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healthydoc
healthydoc, Board Certified Physician
Category: Neurology
Satisfied Customers: 1986
Experience:  Board Certified U.S. Neurologist
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Greetings, I am a carer for a gentleman 85 years old, very

Resolved Question:

Greetings,

I am a carer for a gentleman 85 years old, very advanced dementia ( screaming fits sometimes all day long, lately almost second day ) . He was on lyrica in the past year, the does being increased , now we are on 350 mg per day. Lately, he was prescribed lorazepam too, 2 mg per day. Because his screaming fits in the past two weeks became almost nonstop, and daily, and because the GP did not do anything about it, i decided to decrease his lyrica dosage. Yesterday i gave him 300 mg. and since today 250 mg. what is your advice? Also, is there any other medication? Lyrica went well for a while, but in the past month, obviously it doesn't do any good. Lorazepam did not actually help either. Are they alright together? The GP is not helpful at all. Lyrica was prescribed by the Jasmine center, but the dosage was increased regularly, everytime we complained about his behaviour deterioration, by the GP. Now, the GP is reluctant and not cooperative in referring him to the Jasmine center for a reassess, saying that that is all that can be done for him, medication wise. I do not believe this. She is not a neurologist. Please help with advice about this medications and the fact i decreased his dosage from 350 to 250 . Do thank you in advance.
Submitted: 3 years ago.
Category: Neurology
Expert:  healthydoc replied 3 years ago.

healthydoc :

Hello and thank you for your question. I'm sorry to hear about this gentleman. Lorazepam is not the best medication to handle agitation in individuals with advanced Alzheimer's dementia. My suggestion for you is to first determine why he is getting worse. Sometimes infections such as UTI and upper respiratory infections can lead to worsening of mental status. Treating the underlying cause can improve behavior. However, if the behavioral change has been getting worse progressively, my suggestion would be for you to try a medication called quetiapine. Alternative to quetipine is aripiprazole. Both of these medications may be used for treating agitation. He may need to by psychiatrist in order for either of these medications to be prescribed.

Customer: He has just been treated for UTI. Without a urine sample, they just prescribed antibiotics, by the phone. We just completed the antibiotic set. Macrodantin. 2 weeks before he got antibiotics for a suspicion of cold. But his screaming fits are quite stable, no matter what. About the lyrica decreasing dosage, is that alright?
Customer: Also, how to get to a psychiatrist without referral from GP?
healthydoc :

Lyrica dosing should have no bearing on his mental status. If anything, it can make him lethargic. It should not make him more agiatated. As for the UTI, you will have to allow him some time to recover from the infection before you a notable change in his mental status. Two weeks is often insufficient for patients to get back to their baseline.

healthydoc :

You will need to speak to your GP regarding a psychiatry evaluation.

Customer: Thank you. What would you do regarding the current dosage of lyrica and lorazepam, till the GP will decide to act?
healthydoc :

You should not change the dosing of either. Discontinuing lorazepam would not be advisable. This medication needs to be weaned off.

Customer: The medicines that you mentioned, are incompatible with a person with very slow heart rate? He has this anomaly. He is on nicorandil and simvastatin.
healthydoc :

No they are not incompatible for patients with slow heart rate. Neither of the medications that you mentioned should interact with quetiapine or aripiprazole.

Customer: Do you agree with him being prescribed lyrica in the first place?
healthydoc :

Lyrica is a medication for neuropathic pain and is also indicated as an anti-seizure medication. I have seen some psychiatrists you it for anxiety, however its benefit for this purpose is not well known.

healthydoc :

Lyrica is not indicated for treating dementia or agitation

Customer: I see.
Customer: So a psychiatrist, not a neurologist should be contacted?
healthydoc :

Since he is displaying signs of severe agitation, a psychiatrist would be more appropriate choice.

Customer: I understand. It is so baffling the whole behaviour of the GP, of the people from Jasmine center! who closed his case! also the fact that Lyrica, a drug not for mental status, worked for more than 6 months, and lately it doesn't
healthydoc :

I'm not sure that the Lyrica was doing anything at all to begin with

Customer: Me neither, but it was obvious he calmed down after talking it, then he got used with it, then became agitated again, then the dosage was increased, so on so forth until it did not have any effect any more. So maybe it was all just his own erratic behaviour, not the effect of lyrica per se?
Customer: Can i specifically ask a GP to refer him to a psychiatrist? Even if the GP is reluctant? Based on your reply ?
healthydoc :

Since Lyrica has a sedating effect it may have more likely put him to sleep instead of controlling his behavior.

Customer: I see.
Customer: So, can i specifically ask the GP to refer him to a psychiatrist even if the GP tells me there is no need, or who god knows what motives will she invoke?
Customer: Brb
healthydoc :

I think a psychiatrist (or may be a geriatrician) would be the best person to consult. I suggest you insist on the referral.

Customer: I am back, i see ....
Customer: The fact that i decreased lyrica can hurt him ?
healthydoc :

Not really...it should have no bearing...however you should not stop the lorazepam

healthydoc :

Abruptly stopping lorazepam can lead to seizures.

Customer: About that, the GP was so confused, first she said we can increase to 4 mg per day, then after we gave him one pill, he was so out of it, sleeping all the time, than she said you give him only 2 mg per day, so practically, we alone, decided to increase from one pill per day to two pills per day, meaning 2 mg. is that too much for him? Or too little?
Customer: It does not calm him down at all
healthydoc :

I would have the GP wean it down gradually.

Customer: We only give it to him in the past two , or three weeks.
Customer: I see
Customer: so in your opinion,n lorazepam prescription was hazardous too?
healthydoc :

Not really hazardous...but inappropriate

Customer: Amazing, right?
healthydoc :

it can work on short notice....but not good for preventing agitation

Customer: Ok, now, i can save this chat, right?
healthydoc :

yes you can come back to the chat

Customer: And may i ask about your neurology experience?
healthydoc :

I am a board certified neurologist in practice in the US for 12 years

Customer: I mean can i use your name and qualification as quote when i speak with the GP?
Customer: Oh my god, i am in UK
Customer: Don't get me wrong, i trust USA doctors even more,
Customer: Just the website is justanswer.co.uk
healthydoc :

I understand. This is an international website so you can got a physician from almost anywhere.. In this case you have one from the US

Customer: I see. Well, doctor, do thank you very much for your help. In the future, if i have more questions, i need to pay again, or can i contact you again for the same case?
healthydoc :

You may need to pay again since you may have another physician answering the question.

healthydoc :

You can also request me.

Customer: I see. Do thank you very much for your help. I do appreciate it ! ! !
Customer: I wish you an easy shift and lots of coffee !!
healthydoc :

You're welcome. Please do rate our chat positively! Thanks and take care.

Customer: Sure. Bye
healthydoc :

Thank you!..sipping as we chat.

Customer: Smiling, au revoir ,
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