Category Archives: Psychiatric Medication

Prozac: Depression medication of choice?




Prozac Depression Medication: Overview

In addition to depression, Prozac is a medication used to treat bulimia, obsessive compulsive disorder and often symptoms of premenstrual syndrome. Prozac is a depression medication referred to as a selective serotonin reuptake inhibitor (SSRI) which many clinicians and researchers believe increases the level of the neurotransmitter serotonin in the brain. Serotonin is believed to contribute to elevating moods by increasing the level of this neurotransmitter in the brain in such mood disorders as depression. Neurotransmitters are brain chemicals that are discharged by neurons and absorbed by other neurons to complete activities and assist with our moods. Excess neurotransmitter discharged by neurons are reabsorbed back up into the initiating neurons if not absorbed by another neuron. This additional unabsorbed neurotransmitter is believed to enhance moods and reduce depression.

Prozac is most often prescribed to treat depression in the moderate to severe range or what is referred to as major depression, which often has a serious effect on daily activities and functioning. The symptoms of major depression include low energy and low mood, decreased sex drive, feelings of guilt or worthlessness, changes in sleeping habits and appetite, concentration problems, a slowing of the thinking processes and suicidal thoughts and ideation. Prozac is not only taken for major depression however, in may be used for various other mental health disorders such as obsessive-compulsive disorder, and premenstrual dysphoric disorder. Although it is most often prescribed for adolescents, adults and the elderly, it has been prescribed for children at times.

Prozac Depression Medication: Obsessive-compulsive Disorder

Although it is most often used in treating depression, prozac is a medication sometimes prescribed in the treatment of obsessive-compulsive disorder. Obsessions are repetitive thoughts and compulsions are repetitive actions usually performed to reduce anxiety associated with the obsessions. Prozac may also be used to treat eating disorders such as bulimia nervosa, which is a binge eating disorder that involves deliberate vomiting to reduce weight. Prozac is also used at times to treat premenstrual dysphoric disorder

Premenstrual Dysphoric Disorder:

PMDD, which is referred to more commonly as premenstrual syndrome (PMS) which includes mood changes such as depression, anxiety, irritability, persistent anger and mood swings. It is marketed when used for PMDD under the brand name Serafem, which basically has the same active ingredients as the brand name Prozac. The symptoms of PMDD usually begin about 1 to 2 weeks before a woman’s premenstrual period, and includes symptoms such as breast tenderness, headaches, joint and muscle pain and bloating. PMDD can frequently be severe enough to interfere with a woman’s daily activities and relationships and is believed to be helped by this depression medication.




Prozac Depression Medication Precautions:

It is important to always be honest and open with your physician when taking Prozac. You should give a complete medical history, including any history of kidney disease, liver problems, heart problems, seizures, history of diabetes and allergies. Prozac has been known to make individuals drowsy or dizzy, making it necessary to be cautious when performing activities that require a high level of alertness such as driving or operating heavy machinery. Alcohol consumption should also be limited when on this depression medication. Prozac use should also be limited if you have a history of alcohol dependency, liver disease or diabetes. Like many medications, precaution may be necessary when this drug is used by the elderly as they have a higher level of sensitivity and seem to metabolize medications more slowly. This medication may also need to be monitored intensively and used only if necessary if you’re pregnant or plan to become pregnant soon as this medication is believed to pass into breast milk. Because of this possible risk to the infant, Prozac may need to be discontinued or breast-feeding may need to be curtailed while taking this drug. Obviously, continuous discussions with your physician are imperative while pregnant or breast-feeding because of these risks.

Some important information about this depression medication:

It is very important to understand that there can be very serious interactions when taking prozac in conjunction with other medications such as the MAO inhibitors (MAOI’s). When combined, the interaction between prozac and the MAOI’s such as nardil, parnate and marplan and can be fatal. Also, it is important to understand that caution may be necessary when taking prozac over prolonged periods of time. If you are taking any other medications, you need to notify your doctor immediately before starting Prozac.

Prozac Depression Medication Side Effects:

Although the side effects of the depression medication prozac seem to be less than the previous generation antidepressants such as imipramine, amitriptyline, desipramine and nortriptyline, there are still side effects associated with this medication that you need to be aware of. Some of the most common prozac side effects include dry mouth, sweating, insomnia, nausea, drowsiness and headache. Some of the less likely side effects are even considered to be more severe such as unusual weight loss and loss of appetite, decreased interest in sex, flulike symptoms, uncontrollable movements including tremors, and severe and unusual mood changes. Even more potentially dangerous but even less likely prozac side effects include vision changes, white spots and swelling in the mouth and tongue, trouble swallowing, prolonged and painful erection and changes in sexual ability. The most severe prozac side effects are fast and irregular heartbeat and fainting. Although allergic reactions to prozac are rare, they include rash, itching, trouble breathing and dizziness, and swelling. If you notice any of these allergic reactions after initiating treatment with prozac, you need to notify your doctor immediately. A more complete listing of prozac medication side effects follow.

Most Common Prozac Depression Medication Side Effects:

Abnormal dreams, abnormal ejaculation, abnormal vision, increased anxiety, dry mouth, dizziness, reduced sex drive, flulike symptoms, flushing, gas, headache, itching, impotence, loss of appetite, insomnia, nervousness, sinusitis, nausea, sweating, rash, sleepiness, sore throat, weakness, upset stomach, tremors, yawning, vomiting

Less Common Prozac Side Effects:

Abnormal taste, agitation, emotional instability, ear pain, frequent urination, high blood pressure, weight gain, sleep disorders, bleeding problems, chills, confusion, ringing in the ears, loss of memory, palpitations, increased appetite

There are some other even more rare side effects associated with prozac. If you develop any new or unusual symptoms you need to contact your physician immediately.

Prozac and Other Food and Drug Interactions:

Along with the prozac side effects mentioned above, there are also food and drug interactions that can occur when taking this antidepressant medication. The most serious of these interactions may be the interaction of prozac with the MAOI medications previously mentioned. Prozac mixed with these drugs can have a serious and even fatal medication interaction. Also, it is important to recognize that prozac in addition to any other medications can cause the effect to be increased, decreased or altered in various other ways. You should always talk with your physician when taking Prozac with the following medications:

Alprazolam (Xanax)
Carbamazepine (Tegretol)
Clozapine (Clozaril)
Diazepam (Valium)
Digitoxin (Crystodigin)
Drugs that impair brain function, such as sleep aids and narcotic painkillers
Flecainide (Tambocor)
Haloperidol (Haldol)
Lithium (Eskalith)
Other antidepressants (Elavil)
Phenytoin (Dilantin)
Pimozide (Orap)
Tryptophan
Vinblastine (Velban)
Warfarin (Coumadin)

Special Warnings If You’re Pregnant or Breast-Feeding:

This medication has not been adequately studied for people who are pregnant or breast-feeding. If you’re pregnant or plan to get pregnant in the future or are breast-feeding your child, you need to be in constant discussion with your doctor to determine whether you may continue with this medication or need to discontinue breast-feeding. This medication is known to appear in breast milk and should probably be discontinued.

Prozac Dosage:

Prozac is usually taken once or twice a day and should be taken exactly as prescribed by your doctor. Also, it needs to be taken regularly to be most effective. If possible, you should take it at the same time every day. Some people have found that it takes prozac as much as four weeks to feel significant effects from this medication and to feel any relief from their depression symptoms. Additionally, some doctors recommend continuing prozac for approximately nine months beyond the initial three-month treatment period. Some people with a diagnosis of obsessive-compulsive disorder may not feel the full effects for as much as five weeks.

Recommended Prozac Depression Medication Dosages:

The most common prozac dosage is 20 mg daily, usually taken in the morning. Your doctor may increase your dosage after several weeks if there has not been adequate symptom improvement. Elderly persons with liver and kidney disease and individuals taking other medicines may have their dosage adjusted by their physician.
When taking a prozac dosage over 20 mg, the physician may ask that you take two smaller doses in the morning and noontime rather than just once a day.

The usual dosage of prozac for depression is between 20 mg and 60 mg per day. The usual prozac dosage for obsessive-compulsive disorder usually ranges from 20 mg to 60 mg per day, although at times the maximum of 80 mg has been prescribed. For bulimia nervosa, the usual prozac dosage is 60 mg taken in the morning. The doctor may start at a lower dosage and increase to these levels over time. The most common dosage of prozac for premenstrual dysphoric disorder is 20 mg per day.

For patients who have been treated successfully with daily prozac, the doctor may consider a more long-acting form sometimes referred to as prozac weekly. The doctor may then ask you to discontinue daily doses for about seven days before taking your first weekly dosage.

You should never take more than one dosage of prozac at a time. If you miss your most recent dosage you need to take it as soon as possible. If a significant amount of time has passed, you may need to miss that dosage and return to your medication routine as soon as possible.

Prozac Over Dosage:

Like all medications, prozac depression medication needs to be taken as prescribed. Dosages in excess to the prescribed amount can be dangerous and even fatal. Combining prozac with other medications may also result in over dosage. If you suspect an overdose of prozac, you need to contact your doctor or local emergency room as soon as possible.

The most common symptoms of prozac over dosage are sleepiness, vomiting, seizures, nausea, and rapid heartbeat. The less common symptoms of prozac over dosage are irregular heartbeat, high fever, fainting, delirium, coma, mania, low blood pressure, rigid muscles, sweating and stupor.

By Paul Susic Ph.D. Licensed Psychologist



What are the depression medications and how do they work?




How do depression medications work?

The depression medications work through their effect on the biochemistry of the brain which then affects our thinking processes. Our thoughts, actions and moods are activated by the nerve cells in the brain which are referred to as neurons. The thoughts, actions and moods that we experience in our daily lives involve neurons in specific areas of the brain being activated and then communicating with other neurons using a biochemical referred to as a neurotransmitter. These neurons frequently work together with other neurons, which then form networks in specific areas of the brain which allows us to complete specific actions and thought processes.

Some of the main biochemical messengers (neurotransmitters) which communicate with other neurons when completing thoughts and actions are of specific biochemical types including norepinephrine and serotonin. There are other neurotransmitters that are very important to our lives and functioning such as dopamine, which is involved in various mental processes such as when you feel pleasure or happiness. However, the neurotransmitters norepinephrine and serotonin have been found to correlate highly with how a person thinks and feels and experiences specific moods. Depression medications tend to primarily increase these two neurotransmitters. Medications of these types are usually referred to as SSRI’s or selective serotonin reuptake inhibitors. The SSRI’s are believed to focus on increasing the level of serotonin even though their selectivity is now somewhat controversial. Some of the newer antidepressant medications are known to increase both serotonin and norepinephrine and are referred to as serotonin norepinephrine reuptake inhibitors or SNRI’s.

There are some depression medications that have been around for a long time including the tricyclic antidepressants and monoamine oxidase inhibitors or what are referred to as MAOI’s. These medications are believed to affect several of the neurotransmitters in the brain rather than selectively affecting just serotonin and norepinephrine.




Antidepressant Medication: Selective Serotonin Reuptake Inhibitors:

As previously mentioned, these depression medications are believed to selectively affect the neurotransmitter serotonin in the brain. This selectivity however is currently in debate among researchers and doctors. The description of selective serotonin reuptake inhibitors may not be an accurate description due to this debate of their selectivity. However, although this issue is somewhat controversial they are still referred to in conventional medicine and by physicians as belonging to the SSRI class of medications. The SSRI depression medications follow.

Selective Serotonin Reuptake Inhibitors:

Prozac
Lexapro
Paxil
Luvox
Zoloft
Seraphim
Pexeva
Raniflux.
Brisdelle
Selfemra

Additional depression medications also have some effect on the serotonin level of the brain but are not usually referred to as selective serotonin reuptake inhibitors. These include:

trazodone (Desyrel)
vilazodone (Viibryd)
etoperidone (Axiomin, Etonin)
vortoxetine (Brintellix)
buspirone (BuSpar)

These medications are also included in this section due to their similar side effect profile.

The SSRI’s seem to be generally well tolerated but do have some common side effects which include drowsiness, difficulty achieving an orgasm and heartburn. More specific side effects are included in relation to specific medications on their respective pages. They can also affect a loss of appetite at times and have been known to also interact poorly with other medications. You should always consult your pharmacist or physician prior to mixing these medications with any other drugs.

Serotonin Norepinephrine Reuptake Inhibitors (SNRI):

One of the more recent depression medications which are marketed for their effect on both norepinephrine and serotonin are the serotonin norepinephrine reuptake inhibitors. The medications which fall within this category follow.

Serotonin Norepinephrine Reuptake Inhibitors:

venlafaxine (Effexor)
tofenacin (Elamol, Tofacine)
dezvenlafaxine (Pristiq)
duloxetine (Cymbalta)
levomilnacipran (Fetzima)
milnacipran (Ixel, Savella)

Additional depression medications that affect primarily serotonin along with norepinephrine are also not included in the category of SSRI’s including:

setiptline (Tecipul)
mirtazapine (Remeron)

There are many critics of the medication classification system which state that medications seem to be classified in a rather arbitrary way possibly to switch patients from one drug class to another if their previous medication does not seem to work.

Many of the same negative side effects listed for the SSRIs can also be included in the side effect profile for SSRI’s. These may include withdrawal symptoms and possible tardive dysphoria. Duloxetine (Cymbalta) and venlafaxine (Effexor) have both been included in the top five medications reported to the FDA MedWatch associated with very serious concerns such as violence including injuries to self, suicidal tendencies and possible homicidal ideation.

Depression Medication: The tricyclics

The tricyclic antidepressant medications are some of the older depression medications going back several decades. Their name is derived from their chemical structure and are still believed to be effective in combating depression for some people. Unfortunately, they have some side effects which are troublesome for some people that are not shared by the newer SSRI’s and SNRI medications. Some of the primary side effects which seem to be of concern to many people are dry mouth, constipation and drowsiness. Once again, more specific side effects associated with each medication are identified on the individual antidepressant medication pages.

Tricyclic Antidepressant Medications:

amitriptyline
desipramine
nortriptyline

All of the tricyclic depression medications are now in generic forms and produced by additional manufacturers.

The Monoamine Oxidase Inhibitors (MAOI’s):

Another classification of medications that have been around for several decades and are still in use are the monoamine oxidase inhibitors or the MAOI’s. They are still found to be effective for some types of depression. However, one of the primary concerns with MAOI’s is that they have very serious, even potentially life-threatening concerns for interaction with other drugs. Your doctor needs to be very involved when taking these medicines in helping you to avoid foods that may interact poorly with these medications resulting in life-threatening consequences.

Monoamine Oxidase Inhibitors (MAOIs):

Parnate (tranylcypromine).
Nardil (phenelzine)

Miscellaneous Antidepressants:

A final category of depression medications that really do not fit well in other specific categories include the following:

Serzone (nefazodone)
Wellbutrin (bupropion
Remeron (mirtazapine)

Depression Medications: Conclusion

Depression medications have evolved significantly over the last several decades with the introduction of newer medications including the selective serotonin reuptake inhibitors and the selective norepinephrine reuptake inhibitors. These medications are frequently selected for their effectiveness for specific symptoms as well as well as their respective side effect profiles. Although these medications are marketed according to specific categories as previously mentioned, these categories do not always represent the selectivity and specificity of the neurotransmitters that are affected. Also, older antidepressants such as the tricyclic antidepressants have had a long history and continue to demonstrate effectiveness for some mood disorders, although the side effect profile seems to be more troublesome for some individuals.

By Paul Susic Ph.D. Licensed Psychologist




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Namenda (Memantine): Medication for Alzheimer’s disease?




Is Namenda (Memantine) a good medication for Alzheimer’s disease?

Namenda (Memantine) is one of the newer medications approved by the FDA for the treatment of Alzheimer’s disease. This Alzheimer’s disease medication is manufactured by Forest Laboratories and is marketed in the United States under the name of Namenda for patients who are suffering from moderate to more severe forms of Alzheimer’s disease or dementia. It began being marketed in January, 2004 in the United States although it previously was sold for some time in Canada and Germany. Many families of Alzheimer’s or dementia patients have been purchasing the medication from Canada for some time over the Internet. Some of the current estimates are that possibly 4 million patients currently have Alzheimer’s disease, with about 1 million suffering from severe symptoms of dementia. Namenda (Memantine) medication is the first drug offered for use with patients in the moderate to severe stages of Alzheimer’s disease.

Does Namenda (Memantine) medication help?

Namenda has been found to help with the thinking and memory skills of patients who have moderate to severe impairment in their cognition. Cognition is their ability to think through their problems. Namenda does not help everyone but has been found to help some people to slow the pace of deterioration, which allows some individuals to maintain some of their cognitive skills and functioning capabilities for a longer period of time. This obviously helps both the Alzheimer’s patient and the caregivers in many ways.




Is Namenda (Memantine) different from any other Alzheimer’s medications?

There are some similarities between Namenda and some of the other Alzheimer’s and memory drugs on the market. However, there are actually more differences than similarities. One of the main similarities is that very much like other Alzheimer’s medications (Aricept, Exelon, Reminyl and Cognex) it does not really improve the functioning or memory skills of the individual. It merely retards the deterioration, which then allows the individual to function at a higher level and maintain their independence for a longer period of time. Additionally, the most prominent feature of Namenda is that unlike the other Alzheimer’s medications it is known to be more effective in the moderate to severe stages of the disease. Some of the other medications seem to be more oriented toward the mild to moderate stages and are rarely prescribed for individuals who have more pronounced symptoms. These other medications delay the breakdown of the brain chemical acetylcholine, which is a neurotransmitter and extremely important to the communication between nerve cells in the brain. Namenda blocks excess amounts of the neurotransmitter glutamate, which is believed to damage and/or kill nerve cells in the brain. Physicians now prescribe combinations of the memory medications to get better results and to ease the transition from the mild to moderate or severe stages of the disease.

Is there much hope for Namenda?

One of the newer developments is that doctors now use Namenda with Aricept and other memory medications as an adjunctive treatment and also to assist as Alzheimer’s disease continues to progress. However, this medication is not considered to be a miraculous cure for Alzheimer’s disease. It should not be given a false sense of hope that it is going to turn back the hands of time and restore previous memory and functioning. Even for patients with the most severe symptoms of Alzheimer’s disease, this is considered merely a means to delay the deterioration in memory. Also however, it may be an additional step toward more effective treatments and possibly, eventually a cure for Alzheimer’s disease.

Namenda Side Effects:

Vomiting, sleepiness, pain, high blood pressure, headache, hallucinations, dizziness, coughing, constipation, confusion

Namenda Special Warnings and Side Effects:

This medication is not recommended for people with severe kidney impairment. Also, there are disease conditions which cause or alter the alkaline balance in the urine, which could result in a buildup of this medication in your body. You should always tell your doctor about any kidney problems such as renal acidosis, urinary tract infections or major dietary changes.

Namenda Side Effects and Drug and Food Interactions:

In addition to the Namenda side effects mentioned above, this medication should not be taken with some other medications as the effects of either or both may be increased, decreased or altered in some other way. As always it is important check with your doctor before you take Namenda with any of the following medications:

Amantadine (Symmetrel)
Cimetidine (Tagamet, Tagamet HB)
Cough suppressants that contain dextromethorphan (usually denoted as “DM”)
Glaucoma drug such as Diamox and Neptazane
Hydrochlorothiazide (HydroDIURIL)
Ketamine (Ketalar)
Nicotine (Nicoderm patch, Nicorette gum)
Quinidine (Quinidex)
Ranitidine (Zantac)
Sodium bicarbonate (baking soda, Alka-Seltzer)
Triamterene (Dyrenium DM)


Namenda Dosages:

Recommended Namenda Dosages for Adults:

The recommended Namenda dosage for adults is 10 mg taken twice a day. At the initiation of treatment with this medication, it is recommended to take it at the dose or 5 mg once a day for seven days, and then gradually increasing it by 5 mg every seven days, up to a maximum dosage of 20 mg.

As you increase Namenda and you notice any side effects, your doctor may want to wait a week or so before increasing you dosage. Your physician may also be very careful with people who have impaired kidney functioning and may stay at a lower dosage.

How should your Namenda dosage be taken?

Namenda should be taken exactly as prescribed by your doctor. As mentioned above, the usual Namenda dosage is increased gradually over one week intervals, usually at the level of 5 mg per week. Most doctors will wait a week before increasing the dosage. Taking dosages in it excess of the recommended amount will have no additional benefit for the patient. This medication can be taken with or without food.

Missed doses….

If you miss your latest dose of Namenda you should take it as soon as possible. However, if it is almost time for the next dose you should skip the missed dosage and return to your usual dosing schedule. Never take two doses of Namenda at the same time.

How do you store Namenda?

This medication should be stored at room temperature.

Over dosage of Namenda:

If Namenda is taken in excess of the recommended dosage you may have serious consequences. If you believe you may have taken an over dosage of this medication, you should call your doctor or seek immediate emergency medical attention.

Symptoms of Namenda overdosage:

Stupor, sleepiness, restlessness, psychosis, loss of consciousness, hallucinations
Taking this medication as directed is absolutely essential to the effective use of this medication for Alzheimer’s disease.

Adapted from the PDR Family Guide to Prescription Drugs 9th Edition by Paul Susic Ph.D. Licensed Psychologist




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Aricept (Donepezil): Medicine for Alzheimer’s Disease?




Aricept: Brand Name

Donepezil: Generic Name

Aricept (Donepezil): Medicine:Overview

Aricept is a medicine used to treat Alzheimer’s disease and other forms of dementia in the earlier stages of the disease process. It is not a cure but may offer some improvements in an individual’s memory, language skills, attention, and ability to perform normal activities of daily living. Aricept is a medicine that is usually prescribed in the earlier stages for what is usually referred to as mild or moderate dementia. The generic form of Aricept, donepezil has been approved by the FDA. In order to receive the best price on Aricept at your local pharmacy ask for the generic form, donepezil.

Aricept (donepezil) medicine information your doctor needs to know:

In order to prescribe this medicine for Alzheimer’s disease, your doctor needs to know if you have any of the following conditions:

• if you’re breast-feeding, pregnant or trying to get pregnant
• if you have any allergies to this medicine or any other medicines, foods, dyes or preservatives
• if you have any stomach ulcers and bleeding or stomach or intestinal disease
• if you have severe headaches
• seizures or convulsions
• Parkinson’s disease
• low blood pressure
• liver problems or disease
• heart disease or problems associated with heart rhythm
• any head injury
• difficulties passing urine

How is this medicine usually taken?

Aricept (donepezil) is in a tablet form and is taken by mouth. These tablets should be taken with a glass of water or may be taken with food. Always follow the dosing routine prescribed by your doctor. This medicine is frequently taken before bedtime and should never be taken more often or less than the recommended frequency. It should continue to be taken even if symptoms get better. You should never quit taking this medicine unless your physician tells you to. You should contact the pediatrician to find out if this medication can or should be used for children.




Aricept (donepezil) dosage;

Aricept (donepezil) dosage for mild to moderate Alzheimer’s disease:
For adults, the usual starting dosage is 5 mg once a day. Your doctor may then increase your dosage as necessary or appropriate.

Aricept (donepezil) dosage for severe Alzheimer’s disease:

The usual dosage for severe Alzheimer’s disease for adults is 10 mg once a day. Sometimes a dosage of 10 mg a day is also used for maintenance for individuals with severe Alzheimer’s disease. Your dosage will be adjusted by your doctor according to your own individual needs.

If you miss a dose of your medicine, you should take it as soon as possible. If it is almost time for your next dose you should only take the upcoming dose. You should never take extra dosages or double up on your medicine.

Side effects of Aricept (donepezil):

Side effects may occur with the use of this medicine. If you notice any Aricept side effects you need to report them to your doctor immediately. Some of the main side effects can include:

• weight loss
• vomiting
• unusual bruising or bleeding or red or purple spots on the skin
• uncontrollable movements
• sweating
• stomach pain
• heart palpitations or slow heartbeat
• hives or a skin rash
• agitation, increased confusion or nervousness
• fainting, falls or dizziness
• severe diarrhea
• changes in vision or balance

Some of the following Aricept side effects usually don’t require medical treatment but should be reported to your doctor if they continue or seem to be problematic:

• muscle cramping
• pain in the joints
• nausea
• limited or loss of appetite
• heartburn or indigestion
• headache
• drowsiness
• mild diarrhea

Is there anything else that may interact negatively with donepezil?

You should tell your doctor about all medications you are taking including nonprescription medicines, herbal products and nutritional supplements. Also, you should tell your doctor if you are a frequent user of drinks that contain caffeine or alcohol, if you smoke or use any illegal drugs. These can have an effect on how your medicine works. You should also consult with your healthcare practitioner prior to discontinuing or reducing any of your medications. Some of the following medications may interact negatively with Aricept:

• some antidepressants such as fluoxetine, fluvoxamine, paroxetine, sertraline
• some antibiotics such as erythromycin and clarithromycin
• some diabetes drugs
• atropine
• benztropine
• bosentan
• carbamazepine
• dexamethasone
• dicyclomine
• digoxin
• galantamine
• glycopyrrolate
• hyoscyamine
• Ipratropium
• Itraconazole or ketoconazole
• medications for motion sickness
• medicines for treating HIV infection or AIDS
• muscle relaxers for surgery
• modafinil
• nonsteroidal anti-inflammatory drugs such as ibuprofen
• oxybutynin
• phenytoin
• phenobarbital
• propantheline
• quinidine
• rifampin, rifabutin, rifapentine
• rivastigmine
• St. John’s wort
• tacrine
• trihexyphenidyl

Where should I store Aricept?

Aricept may be stored at room temperature between 15° and 30°C (59° and 86°F). You should always keep it out of the reach of children. Always throw away any unused medications after the date of expiration.

Some final words about Aricept (donezepil) medicine for Alzheimer’s disease:

Aricept is a medicine that has been found to assist in delaying the gradual deterioration associated with dementia and Alzheimer’s disease. However, there is no cure for Alzheimer’s disease and only an experienced clinician can help to determine whether you or your loved one has Alzheimer’s or some other type of dementia that may be assisted with Aricept (donezepil).

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the AARP Guide to Pills by Maryanne Hochadel PharmD BCPS, (editor-in-chief)





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Alzheimer’s Disease Medications: What You Really Need to Know




Alzheimer’s Disease Medications Overview:

Alzheimer’s disease medications have been prescribed over the last couple of decades and have had some benefit for individuals suffering from this devastating disease. However, it is essential to recognize that medications for Alzheimer’s disease and other forms of dementia are not a cure and have some limitations in preventing the continuing deterioration of the brain. The American Academy of Neurology concluded that these drugs which are primarily cholinesterase inhibitors “should be considered in patients with mild to moderate Alzheimer’s disease although studies suggest a small average degree of benefit.” Clinicians who prescribe these drugs frequently will give them for about a two months trial and may discontinue their use if no improvement is seen.

Alzheimer’s Disease Overview:

In order to determine the necessity for Alzheimer’s disease medications, first you must have a good understanding of the disease and its various forms. Alzheimer’s disease is a progressive deterioration of the brain that significantly impairs memory, thinking, problem-solving and eventually activities of daily living. It is most commonly found among the elderly, and currently is believed to account for 50% to 60% of all cases of dementia. It is estimated that by the year 2050 a possible estimated 11.3 million to 16 million Americans may suffer from Alzheimer’s disease.

It is not currently understood what causes Alzheimer’s disease, although several factors have been identified which may impact upon its development including family history and genetics and advanced age. Some estimates state that approximately 10% of individuals over the age of 65 may have the disease and nearly half of individuals over the age of 85 may be affected by the disease as well.




It is believed that Alzheimer’s disease causes a loss of brain cells resulting in memory loss, language difficulties, problems performing familiar tasks, disorientation to time and place, problems in abstract thinking, changes in mood or behavior, and even changes in personality. The disease process is varied and progressive and may occur over several years or many.

Alzheimer’s Disease Medications and Diagnosis:

In order to determine whether Alzheimer’s disease medications are necessary or appropriate, a definitive diagnosis is required. The most well defined diagnosis can only be conducted by examining the brain tissue upon autopsy. Obviously, prior to an autopsy, in order to have the most probable diagnosis, a complete medical examination needs to be completed evaluating a complete medical history, physical assessment, neurologic and mental evaluation, radiological findings and laboratory tests by a doctor familiar with the disease and the testing process associated with Alzheimer’s disease. There is no one test that can be conducted at this time to determine whether Alzheimer’s disease exists. Research and clinical experience has found that the disease progression for Alzheimer’s can vary from 3 to 20 years after the onset and possibly another 8 to 10 years after it has been diagnosed. This extensive diagnostic process will be conducted prior to prescribing any Alzheimer’s disease medications.

Alzheimer’s Disease Medications and Treatment:

Currently there are no medical treatments or medications known to cure or even stop the progression of Alzheimer’s disease although several have been found to delay the progression. Currently the most widely used Alzheimer’s disease medications are:
donepezil (Aricept),
rivastigmine (Exelon),
galantamine (Razadyn, Reminyl),
memantine (Namenda)
Namzaric
and tacrine (Cognex).

These medications are believed to primarily increase a neurotransmitter (brain messenger) called acetylcholine in the brain, which is believed to be affected by the Alzheimer’s disease process.

Alzheimer’s Disease Medications and the Progression of the Disease:

The Alzheimer’s disease medications currently on the market cannot cure or even stop the progression of the disease process. However, they are believed to limit the severity of the symptoms of confusion and memory loss for a period of time and to delay its progression.

Two types of medications have been approved by the US Food and Drug Administration (FDA) to treat the symptoms of Alzheimer’s disease. The first is the cholinesterase inhibitors which includes Aricept, Exelon and Razadyn and memantine (Namenda). These are used to treat some of the basic symptoms of memory loss, confusion, disorientation, problem solving and reasoning. More recently there is a medication that combines one of the cholinesterase inhibitors (donepezil) with memantine called Namzaric.

Medications for the Early to Moderate Stages of Alzheimer’s Disease:

The medications that are currently used to treat the early to moderate stages of Alzheimer’s disease all fall within the classification of cholinesterase inhibitors. These medications are used to treat the symptoms of memory loss, language difficulties and the basic thinking and reasoning skills.

The cholinesterase inhibitors are believed to prevent the breakdown of acetylcholine, which is a neurotransmitter in the brain. This chemical messenger is very important in the process of learning and memory and is involved in the communication process between nerve cells. It is believed to be necessary to keep the acetylcholine levels high in the brain if possible. By keeping the levels of these chemical messengers high it seems to delay or slow down the progression of the disease process. The effectiveness however varies from individual to individual. These medications are usually well-tolerated although side effects have been noted to include nausea, vomiting, increased frequency of bowel movements and loss of appetite.

Alzheimer’s Disease Medications for the Moderate to Severe Stages:

The only medications prescribed for the moderate to severe stages of Alzheimer’s disease are memantine (Namenda) and a combination of memantine and donepezil referred to as Namzaric. Memantine is usually prescribed to improve memory, reasoning, language skills, attention and the ability to perform simple tasks. Memantine can be used alone or with donepezil (Aricept). There has been some research that indicates that taking a cholinesterase inhibitor such as Aricept along with memantine may be helpful. Namzaric combines the two into one medication.

Memantine is believed to regulate glutamate in the brain which is a chemical involved in information processing, as well as storage and retrieval of information. It has been found to improve the mental and daily functioning for some people. No medication however is harmless and side effect free, with some of the basic side effects including confusion, dizziness, headache and constipation.

Alzheimer’s Disease Medications and the Future:

Medications used to treat Alzheimer’s disease are relatively new and have been developed primarily over the last couple of decades. Currently, there is no cure for Alzheimer’s disease and medications are used to moderate and possibly delay the progress of the disease. Research is constantly being developed using people with mild cognitive impairment compared to healthy volunteers used as control subjects. However, we are only on the cutting edge of developing effective Alzheimer’s disease medications.

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from Worst Pill Best Pills: A Consumer’s Guide to Avoiding Drug-Induced Death or Illness and additional information from alz.org.





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