Could my loved one benefit by taking Alzheimer's Medications in combination therapy?
Carole and Bob, I am rather curious about the posts where folks refer to the use of Aricept. My mother started out on Aricept only, then Namenda only and didn't do that well. It seemed like she declined quickly.
At one point I asked a close friend who is a pharmacist about whether or not she was on the right med. She told me dementia should be treated with two different classes of dementia medications and as soon as we got her on Namenda and Exelon she leveled out and did very well for the last two years of her life.
I'm wondering if this is something that might be worth discussion here.
Constance
Carole Larkin MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementia care. She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementia issues. Carole can consults with families via telephone nationwide on problems related to dementia. Her company, ThirdAge Services LLC, is located in Dallas, TX.
Constance,
I'll be happy to put my two cents in (as usual!).
The pharmacist is SO right.
For the 30% or so people who get benefit from the Alzheimer's meds, it's a combination therapy that stands the best chance of affecting the symptoms (read behavior and general cognition) positively.
Aricept is the best known of a group of 4 FDA approved medicines that work on one type of neuro-transmitters (little, tiny things in our brains that help our brain cells talk to each other better. they sort of float from one brain cell to another, carrying our thoughts). The others in that group are Exelon, Razadyne, and Cognex (the oldest one and rarely used nowadays).
People can and do switch to one another of these four drugs, if one has too many side effects or one appears to work better than another. (Exelon has the medicine in the form of a patch worn on the skin, which sometimes helps with the gastrointestinal side effects of pills ( nausea, vomiting, diarrhea, etc...) the manufacturers of these drugs say that they are for early to mid Alzheimer’s.
The other drug, Namenda, works on an entirely different set of neurotransmitters, (The little, tiny things in our brains that help our brain cells talk to each other better.)
That manufacturer says it is for mid to late stage Alzheimer’s. Many have found that using both sets of drugs does more for the person with Alzheimer’s than one drug alone. Recall that we are talking about 30% of the Alzheimer’s population that takes the drugs. It’s like a one, two punch to the disease.
Usually the Aricept type drug is started first, slowing building in strength ( in doctor speak – titrating up) first at 5 mg, then up to 10 mg. (Aricept now comes in 23 mg, but my understanding it doesn’t do one heck of a lot more than the 10 mg.)
Then Namenda is added, again titrating up to 10 mgs. Some doctors add B-12 to these two, believing that the B-12 boosts the strength of both. (I like that idea myself.) For those doctors who believe in the drugs, and not all do by a long shot, that’s considered the best way to use them.
Should the drugs be taken at all?
Well, that’s a whole other question which I address in the article.