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Joined: 1/14/2015
Posts: 40463
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Originally posted by: arm
My husband has been on aricept 10mg for 4 years now. It has helped alot. The doctor put him on 23mg this past Monday. That has been 3 days. He has been sick for 3 days. I called and she said that he needed to eat starches when taking it. So this morning I loaded him up on starchy foods. He was sick. She said to give it 2 weeks to get in his system. He had no side affects from the 10mg. He keeps saying that he wants to take it to get better. We know that he is not going to get better, just slow it down. Our daughter is getting married in 14 days and I do not want him sick at the wedding. I also don't want him sick everyday from now on. Has anyone else been on the aricept 23mg and had problems and have they gone away or did you discontiue use? It is no way to live being sick and staying on the couch all day long.
I know that he has been progressing. I do not know if it is the Holidays and the wedding, so much change going on. I want what ever is going to help him. He was so excited to try a new drug.
I don't know how long to wait and see if it will get better. He has had no side affects from any of the drugs until now.
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Originally posted by: Cathy J. M.
Sometimes I wait to implement a medication addition or tapering off in order to get past a big event. I think that would be reasonable in the case of this wedding.
I don't know if you'd need to taper it gradually after only 3 days -- you could check with the doc.
BTW, is your husband on Namenda as well as Aricept? Unless there's a strong reason why not, I'd want Namenda added on (which has to be done gradually) before increasing the Aricept. As I recall, the combination of Aricept and Namenda is getting a pretty good track record -- whereas the high dosage of Aricept is kind of iffy. (If you look at the Aricept 23mg website and read the statistics, you can see that the chances of negative side effects are pretty high in proportion to the chances of benefit. That doesn't mean it won't be worth it for some people.)
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Originally posted by: Snorky
My DH has been on the 23 for about 3 weeks and has had no side affects. He is also on the Namenda since he started the Aricept a 2 years ago. I can see no difference in anything except his reasoning ability which I think is the AD anyway. He's the one with the salad dressing issue and won't refrigerate that and broccoli and ham and I can't convince him otherwise, otherwise I think he's done very well with the 23.
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Originally posted by: JAB
arm, I'm not so sure the possible additional benefits merit suffering from the probable additional side effects:
http://alzheimers.infopop.cc/e...=673301084#673301084
The only improvement was on the SIB (an "MMSE" for the severely impaired) ... not on the much more extensive CIBIC+ which includes caregiver observations. IMO, if you can't detect an improvement ... why put him through misery?
We've had some caregivers come on other forums to talk about their loved ones developing some very unpleasant side effects.
Ditto what Cathy said about adding Namenda, if he's not on that. And you might also consider Axona, which is compatible with cholinesterase inhibitors and Namenda. (Although you'd want to start pretty low and ramp up slowly with Axona. And maybe wait until after the wedding...)
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Originally posted by: arm
He has been on aricept for 4 years and Namenda for 3 years. He gradually went on Nambeda and started out on the 10mg aricept. He does hold his own on testing each year except on the excecutive functioning. He is having diffuculty with his word find and speaking. He is very careful with this. He use to wrap presents better than anyone I knew. Now he cannot figure out how to do it. I am going to have to look at some more things on the 23mg. I agree that I do not know if the benifits out weigh the side affects.
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Originally posted by: arm
Well, he took the medicine this morning with mashed potatoes. Yes mashed potatoes for breakfast. The other day he was sick his mother brought him over mashed potatoes and he said that it made him better. He would not take the medicine with dinner only in the morning. So I guess that mashed potatoes are for breakfast now.
He said that he felt better like 10 times today. He said that he had his mind back. But then he went and picked up the remote to the tv to answer the ringing phone. He thinks that the Aricept 23mg is the miracle drug. He said he will get better now.
Snorky
did your husband get better in his reasoning skills or worse? Have you seen a significant improvement with the 23mg. Do you think it will take several months before we see any change with the new medicine? I know that the doctors say sometimes that it takes several months to do anything.
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Originally posted by: Rkg
Just a warning, if the sickness/sideeffects continue, get him off of it!
I have been through almost 3 months of cleaning up side effects, it took longer to get over the side effects than my DH took the Aricept.
The one up-side to the Aircept for my Dh was his verbal skills came back. But now they are going back down.
Having experienced what I have here lately with side effects, I so agree with JAB! Possibly not worth it!
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Originally posted by: jfkoc
Why now? Do you have two weeks to experiment? Unless contraindicated, I would wait until after Christmas.
My husbands Namenda was stopped first then the Ariceipt. Two months apart, by Dr. orders and no weaning.
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Originally posted by: Snorky
quote: Originally posted by arm:
Snorky
did your husband get better in his reasoning skills or worse? Have you seen a significant improvement with the 23mg. Do you think it will take several months before we see any change with the new medicine? I know that the doctors say sometimes that it takes several months to do anything.
I can't say that it has helped at all. I think it is a time released ARicept that is just suppose to slow down the process. I don't think it has any curing in it. Then the other thing is how do you know if it helps or not? Actually, his reasoning abilities are getting worse, so I can't say that it's making any difference there. The only faith I have is that it might help slow down the brain disaster, whatever that might be. Maybe in time I will see something but this last week has been worse in his reasoning.
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Originally posted by: Cathy J. M.
quote: Originally posted by arm:
He thinks that the Aricept 23mg is the miracle drug. He said he will get better now.
I think that's great -- adds a hearty placebo effect to whatever the additional Aricept can do.
I often tell my partner that her memory pills are definitely working. It doesn't hurt anything and encourages her -- and the better she feels overall, usually the better she thinks. (Same holds true for the rest of us.)
Seems as if the only time it would be a drawback for the LO to believe they were going to get completely well, would be if it hindered important discussion of plans for the future that they were capable of helping to make.
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Originally posted by: Be Strong 2
Don't know about the added value of the mega-size Aricept, but when DW went up to 10 mg she developed nausea. At the recommendation here about anti-nausea wrist bands we tried some. After a few days the nausea lessened and then disappeared. Did the wrist bands work or did DW just become accustomed to the larger dose? Who knows but no more nausea. We got "Sea Bands" from Walgreen; for $11.95 worth the try.
Bob 
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Originally posted by: JAB
quote: Yes mashed potatoes for breakfast.
Hey, that sounds good! Mashed potatoes is comfort food, good any time of day. We used to have a German babysitter, way back when, who would serve us potato pancakes for breakfast. Yum! And my husband used to love creamed chipped beef over mashed potatoes for Sunday breakfast.
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Originally posted by: JAB
Jon Boy, hi! You're new. Welcome to the forum. Please tell us more about you and your wife, and whether there's any way we can help.
Have you seen any indications that the higher dose is helping?
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Originally posted by: DMM754
They increased my husband's aricept to 23mg, he felt lousy with GI distress,belching,cramps etc...We gave it 2 weeks and went back on the 10mg with relief of GI symptoms
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Originally posted by: Jon Boy
My wife has been on 23 for three months with no side effects.
quote: Originally posted by arm:
My husband has been on aricept 10mg for 4 years now. It has helped alot. The doctor put him on 23mg this past Monday. That has been 3 days. He has been sick for 3 days. I called and she said that he needed to eat starches when taking it. So this morning I loaded him up on starchy foods. He was sick. She said to give it 2 weeks to get in his system. He had no side affects from the 10mg. He keeps saying that he wants to take it to get better. We know that he is not going to get better, just slow it down. Our daughter is getting married in 14 days and I do not want him sick at the wedding. I also don't want him sick everyday from now on. Has anyone else been on the aricept 23mg and had problems and have they gone away or did you discontiue use? It is no way to live being sick and staying on the couch all day long.
I know that he has been progressing. I do not know if it is the Holidays and the wedding, so much change going on. I want what ever is going to help him. He was so excited to try a new drug.
I don't know how long to wait and see if it will get better. He has had no side affects from any of the drugs until now.
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Originally posted by: DLMifm
quote: Originally posted by JAB:
The clinical trial showed that the risk of adverse side effects increases when switching from 10mg to the timed-release 23mg. So if you switch, be aware of this possibility and keep track of your loved one's behaviors to see if new symptoms crop up or old symptoms are exacerbated.
when we started Aricept we cut the 5's in half and we went 5, the 7.5 then 10 because going to 10 from 5 caused side effects. Are the 23's tablets or capsules?
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Originally posted by: JAB
The clinical trial showed that the risk of adverse side effects increases when switching from 10mg to the timed-release 23mg. So if you switch, be aware of this possibility and keep track of your loved one's behaviors to see if new symptoms crop up or old symptoms are exacerbated.
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Originally posted by: JAB
quote: Are the 23's tablets or capsules?
They are a time-release formulation, and Cathy's right -- they should not be cut or crushed because of that.
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Originally posted by: Cathy J. M.
quote: Originally posted by DLMifm: quote: Originally posted by JAB:
The clinical trial showed that the risk of adverse side effects increases when switching from 10mg to the timed-release 23mg. So if you switch, be aware of this possibility and keep track of your loved one's behaviors to see if new symptoms crop up or old symptoms are exacerbated.
Since they're time-release, I doubt if it's OK to cut them -- but I'm not sure. when we started Aricept we cut the 5's in half and we went 5, the 7.5 then 10 because going to 10 from 5 caused side effects. Are the 23's tablets or capsules?
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Originally posted by: ipoe
It looks to me like if the 23 mg is timed release, it shouldn't cause this distress.the 10MG is immediate release. looks like timed release would be better..just a thought. We haven't tried it yet, going to wait until after the first of the year, i think. first prescription is free with a voucher until sometime near the middle or end of January. May have to download and print voucher off computer, i am not sure yet..
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Originally posted by: ipoe
thanks for comments ..does anyone think it might be better to give 10MG twice a day?
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Originally posted by: JAB
quote: Originally posted by ipoe:
thanks for comments ..does anyone think it might be better to give 10MG twice a day?
No.
The blood levels that would be reached with two 10mg tablets would likely be very different -- quite a bit higher -- from those reached with one 23mg extended release pill. I haven't seen the pharmacokinetics for Aricept, but I know for a med that I take, one 400mg tablet reaches the same maximum blood levels as one 600mg extended release.
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Originally posted by: Starling
Ask her about the Ativan gel. That is what they turned to at the nursing home when they needed to calm my husband down. Worked so well they put him on it every day. They cut the dose in half and give him half in the morning and half at night.
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Originally posted by: JAB
quote: I was going to do the 2 10mg pills till I ran out of them but sounds like that isn't a good idea.
It's not. But hang onto them ... if the 23mg causes too many side effects (anger or agitation, for example ... ?) you may want to go back to the 10mg.
Risperdal Quicklet (orodispersible) is a new formulation that purportedly dissolves within seconds on the tongue without water. Janssen-Cilag claims it dissolves so rapidly, it is "almost impossible to spit out the active ingredient." It's supposed to be good for "acute" situations, and for patients who have difficulty swallowing ordinary tablets. This is quite new ... I wasn't aware it's available in the US yet.
Well, I'm not seeing it under that name, but I am seeing "Risperidone Orally Disintegrating" on www.drugs.com:
"The recommended initial dose is 0.5 mg twice daily in patients who are elderly or debilitated, patients with severe renal or hepatic impairment, and patients either predisposed to hypotension or for whom hypotension would pose a risk. Dosage increases in these patients should be in increments of no more than 0.5 mg twice daily. Increases to dosages above 1.5 mg twice daily should generally occur at intervals of at least 1 week. In some patients, slower titration may be medically appropriate.
"Elderly or debilitated patients, and patients with renal impairment, may have less ability to eliminate risperidone than normal adults. Patients with impaired hepatic function may have increases in the free fraction of risperidone, possibly resulting in an enhanced effect [see CLINICAL PHARMACOLOGY (12.3)]. Patients with a predisposition to hypotensive reactions or for whom such reactions would pose a particular risk likewise need to be titrated cautiously and carefully monitored [see WARNINGS AND PRECAUTIONS (5.2, 5.7, 5.17)]. If a once daily dosing regimen in the elderly or debilitated patient is being considered, it is recommended that the patient be titrated on a twice daily regimen for 2 to 3 days at the target dose. Subsequent switches to a once daily dosing regimen can be done thereafter."
Carries the same warnings about use in elderly dementia patients as regular Risperdal.
I'm not seeing anything about PRN.
"Risperdal Quicklet was developed in 0.5 mg, 1 mg and 2 mg doses and has been shown to be bioequivalent to comparable dosages of the standard oral tablets. The efficacy and safety of Risperdal Quicklet is comparable to standard, oral Risperdal tablets, and therefore can be used for the treatment of the same symptoms, disorders or medical conditions." I'm seeing a wider range of strengths than in this earlier PR release, 0.25 - 4 mg.
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Originally posted by: C.Traill
I'd wonder about the Risperdal Lozenge used as a immediate control for "temper tantrum". I think a more logical use would be ... daily. For instance if anger episodes occurred late afternoon early evening then daily pre-episode time. Thoughts JAB?
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Originally posted by: Snorky
We saw the Psychiatrist for the first time today because of the anger that DH has had that I've been chatting about and she put him back on Aricept 23 and couldn't understand why his Neuro took him off a week ago. I was going to do the 2 10mg pills till I ran out of them but sounds like that isn't a good idea. She also prescribed Resperidal(sp) not every day but a lozenges to put under the tongue if/when he gets frustrated and angry. My only issue is how am I going to get him to do that when he's having a temper tantrum!! She's not strong on a lot of meds which I appreciate but I wish there was a "happy pill". He has had no issues with Aricept or Namenda and been on them 2 years.
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Originally posted by: DLMifm
One thing that makes this discussion group stand out from others is the willingness of members to actively participate. There are a few similar groups with limited activity. Topics are raised but members ignore them.
JAB is a gem. And there are many others!!
Tis the season to say thank you all.
quote: Originally posted by LCB: quote: Originally posted by DLMifm: I have said it before  JAB please write a book. Or better yet a Blog. You offer such terrific information, Just posting your forum posts to a blog would aggregate it in a single place. JAB you are fantastic.
I totally agree! I am new here (don't even have a diagnosis yet) but I learned very quickly to follow those links that JAB so generously provides. And there are others who are equally as helpful, and I don't want to leave anyone out, but I can recall their names without looking...lol) Anyway, thanks JAB and everyone who works so willingly to help us navigate what is promising to be a rocky journey. One thing I do is click on the name and find all their posts. I have run across some real gems that way. I love this place, this cyberspace that has become so real to me so quickly. JCB
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Originally posted by: LCB
quote: Originally posted by DLMifm: I have said it before JAB please write a book. Or better yet a Blog. You offer such terrific information, Just posting your forum posts to a blog would aggregate it in a single place. JAB you are fantastic.
I totally agree! I am new here (don't even have a diagnosis yet) but I learned very quickly to follow those links that JAB so generously provides. And there are others who are equally as helpful, and I don't want to leave anyone out, but I can recall their names without looking...lol)
Anyway, thanks JAB and everyone who works so willingly to help us navigate what is promising to be a rocky journey.
One thing I do is click on the name and find all their posts. I have run across some real gems that way.
I love this place, this cyberspace that has become so real to me so quickly.
JCB
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Originally posted by: Snorky
JAB, thanks so much for the information. Today DH was so bad with anger and irritability that on the way to the Neurologist (saw the Psychiatrist yesterday) I stopped to see the Psychiatrist to ask if there wasn't something we could do. She wrote the prescription for .05 of the Risperdal 2 times a day. The Risperdal ODT .05 one is for fast acting if I need it right away for too much anger. I started him on the Aricept 23 last night and am assured that it doesn't cause anger by the Neuro. I don't know what to believe. However he had this much anger 10 days ago when he became somewhat physical(pushed me) and he wasn't on it then. Tonight he is calm and wants to be like usual(although it's not usual anymore) I'm getting pretty discouraged and want to find some pill that will calm him.
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Originally posted by: DLMifm
I have said it before JAB please write a book. Or better yet a Blog. You offer such terrific information, Just posting your forum posts to a blog would aggregate it in a single place.
JAB you are fantastic.
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Originally posted by: Lisa2010
Hi Jab, My Mother didn't have any side effects from Aricept 10, she was fine on that one. The things that are happening didn't start until 2 yrs. after starting Aricept and is something that Alzheimer's itself causes according to her doctor and all the books. The doctor said that those severe side effects she had while on Aricept 23, was very common with that dose, that a lot of people can't take it and also she is a very small women only 5 ft. and 125 lbs. so, it was probably too strong for a women of her size. We won't take her off Aricept 10, because as a matter of fact, we did have her in a clinical trial of the Excelon Patch for advanced alzheimer patients and she was declining at a very fast rate on that one, and in order to do that we had to stop the Aricept and that was the result. She was doing much better with the Aricept then on the Excelon Patch. We took her off that trial a month and a half ago and put her back on Aricept after that, then the doctor tried the Aricept 23 and now back to the Aricept 10 She is now doing much better since being off the Aricept 23. So if stopped the Aricept we already know that she would decline very, very fast and I am not ready to lose her. I will have to look up that other book and article you mentioned, I haven't heard of them. Thank you.
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Originally posted by: JAB
quote: I started him on the Aricept 23 last night and am assured that it doesn't cause anger by the Neuro.
Frequent side effects of Aricept observed during clinical trials include: irritability, aggression, restlessness, abnormal crying, nervousness, delusions, hostility, hallucinations, personality disorder. (Given the gastrointestinal problems that often crop up, it seems a no-brainer that an ADLO might not be in a sunshiny mood...) Infrequent: emotional lability, paranoia, melancholia, pacing.
My favorite website for looking up side effects: http://www.rxlist.com (Also recommended by Johanna, so you know it's good!  )
Mind you, if the Aricept helps his cognitive function, it might reduce the behavioral issues ... depending on what's causing them.
There are indeed many wonderful members on these boards. I've learned so much from them, and would like to add my heartfelt thanks to DLMifm's. Like LCB, I hesitate to list them, for fear of hurting the feelings of anyone I might inadvertently leave out. The list is very long...
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Originally posted by: Lisa2010
My Mother was on Aricept 23 for a week before I had to take her off of it. She was okay the first few days and then suddenly got very sick, she slept until 12noon one day and was very tired all that day and she wouldn't eat,the next day, she was exhausted all day, she didn't eat and she could barely stand up and went to sit down and missed the chair and fell, the next day, exhausted all day and night, didn't eat at all, couldn't stand up, couldn't talk and what little she did try to say came out all wrong and I couldn't understand what she was trying to say and she would fall backwards when I tried to stand her up.
Needless to say this drug is very dangerous,I would not recommend anyone try it. I called her doctor and he said to stop it immediately and put her back on Aricept 10 again. She was on that one since 2006 and had no problems, other then it wasn't really doing much for her. She was declining pretty rapidly even though she takes it along with Nemenda.
My Mother is in the Advanced stages of Alzheimer's now, has hallucinations and thinks people are here that aren't and they are speaking to her, she always thinks someone is sick, everything on TV is real and right there in front of her and she wakes up in the middle of the night thinking it's morning and wants to make breakfast, she is incontinant and her words get confused sometimes. All in all it's better then what was happening with Aricept 23, as soon as I took her off that one, she was back to her self again, in the way that I just described anyway.
My Mother is going to be 83 on New Years Day and even though she gets confused as to how I am related to her, at least she still recognizes me, she calls me every other name but my own sometimes, but she recognizes me as someone close to her. She thinks all her children are still little and looks for me, but as a baby or little child, which is why she thinks I am someone else.
The late afternoon and evenings are the worst part of day for her and us. It is called Sundowning and is the worst as some of you probably are noticing now. I would like to recommend a book to read that might help you, it explains all the different stages of Alzheimer's and what to expect and other things that can be of help. The book is called: Coach Broyles' Playbook for Alzheimer's Caregivers and you can get it through the Alzheimer's Association by calling, 800-272-3900 or by going to Playbook on the Web: www.alzheimersplaybook.com. I have this book and it explains a great deal and will be of help to anyone from early stages to late stages. Please call and get it, it will help you, but be prepared there are some things that won't be pleasant to hear, but you will need to know and it will help to know before it actually happens. Good luck and God Bless.
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Originally posted by: JAB
I thought I didn't recognize the name ... you're new! Hi, Lisa, welcome to the forum.
You're right, Coach Broyle's Playbook is excellent. Another resource we often recommend, if you haven't seen it yet, is Jennifer Ghent-Fuller's article, "Understanding the Dementia Experience":
http://alzheimers.boomja.com/A...xperience-59731.html
And a book that has many excellent tips on how to cope with behavioral problems such as those you're describing is Jolene Brackey's "Creating Moments of Joy":
http://www.enhancedmoments.com/
Click on "Products" and scroll down.
I wonder ... if your mother reacted so strongly to the higher dose of Aricept, and her symptoms are progressing pretty quickly now, whether she might actually have developed chronic side effects from the lower dose, as well. That does happen in some of our loved ones. Have you talked with the doctor about possibly switching to one of the other cholinesterase inhibitors (Exelon patch, or Razadyne/galantamine), or maybe just weaning her off the Aricept?
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