My mum just started taking Quetiapine 4 days ago - prescribed by the Psychiatrist at the Older Person's Mental Health team.
She is 90 with AD (& poss Lewy Body) - it was prescribed because she's been having such a bad time with hallucinations which are visual & auditory.
I am glad they are trying her on these tablets & the possible side-effects have been explained to me, but it's a case of weighing up benefits against risks. They've started her on a very low dose - half of a 25mg tablet every morning. The Psychiatrist is in touch with me to monitor how it's going, & is coming to visit mum at home (with me present) on 28th Aug.
At the moment the carers give her the half-tablet in the morning (the pharmacy label says morning), with her other meds.
The carer comes for 1hr each morning 10.00 /11.00am. The tablets are absolutely tiny & round & impossible to successfully break in half. I bought a pill cutter but they're even too small for that! The carer says she's been cutting them with scissors & can more or less get a half but the rest just crumbles to nothing.
Very quickly after taking the tablet, the drowsiness sets in - which has been alarming the carer & she rang me at work in a panic & reported it to the care manager. She's only been on them for 4 days but they knock her out, even with such a small dose. I put in place an extra carer visit around 2.30pm on days I'm working, which started on Mon last week, in anticipation of her starting on the new tablets, so they can check on her. She has an early evening carer visit & I visit after work too. I have left a message for the Psychiatrist re the drowsiness - but I think the hallucinations are easing off.
My dilemma is do we carry on giving Quetiapine in the morning & accept that she's going to be zonked out for a few hours where she sits on the sofa, but with the knowledge that the carer will come again early afternoon (or me if I'm not at work), & it's daytime so it's bright & she can see if she wakes up & wants to get up for the loo (which is normally a frequent & urgent event - with looming incontinence I think). She is very doddery & wobbly anyway & uses a Zimmer frame, so the drowsiness is a concern. She does wear a falls monitor & an alarm pendant.
..........OR......
do we switch to giving them in the evening with her other meds (including Memantine which she's only been on for a few weeks). Night time seems the obvious thing - but my worry is that due to her normal wobbliness & constant urgency & frequency going to the toilet, if she's very drowsy from the Quetiapine (& the Memantine) she is at an even greater risk of a fall when she gets up in the night to go to the loo. Or if she sleeps right through, (which would be wonderful!), when she wakes up in the morning the terrible urgency to go to the loo will be very difficult for her & she may even wet herself or worse during the night. She already wears pull-ups or the pads & pants supplied by the continence service (she has been referred & are awaiting a home visit from the continence nurse, but she sent pads & pants ahead of her being able to visit). The trouble is mum cannot understand that she can have an 'accident' in the pads/pants & they can just be thrown away & clean ones put on. She has problems dealing with pads/pants on her own & every trip to the toilet is a major upheaval. The time her evening carer comes & gives mum her meds is around 6.30/7.00pm - too early to take the Quetiapine & too early to go to bed. If she takes them then she'll be zonked out on the sofa until the early hours then it'll be dark & she'll be all drowsy & disorientated when she comes round & then has to through the whole rigmarole of going to the loo, & carrying out all her bizarre night-time rituals, then finally getting to bed. Falls are more likely then I think.
Which leaves one more option - for me to go round later at night & put her into bed & give her the tablet & hope she stays there & sleeps right through & hope for the best! I don't really want to have to drag myself out late every night to do that & I know I'll be stuck there for ages, it won't be a quick visit, it never is! Sorry, that sounds mean, but once I start doing that, I'm stuck with it which will make our life difficult. The care agency unfortunately don't do night visits.
Sorry for the long post ! Any thoughts & suggestions would be welcome please!
She is 90 with AD (& poss Lewy Body) - it was prescribed because she's been having such a bad time with hallucinations which are visual & auditory.
I am glad they are trying her on these tablets & the possible side-effects have been explained to me, but it's a case of weighing up benefits against risks. They've started her on a very low dose - half of a 25mg tablet every morning. The Psychiatrist is in touch with me to monitor how it's going, & is coming to visit mum at home (with me present) on 28th Aug.
At the moment the carers give her the half-tablet in the morning (the pharmacy label says morning), with her other meds.
The carer comes for 1hr each morning 10.00 /11.00am. The tablets are absolutely tiny & round & impossible to successfully break in half. I bought a pill cutter but they're even too small for that! The carer says she's been cutting them with scissors & can more or less get a half but the rest just crumbles to nothing.
Very quickly after taking the tablet, the drowsiness sets in - which has been alarming the carer & she rang me at work in a panic & reported it to the care manager. She's only been on them for 4 days but they knock her out, even with such a small dose. I put in place an extra carer visit around 2.30pm on days I'm working, which started on Mon last week, in anticipation of her starting on the new tablets, so they can check on her. She has an early evening carer visit & I visit after work too. I have left a message for the Psychiatrist re the drowsiness - but I think the hallucinations are easing off.
My dilemma is do we carry on giving Quetiapine in the morning & accept that she's going to be zonked out for a few hours where she sits on the sofa, but with the knowledge that the carer will come again early afternoon (or me if I'm not at work), & it's daytime so it's bright & she can see if she wakes up & wants to get up for the loo (which is normally a frequent & urgent event - with looming incontinence I think). She is very doddery & wobbly anyway & uses a Zimmer frame, so the drowsiness is a concern. She does wear a falls monitor & an alarm pendant.
..........OR......
do we switch to giving them in the evening with her other meds (including Memantine which she's only been on for a few weeks). Night time seems the obvious thing - but my worry is that due to her normal wobbliness & constant urgency & frequency going to the toilet, if she's very drowsy from the Quetiapine (& the Memantine) she is at an even greater risk of a fall when she gets up in the night to go to the loo. Or if she sleeps right through, (which would be wonderful!), when she wakes up in the morning the terrible urgency to go to the loo will be very difficult for her & she may even wet herself or worse during the night. She already wears pull-ups or the pads & pants supplied by the continence service (she has been referred & are awaiting a home visit from the continence nurse, but she sent pads & pants ahead of her being able to visit). The trouble is mum cannot understand that she can have an 'accident' in the pads/pants & they can just be thrown away & clean ones put on. She has problems dealing with pads/pants on her own & every trip to the toilet is a major upheaval. The time her evening carer comes & gives mum her meds is around 6.30/7.00pm - too early to take the Quetiapine & too early to go to bed. If she takes them then she'll be zonked out on the sofa until the early hours then it'll be dark & she'll be all drowsy & disorientated when she comes round & then has to through the whole rigmarole of going to the loo, & carrying out all her bizarre night-time rituals, then finally getting to bed. Falls are more likely then I think.
Which leaves one more option - for me to go round later at night & put her into bed & give her the tablet & hope she stays there & sleeps right through & hope for the best! I don't really want to have to drag myself out late every night to do that & I know I'll be stuck there for ages, it won't be a quick visit, it never is! Sorry, that sounds mean, but once I start doing that, I'm stuck with it which will make our life difficult. The care agency unfortunately don't do night visits.
Sorry for the long post ! Any thoughts & suggestions would be welcome please!