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  1. #1
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    Alternatives to Aricept.

    Today I had a call fom the day hospital where Bill has been attending once a week since August for assessment. The key worker said that the doctor was thinking of taking him off Aricept. She seems to think that it is no longer doing him any good and that his scores have dropped. She is going to do some testing on Monday then decide if she will change his medication. This has come as quite a shock. I'm worried that I have been so focused on dealing with mum that I haven't noticed things might not be so good with Bill. He has been on Aricept for around 8 years now and I thought it was still ok for him. I don't know what they will change him to and I'm a but worried he will deteriorate if he comes off it. I wondered if anyoone had experience of alternatives.
    Izzy
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    ABOUT ME.

    'The best things in life are nearest: Breath in your nostrils, light in your eyes, flowers at your feet, duties at your hand, the path of right just before you. Then do not grasp at the stars, but do life's plain, common work as it comes, certain that daily duties and daily bread are the sweetest things in life.'
    Robert Louis Stevenson
     

  2. #2
    Dear Izzy, just read your post.

    As far as I am aware the three main drugs used are Aricept, Exelon, and Reminyl. They are all similar and of the group of acetylcholinesterase inhibitors.

    The only other drug I know of is Ebixa.

    Fact Sheet 407 would give you more info. I hope another member might be better informed than me. Thinking of you both.
    Connie

    Carer and Volunteer Moderator

    "Today is as good as it gets" - Lionel, upon diagnosis 2002
     

  3. #3
    Hi Izzy,

    I have no medical background, but below is a list of the more well-known medications used with dementia patients.

    You must of course discuss them with a doctor first, and see what he/she thinks, and whether they are available or would be useful.

    Sometimes in later stages, no drugs seem to be of much use. My Dad is in late stages and the only drug/vitamin my mother now gives him which she swears by is Fish Oil tablets (http://www.sciencedaily.com/releases...0528141248.htm).

    But anyways here is a list of the more scientific types of medications. Its probably useful to post them here with their various names anyway as it can be confusing knowing which is which, sometimes you think its a new drug, but then find out its just a different name for the same drug. For that reason I have also included the Aricepts link, for those who want more information on it, even though thats the one your father is being taken off.

    Cerebrolysin - *Approved outside U.S. http://www.alzforum.org/dis/tre/drc/detail.asp?id=39

    Exelon™, Rivastigmine tartra
    http://www.alzforum.org/dis/tre/drc/detail.asp?id=87

    Galantamine, Reminyl™
    http://www.alzforum.org/dis/tre/drc/detail.asp?id=89

    Memantine, Ebixa™, Namenda™
    http://www.alzforum.org/dis/tre/drc/detail.asp?id=51

    Tacrine, Cognex™
    http://www.alzforum.org/dis/tre/drc/detail.asp?id=90

    Donepezil, Aricepts™
    http://www.alzforum.org/dis/tre/drc/detail.asp?id=86

    Best wishes,
    Nat

    The mantra that gets me through the bad times:
    "This too in time will pass... This too in time will pass...."
     

  4. #4
    Hi Izzy,

    I'm really sorry that you've been confronted with this on top of everything else.

    Many people on TP have reported downturns in their loved ones abilities after stopping Aricept (this is for people who had improved whilst taking it), so I would approach this proposition with care.

    I don't know how medics can ascertain that a drug like Aricept is no longer offering any benefit. My understanding of the NICE guidance, withdrawing medication after MMSE scores fall below 10, is that to some degree it is based on an economic model, where the main cost benefit is keeping someone out of a care home.

    My MIL's CPN told us that the local policy was, assuming no adverse reactions, to keep people on medication as long as possible. Even for someone with advanced AZ, the medication can make the difference between being able to express needs such as thirst or hunger and not being able to communicate these things at all.

    Looking at the AS factsheet on drug treatments:

    http://www.alzheimers.org.uk/factsheet/407

    Aricept, Exelon and Reminyl all work in a similar way, and are known as acetylcholinesterase inhibitors. Ebixa works in a different way to the other three.
    So, the guidance for Aricept, Exelon and Reminyl is the same as they all work on the same principle - reducing the breakdown of the neurotransmitter acetylcholine in the brain.

    The other drug Ebixa is different (in the US I believe it is licensed for moderate to severe AD) and NICE guidelines limit it to clinical trials, but consultants have the authority to prescribe based on clinical judgment.

    There is even some evidence that Aricept and Ebixa taken in combination are even more effective and there is a clinical trial underway in the UK to investigate this question:

    http://neuroscience.iop.kcl.ac.uk/domino/default.aspx

    I hope you can try and convince the consultant that this would not be in Bill's or your best interests at the moment.

    Take care,
    Sandy
    Talking Point Member
     

  5. #5
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    Thanks Connie. I know I should have looked at the fact sheets. I'm too impatient! We're away for the weekend for my nephew's wife's 40th and I'm surfing using my phone! I will have a good look at the sheets on Sunday so that I will be prepared when they tell me what they're changing the medication to. Thank Connie. Izzy x
    Izzy
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    ABOUT ME.

    'The best things in life are nearest: Breath in your nostrils, light in your eyes, flowers at your feet, duties at your hand, the path of right just before you. Then do not grasp at the stars, but do life's plain, common work as it comes, certain that daily duties and daily bread are the sweetest things in life.'
    Robert Louis Stevenson
     

  6. #6
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    Thank you Nat and Sandy. I will have a good look at all the links. I don't feel that it's a financial decision as we have had no problems with him getting Aricept over the last 8 years. I will have to wait and see what is suggested but your links and thoughts will ensure that I am prepared. Thanks again. Izzy x
    Izzy
    Carer and Volunteer Moderator

    ABOUT ME.

    'The best things in life are nearest: Breath in your nostrils, light in your eyes, flowers at your feet, duties at your hand, the path of right just before you. Then do not grasp at the stars, but do life's plain, common work as it comes, certain that daily duties and daily bread are the sweetest things in life.'
    Robert Louis Stevenson
     

  7. #7
    Just wanted to send you both a big hug and hope they decide against the removal of the meds.

    Hugs and love

    xx
    iMac

    Daughter & Carer

    Yesterday, Today, Tomorrow No 2 The Same!
     

  8. #8
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    Thank you iMac. I think they intend to change rather than remove meds so hopefully we'll be ok. Thanks for caring.
    Izzy
    Carer and Volunteer Moderator

    ABOUT ME.

    'The best things in life are nearest: Breath in your nostrils, light in your eyes, flowers at your feet, duties at your hand, the path of right just before you. Then do not grasp at the stars, but do life's plain, common work as it comes, certain that daily duties and daily bread are the sweetest things in life.'
    Robert Louis Stevenson
     

  9. #9
    Dear Izzy, I hope you can persuade them not to take Bill off the Aricept. It's that business of them saying that they think he is not benefitting from it that irks me. What do you think?


    Deborah
     

  10. #10
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    dad has just stopped taking aricept because of fits although they have given him sodium valporate.....i think i will try and persuade them to put him back on it .i will follow this thread with interest
    tim x
     

  11. #11
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    I'm really not sure what to do. Bill has never had side effects from aricept. I am wondering if they think being on it for 8 years he needs a change to another of the same family of drugs - those others have mentioned are in the same group. I do get the feeling that this is not a cost thing but trying to make sure he is on the right drug. I will let you know what transpires. Izzy x
    Izzy
    Carer and Volunteer Moderator

    ABOUT ME.

    'The best things in life are nearest: Breath in your nostrils, light in your eyes, flowers at your feet, duties at your hand, the path of right just before you. Then do not grasp at the stars, but do life's plain, common work as it comes, certain that daily duties and daily bread are the sweetest things in life.'
    Robert Louis Stevenson
     

  12. #12
    I would certainly ask of they are considering Ebixa (Memantine) and keeping him on the Aricept at the same time, as a combination therapy.
    Sandy
    Talking Point Member
     

  13. #13
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    Thank you Sandy. I will do that. Izzy
    Izzy
    Carer and Volunteer Moderator

    ABOUT ME.

    'The best things in life are nearest: Breath in your nostrils, light in your eyes, flowers at your feet, duties at your hand, the path of right just before you. Then do not grasp at the stars, but do life's plain, common work as it comes, certain that daily duties and daily bread are the sweetest things in life.'
    Robert Louis Stevenson
     

  14. #14
    Yes, I too would say what Sandy has...quite a few of the posters on here have been mentioning better results with Ebixa in some recent posts. I know Dad was on it briefly too...for him it only worked in the short term unfortunately.

    So it may not work, but surely some medication aimed at slowing the disease down is better than none, though as I say you do find that most people with dementia do eventually come off all 'dementia' meds as they reach later stages.

    By the way Tim, Dad had to go on sodium valproate (known here as Epilim) because of fits and is still on it (it does seem to help reduce mini-seizures he has). I am not sure from your post if your doctor has suggested that the aricept caused the seizures or if perhaps the two medications aren't good together, but Dad hasn't been on Aricept for years yet he still has seizures, they just seem to be reduced by the Epilim.

    The goods news, is that there was some talk back in late 2008 that sodium valporate itself may be useful in treating dementia itself. I don't know where the research has gone since then, but I have to say, I keep wondering why Dad's slippery slope down the dementia loss of abilities path seemed to slow right down around the time he got put on the Epilim...could be just coincidence, maybe that's how dementia works (things get really bad fast and then slow right down) or maybe it has something to do with a trial drug he was on for a year, but anyways here is an article on sodium valproate as a potential dementia treatment:

    http://www.sciencedaily.com/releases...1208092110.htm
    Last edited by jc141265; 06-02-2010 at 10:22 PM.
    Nat

    The mantra that gets me through the bad times:
    "This too in time will pass... This too in time will pass...."
     

  15. #15
    Hi Nat, thank you for the link about 'sodium valporate'.

    Lionel had been on the medication Exelon for over six years when it was stopped about 18 months ago. I did not see any deterioration in his condition, as he had no abilities left to lose.

    He has been on sodium valporate for about three years, ever since his first major seizure. For me, the srticle made interesting reading.
    Connie

    Carer and Volunteer Moderator

    "Today is as good as it gets" - Lionel, upon diagnosis 2002
     

 

 

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