A person who is living with dementia may be taking medication for this condition and perhaps also for a range of other conditions. It is important to carefully manage this medication.
This month we welcomed a local pharmacist, Damien Keane (Feericks Pharmacy, Leixlip), to the Café and he talked to us about medications in general and key tips to ensure we manage medication successfully.
(1) Know what medications are being taken
You never know when you might need to be able to list the medications that someone is taking. It is a good idea to keep a list handy at all times (e.g. a print out in your bag, a list on your phone).
(2) Dementia medications fall into one of two categories and each group works in a slightly different way within the brain. The generic names are listed below with other brand names in brackets.
- Cholinesterase inhibitors – Donepezil (Aricept), Galantamine (Reminyl, Acumor, Galsya, Gatalin), and Rivastigmine (Exelon)
- NMDA receptor agonists – Memantine (Ebixa, Maruxa, Memdatine)
- For more information on how these drugs work: visit the UK Alzheimer Society Webpage
(3) Medications can cause side effects. The first ten or so listed in the patient medication leaflet are the ones to watch out for. Most medications come in different types and different forms so don’t ‘live with’ the side effects, talk to you GP or your pharmacist to see what alternatives might be available.
Beware of the prescription or drug ‘cascade’ where new drugs are prescribed to manage problems that are in fact side effects of medication you are already taking. Better to try switching to a different medication.
(4) Work with your GP and/or your consultant to ensure that you are on the right medication
Each time you go to an appointment with your GP and/or your consultant, bring an up to date list of medications with you.
Take this opportunity to review the medications with the doctor. If medication changes, ask about possible interactions with other medication, possible side effects and what alternatives are available. If the person you are caring for has trouble swallowing or difficulties taking the medication at the right time, mention this to the doctor as there may be options that are better suited to your situation.
(5) Work with your Pharmacist to understand more about the medication and how to take it and to manage and problems that might arise (e.g. side effects). Always take the medication as directed. If this is a problem in any way, talk to your pharmacist.
(6) If swallowing is a problem, ask if the medication is available in another form.
Be aware that no tablet should be crushed without first checking to see if that is appropriate with your pharmacist. In particular, tables that are slow-release (usually have SR somewhere in the name) or tablets coated in a film, are NOT supposed to be crushed. There are some exceptions where a capsule contains pellets and can be opened – your pharmacist will advise you about this.
(7) If medication is missed …
This is a more difficult question to answer as it depends on the medication and the circumstances. In general, if missed by a short time (up to 3 hours), go ahead and take the medication and perhaps adjust the time of the next dose slightly until you bring it back into line. IF IN DOUBT, contact your pharmacist for advice.
(8) Paracetamol is the best pain killer to use. If something additional is needed, discuss with your pharmacist. Ibuprofen and medications such as Solpadeine can be helpful for acute pain but they can be addictive and can cause digestive problems in the longer term.
(9) If taking Warfarin, be aware that new alternatives are available which require a lot less management. This can be helpful if the person taking the Wafarin has difficultly maintaining the medication regime. Talk to your GP and/or your pharmacist for more details.
(10) A couple this to be aware of….
- Motillium – new indications suggest that prolonged use is damaging. If you are taking this medication on a regular basis, talk to your GP or your pharmacist.
- Grapefruit juice – interferes with how the medication works. Don’t use this when taking medication.
- Gaviscon – high salt content; again it shouldn’t be used on a very regular basis. Other solutions are available.