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Are Quetiapine, Arip And Pramipex The Right Medication For Dementia?

Posted on Fri, 7 Oct 2016

Question: My mother is being treated for dementia and psychosis. She has been put to various drugs since last 10 years. Last month she was on donep 5 and pacitane 1mg in the morning , pacitane 1mg in the afternoon and arip mt 5 and pacitane 1mg in the night since 1 year. However last month suddenly she started refusing food and was not swallowing at all. With much difficulty she was fed a little. She however was taking some liquid by the help of a straw. Last month she was reviewed by her neurologist and her doctor reduced the pacitane to half in the day and half in the night to be stopped after 7 days. Her doctor started pramipax 0.125 mg thrice in a day. The appetite did not show any change but she was able to walk faster and her talks became audible. She is physically weak is helped for everything. She has a pensive mood though she occasionally laughs to funny tv characters. After having pramipax for a month she almost completely stopped taking solid food. Then her doc stopped pramiprazole and started quitiapin 25 mg in the night. Donep 5 and arip 5 are given in the morning. Though there was some improvements in eating for two days after taking quitiapin for 7 days she stops taking even water on somedays. She is 72. Please advise

Answered by Dr. Sudhir Kumar (47 minutes later)

Brief Answer:
Minimum medicines should be given.

Detailed Answer:
Hi,

Thank you for posting your query.

I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.

I have noted the clinical details of your mother and her current problems.

I would like to point out the fact that she is suffering from dementia, for which there is no cure. None of the medicines have that ability to cause significant improvement or cure. Moreover, most medicines have side effects, especially in older people. So, we have to use the lowest number of medicines and the lowest dose.

Donep 5 mg may be continued as it may have beneficial effects on dementia. Donep may cause loss of appetite and nausea feeling in some people.

Arip should be stopped, as there are more side effects.

Quetiapine is useful only to reduce aggression, anger, hallucinations, delusions, etc. If these symptoms are not severe, we need not give it. If it is really needed, we can given 25 mg-half tablet twice daily.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (10 hours later)

Thank you sir for your advices. Infact my mother was initially diagnosed for psychosis and eventually for dementia in the last 10 years. She has been on all types of drugs for bipolar disorder alongwith donep. But all the medicines have had varied degrees of side effects after prolonged use. She was on arip mt 5 since the last one year alongwith donep. She also has had a history of seizures from use of schizopin. Can arip be stopped or have to be tapered? She has become somewhat aggresive. Please advise.

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer:
Arip should be gradually tapered.

Detailed Answer:
Thank you for getting back and providing more information.

Yes, it is better to stop arip after slow tapering, in consultation with local psychiatrist.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar