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Okay odd question, my mom has moderate dementia and a bit more. She is 100 pounds and 5 ft tall. Dr took her off Remeron and Celexa due to headaches and put her on Ativan point.50mg. He tells me to give her half a pill at 1pm and half a pill at dinner. It is not enough to keep her leveled out throughout the day. I asked him if I could give her 1/2 in morning, 1/2 at 1pm and full one at dinner. He said NO because of her weight and height. I can give her 1/2 morning, 1/2 1 pm and 1/2 at bedtime.

For sleep he had me buy Melatonin 5 mg at the Health Food store. Which worked well the first night, a bit less the second night and even less tonight.

As far as the Ativan is concerned, I am surprised at his response as my aunt who was the same size as Mom took 2mg of Ativan to go to sleep each night and this Gerontologist is saying .75mg (that is point 75mg) is the maximum for Mom.

Somehow I feel like this guy is punishing me and making me suffer for some unknown reason by keeping Mom just barely medicated, just barely!
I don't want her knocked out but when the meds wear off by morning she needs to be completely covered doesn't she? Am I wrong?

i am hoping that some of you that work in this field can help me with this question.

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Side effects - and symptoms of Overdose. Please be aware of this and read the link below. My mom was given one dose of Ativan for moderate anxiety (not sure how much) and she became extremely agitated, was screaming, started hallucinating, couldn't talk / slurred speech, could not drink water or eat food. Please use with caution! http://www.mayoclinic.org/drugs-supplements/lorazepam-oral-route/side-effects/drg-20072296
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@HolyCow, I've read that Ambien can cause a patient to get up in the middle of the night and wander. If your mom is in a facility, that might not be a problem. But it is something to consider.

I'm mostly concerned that she was injured while you were not there, and that they won't tell you what happened. They should give you a full report, or even a written report, just as you would expect from a child care facility if your child was injured while in their care.

I hope you get the peace of mind you need. It sounds like you're going through a very rough patch right now.
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BTW, physicians are careful with their prescriptions of certain medications, such as the benzodiazepines. They are accountable for the prescriptions they write, so generally stick close to the guidelines. This can even be true for palliative care physicians. I understand why they are cautious. They have to consider both the patient and their careers.
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My mother takes Ativan. She has access to three 0.5 mg tablets each day. I give her a bottle with the three pills and let her decide how she wants to use them. She is pretty good with her deciding. She normally takes two of them at night to help her sleep and one in the morning. She has been on some form of benzodiazepine for years. I'm surprised that on the days she forgets to take the Ativan that she doesn't have any withdrawal symptoms. She seems to be psychologically addicted to them to calm her nerves, but not physically addicted. The Ativan works okay with her when it comes to getting to sleep and calming her nerves. She has had generalized anxiety disorder her whole life and has sought relief in pills, rather than other methods.

Ativan is suspected by some of contributing to dementia. It is also known to be addictive. My thoughts on this are that my mother already has dementia and is 87 years old and in poor health. I am more concerned with her comfort at present than I am about addiction.

Most medications don't agree with my mother. She gets very agitated with some and over-sedated with others. Ativan and other benzos are the only psychotropic drugs she has not had trouble with. Since your mother has Alz, I would work with her doctor to find a good therapeutic dose if the Ativan helps to calm her agitation. Comfort is so important when there is dementia, both for the care receiver and giver.
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Ask her MD about a different anxiolytic, perhaps an extended release medication like Xanax XR. (generic: alprazolam ER) It is given once or twice a day, slow release to keep her level. Ativan is quick acting, but short acting and will last 4 hrs at most.
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BTW. for us melatonin was a big waste of time. I know it works for some people however...
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We asked the Dr for something to give Dad once in awhile to calm him down when he gets worked up, he prescribed Seraquel as needed. We gave Dad his first one last night as he was PO'ed at Mom about selling the house. In about an hour he was nicely bathed and ready for bed... HOORAY!!! No more yelling and stressing. I'd rather he be calm and sleepy once in awhile that angry and worked up. I take 1/2 an ativan as needed when I'm all stressed out. Not very often but it seems to help me. So for us, the Seraquel worked right away!
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Angelkw: May I ask if Seraquel is a medication that needs to be taken for a specific time period to know if it actually works or not on a patient? When they gave it to Mom it was point 25 mg and she was only to take 1/2 a pill in the evening. Was that dosage too low?

Also, I had severe panic and anxiety and was given Ativan to sleep point 50 and took 1/2 pill and for the panic attacks given Xanax point 25 and I took 1/2 pill and sometimes need a full pill. I have a new young general practitioner who has told me to choose one or the other but she will not fill both as they are the same thing. I told her that my psychiatrist had prescribed both as one worked better for sleep than the other. She still refuses and this makes me nervous. I do not take either of them on a daily basis but when things get hard with Mom I need them. Now I am wondering if I have to change doctors.
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Angelkw:Thank you so much for your thorough and concise answer! I am printing off your answer to hold on to for future reference!

My mother was diagnosed with dementia moderate to (severe in some areas) around 2008. She is treated for rapid heart beat and has glaucoma (high pressure) in one eye. She is also on Coumadin for blood thinning. She has probably the best immunity that I personally have ever seen. The problem is that her system is a bit different in that medications that NORMALLY work for everyone else, do not work on her. I heard this from her Ophthalmologist and her doctors in the hospital.

She had gall bladder surgery 7 months ago and was kept for 8 days due to her heart rhythm and during this time the "sundowning" really began happening. I stayed with her both day and night but she kept saying she was leaving, walking home herself, not staying. We asked the nurse to please get orders for something to calm her down and allow her to sleep at night. They tried Seraquel, Valium, Haldol, Xanax and many others I do not remember, nothing worked but something caused her to hallucinate and she was wide awake for over 40 hours with zero sleep. After 36 hours I had to ask the nurse for relief so I could go home, take my seizure medication and get some sleep. The nurse said fine and put restraints on Mom as well as a bed alarm. Well she must have gone crazy because there was talk the next morning and a bruise on her arm but no one would tell me what happened, but they kept making comments to her about it. The hospital even told me that they would "handle it in house" but not tell me what "it" was.

We had tried her once on Namenda for 1 month around 2010 and my sister removed her from it (I was on vacation) because she said it was making mom worse, more agitated. Since then she had not been on any other medication for the dementia until the hospital 7 months ago.

I found this Gerontologist who works for a company who deals with dementia/alz patients. When he had her on Remeron and Celexa, she was a bit more sedated but she slept and we slept and we were not losing out minds! When he removed her he pretty much acted like he had given up. He said she cannot take any more SSRI's because they will all give her headaches....really? Namenda and Seraquel did not work so that takes down 2 classes of drugs he says....really? So he tells me that he is running out of options for her. I am shocked as he has only personally used two on her. He says he wants to put her on anti-psychotics and if that doesn't work he will have to put her in the hospital to try and find the right combination of drugs! I do not want that as she goes nuts in the hospital and he will be trying God knows what on her and will have to dope her up so much just to get her to be calm/sedate. It is different from being at home, she is calmer at home.

I told him that I would like to try to keep Mom on the least amount or least doping type of medication that we could use that would still keep her under control and make her sleep, so we could get sleep. So he has her off all medication for about a month then puts her on the Ativan point 50 cut in half, given at 1 and 5pm, nothing else. It kind of does nothing really or it is so slight and she is NOT sleeping. She actually seems more awake and alert. So he says okay here are your choices Trazadone or Melatonin 5mg. I chose Melatonin and bought the pills. She refuses to take ANYTHING THAT IS GOING TO MAKE HER SLEEP! She flat out refused the pill and it is too big to crush and hide in food. So I buy liquid and it puts her to sleep but she does not stay asleep so she is up at 4 or 5am. So I say okay, lets try Trazadone but then I read that it causes rapid heartbeat and messes up your Coumadin levels, which is a problem for Mom.

I talk to the pharmacist and she says what about Ambian ask the doctor if she can take it....he says okay, use a 5 mg pill cut in half. Pharmacist says this is much stronger and she will sleep for 8 maybe 10 hours so be careful. I am worried so I cut the pill in 1/3 the first night and we had to give it to her in ice cream because she will not take a sleeping pill. She finally went to sleep at about 10 pm (3 hours after taking the pill) and was up at 6. So the next night I give her 1/2 a pill and 3 hours later she is asleep and up at 5:30. Last night I gave her 1/2 pill and she was asleep by 10 but up at 4 in my room checking on the dog and had been in there before because the dog had 4 blankets on her that I had not put there and then by 6 am she is up in the livingroom.

Somehow her body is able to override medications or break them down faster as her sleep will continue to diminish each night. This is incredibly frustrating for many reasons, we are playing a guessing game here and I am having anxiety because I do not know what to do and her Gerontologist is not being helpful, he acts like I am a pain in the butt when I call to ask him questions about the meds or tell him something isn't working. If I can't go to her doctor then I am dead in the water, so to speak.

Myself, my daughter and my older sister all live here but I am pretty much the sole caregiver as everyone else stays gone or away so they don't have to help. Mom's health has taken a huge toll on us all as I am having panic and anxiety attacks again, last year my daughter who was an honors student began failing classes as she was utterly depressed and wanted to commit suicide due to Mom and her condition and the upset in the house. My older sister who lives here, cannot handle the situation and stays at work or gone for 4 hours past her quitting time so she does not have to be here, this is also a punishment to me for becoming POA.. I am sinking due to no help and Mom being so unstable.

The Ativan to me is like a very thin skin that is just BARELY controlling her during the day, BARELY. That is IF EVERYTHING IS QUIET AND GOING HER WAY! So I find myself walking on egg shells constantly! The sleep we all need is ever changing as her body overrides her medications or she refuses to take medications. We are all barely hanging on by a thread. I do not know how much longer MY personal health can hold out!!! I am not just saying that either I am afraid of what this is doing to me! I am literally afraid of having a stroke, heart attack, or ulcers or all of the above.

Honest to God I do not know where to go from here.
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We had wonderful results with Seroquel. 10 hours of uninterrupted sleep and he isn't dizzy in the morning. Getting enough sleep makes a big difference in his functioning level as well. My FIL is 94, 125 lbs. he takes 100 mg at bedtime one night and 50 mg the next night - back and forth. When he took the full dose every night he began to sleep too much, 12 to 13 hrs per night but with switching back and forth, he's doing great. He also takes a 2 hour nap ( no drugs) every afternoon .
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Please note that I am not a doctor, I have a masters in Psychology and studied psychotropic drugs intensely as part of my training. Drug treatment as compared to holistic treatment is a passion of mine.

Ativan is a very addictive powerful drug. It should only be prescribed for short time periods to get someone through a particularly tough time to reduce anxiety and panic. However, many doctors keep patients on this drug for long periods of time (which is NOT recommended by the FDA nor any other agency). Once addicted, benzodiazapine drugs can be extremely hard to get off...because they are often USED as a detox drug...how do you detox off of a detox drug?? It is helpful for anxiety and sleep, and is very effective if used properly.

Having said that, the dosage your mom has been prescribed seems fair for a starting level, because the elderly, smaller people (you said she was 100 lbs), and people on other medications can be particularly effected by the sedative effect of the drug, which causes drowsiness and sometimes dizziness. You don't want her in a stupor. If she has other conditions, like heart problems, high blood pressure, etc. this could also be a reason for the dosage he chose.

A person can build up an immunity to this drug, so if it is used over a longer time period, the dosage is usually increased over time, slowly, under a doctors supervision. But as stated before, this drug is not a long term solution.

I am not surprised that he took your mom off of Remeron, as this drug is of the older school of anti depressants. It has many unfortunate side effects including increasing anxiety and agitation (obviously defeats the purpose), suicidal tendencies, and...ironically...increased depression in some patients. Celexa on the other hand is a newer drug, but has its own side effects as well. Finding the right combinations of anti depressants for ANY patient, even younger, physically healthy ones, can be so difficult. It can take many tries and many combinations.

If she is not improving, your doctor may suggest moving her to a drug like seroquel, which can be taken over the long term. Seroquel's purpose is an anti psychotic, but in the elderly it can be seen to decrease agitation, regulate sleep patterns and reduce outbursts and violent tendencies. But, as with many drugs, Seroquel has side effects, and is a very powerful drug not to be taken lightly. There are other drugs in the same class, such as Risperdal and the newer Abilify (which I don't recommend as it hasn't been properly tested in the elderly, and only recently earned it's approval to be used to boost the effect of other drugs).

I don't think the doctor is pushing to have you suffer. I think he is concerned with filling a patient full of unnecessary and unhelpful medications, and is worried about the side effects of some of these powerful drugs. I would, however, journal the effects of the drugs on your mom. Ativan is designed to work on an as needed basis, but most other drugs used for these symptoms take time to build up in the body and you often don't see the full effects for weeks after treatment starts. Using the journal you can assist the doctor to make the right choices for medications for your mom.

You are also questioning the dosage. .75 mg is a regular starting dosage dosage, maybe only slightly low. In fact, usually patients are started at 1mg per day (broken up into several smaller dosages over a 24 hour period) and this is raised to 2mg over time (going as high as 4mg over a longer period). However your doctor knows your mom's history I'm assuming? He may know that she has a higher sensitivity than other people, that she has some other conditions that could interact with this drug, or that she is on other medications that make this drug more powerful than when it is taken alone.

Melatonin is a great treatment for sleep problems, mainly because it is a substance that naturally occurs in the body, that the body makes less of as we age. Instead of a straight dosage of this drug, you may choose the time release formula which releases a certain amount within 30 minutes of taking it, and then slowly releases the rest over the next 6 hours (approximately). This can extend the effectiveness of the drug.

Keep open communication with the doctor and be willing to try the drugs he prescribes over several weeks before deciding they don't work. Most are not designed to work quickly (Ativan is, but most others aren't).

Good luck.
Angel
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