medication may not be useful anymore.
One small pilot study found that most dementia patients can be safely taken off these medications. However, the study was inconclusive about whether this had positive effects on quality of life or length of life. More study is needed.
3. Long-term Medications
There are some medications which provide benefit to people at every stage of Alzheimer’s. Memantine (Namenda) is not a cholinesterase inhibitor. The drug is also sometimes combined with Donepezil, to create a pill called Namzaric®. These medications are intended for moderate to severe Alzheimer’s. Doctors generally recommend these drugs be continued regardless of how your parent has progressed through the disease.
Consider the Side Effects
Some Alzheimer’s medications have serious side effects. Of course, which side effects your parent experiences and how detrimental they are to your parent’s quality of life is a very individual experience. It may be helpful to revisit the side-effects your parent reported when they first started the medication, as these side-effects may now be ignored and/or considered a part of daily life.
Discontinuing the medication can give your parent relief from these side-effects. If they are severe, or particularly limiting in your parent’s circumstances, there may be an improvement in quality of life when stopping them.
Consider Competing Medications
As your parent gets older, they collect more and more prescriptions for various ailments. At some point, your parent’s doctor may have been restricted from using the best medication for your parent because of interactions with another medication they are already using. In some cases, discontinuing Alzheimer’s medications may give your parent the opportunity to use a new medication for another aliment they have.
Of course, you’ll have to talk to your parent’s doctor or pharmacist to find out if this is the case for them.
Everyone’s situation is different, but it’s worth a conversation with your parent’s doctor about their approach to treating your parent’s Alzheimer’s now, and in the future. Don’t forget to include your parent’s pharmacist in the conversation – they may have important insights to add. The team at Aging Life Network is pleased to offer advice and support to help you provide the best care for your parent. Reach out to one of our care managers with any questions or concerns you may have.