Common Medicines
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Misinformation and unqualified advice
You should never start, stop or change prescribed medications based on something you've read, even on this website. There's a lot of misinformation available on the internet, on medical issues as on every other subject. Only doctors and other qualified medical practitioners have the medical knowledge required to determine what's appropriate under a particular patient's circumstances. What may be best for one person may be bad for another person with a different mix of medical conditions.
It is useful, however, to become well-informed on your loved one's medications, and to talk to their doctor or to a qualified pharmacist about any concerns - for example when your loved one's circumstances change in a way you think the prescribing doctor should be made aware of.
Reliable sources of information
To look up any medicine for yourself, the NHS website has a Medicines A-Z - but remember that this can only give general information, not something tailored to your loved one's circumstances and health conditions. See also the NHS website Health A-Z of conditions.
A very useful source of information on medications is of course a qualified pharmacist. They will be able to give advice based on the whole set of medicines that your loved one is taking, but there are limits (as they will know) - for example they don't know the full medical history your GP does, they don't have as much training beyond pharmacy, and some medications may be prescribed for a number of different conditions and they won't know which applies in your case.
Dementia medicines
As an overview, there are two different classes of drug used to treat Alzheimer's Disease and other forms of dementia. They are thought to improve symptoms slightly (including reducing anxiety) but not to slow progression of the disease.
The first class of drug is represented by donepezil (UK brand name Aricept), although there are two other similar drugs in this class - galantamine (UK brand name Reminyl) and rivastigmine (UK brand name Exelon).
The second type of drug is memantine (UK brand name Ebixa).
Your doctor will identify which is the most appropriate treatment, taking account of health issues such as heart disease.
More information is available on the NHS website NHS website Health A-Z for Alzheimer's disease treatment and on the Alzheimer's Society website, under 'drug treatments'.
Sleeping pills and sedatives
We're mentioning sleeping pills (also known as hypnotics) and sedatives (also known as anxiolytics, used to treat anxiety and resulting sleep disturbance) for two reasons. Firstly because sleep disturbance is a common effect of dementia but treating it with sleeping pills carries a serious risk of falls; and secondly because there is a risk of them being misused to sedate people to avoid behavioural issues (the so-called 'chemical cosh').
We're not saying they should never be used, but the medical guidance (referred to below) is that they should be used only for the right reasons, and for relatively short durations rather than forever (and in fact their effectiveness reduces after just 3-14 days of use). We must stress that there can be severe withdrawal symptoms (which can take up to 3 weeks to appear) so you absolutely must consult your doctor before reducing or stopping these medications.
The following quotes are taken from the UK's National Institute for Health and Care Excellence (NICE website, under BNF - treatment summaries - hypnotics and anxiolytics), with its bold and italic emphases and our expansions in [italicised square brackets]:
- Hypnotics
- Before a hypnotic is prescribed the cause of the insomnia should be established and, where possible, underlying factors should be treated.
- Hypnotics should not be prescribed indiscriminately and routine prescribing is undesirable. They should be reserved for short courses in the acutely distressed. Tolerance to their effects develops within 3 to 14 days of continuous use and long-term efficacy cannot be assured. A major drawback of long-term use is that withdrawal can cause rebound insomnia and a withdrawal syndrome.
- Elderly: Benzodiazepines [e.g. lorazepam] and the Z–drugs [e.g. zopiclone] should be avoided in the elderly, because the elderly are at greater risk of becoming ataxic [reduced balance and co-ordination] and confused, leading to falls and injury.
- Anxiolytics
- Benzodiazepine anxiolytics can be effective in alleviating anxiety states. Although these drugs are sometimes prescribed for stress-related symptoms, unhappiness, or minor physical disease, their use in such conditions is inappropriate. Benzodiazepine anxiolytics should not be used as sole treatment for chronic anxiety, and they are not appropriate for treating depression or chronic psychosis. In bereavement, psychological adjustment may be inhibited by benzodiazepines.
- Anxiolytic benzodiazepine treatment should be limited to the lowest possible dose for the shortest possible time.
- Benzodiazepines are indicated for the short-term relief of severe anxiety; long-term use should be avoided.
The NHS website Medicines A-Z reflects this advice on restricted period of use.
A further consideration should be that if the pills were given by a visiting carer at the time of an evening meal (when there's no further visit at bedtime) then there would be a greater risk of falls between the time of the evening meal and when the person gets themselves to bed.
Diabetes (Type 2) medicines
This section relates to Type 2 diabetes, the likelihood of which increases with age, with lack of mobility to exercise, and with poor diet. Type 1 diabetes is very different and is not covered here.
There are two main medicines used to treat Type 2 diabetes in the UK: metformin and gliclazide. Some people may be prescribed both together. Your doctor will determine which is most appropriate for your loved one, taking account of other medicines and health conditions, and will monitor blood sugar levels to determine the correct dose. Too high a dose of gliclazide (or a significant reduction in eating) will continue to reduce blood sugar levels until they are too low, and so metformin is generally prescribed unless a side effect such as vomiting is experienced. For more information on these medicines see the NHS website Medicines A-Z for gliclazide and the NHS website Medicines A-Z for metformin.
Pain relief
We mention painkillers (e.g. paracetamol) so you're aware they may be prescribed 'PRN' (which means 'as needed', abbreviated from the Latin) or as an ongoing treatment. A PRN prescription may be made in advance of specific need, to be ready without delay, considering the potential for interactions between different medicines, and the influence of particular health conditions.
Use of painkillers as an ongoing treatment may be made where there is a known source of pain to be managed, or if the person is unable to communicate and a pain assessment indicates that pain relief should be tried.
Painkillers are sometimes prescribed as a patch that sticks to the skin and releases the medication continuously.
Obviously it's vital that the prescription dose and instructions are followed very carefully.