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marydys Asked May 2021

Nightime agitation? What drugs are safe?

So ever since dad had his subdural hematoma, surgery and now in hospice, they have been very concerned about nighttime agitation and him getting out of bed, falling etc. I'm concerned as well and am happy if he can be sedated at night for his own safety. However they keep trying different things and nothing seems to really fit the bill. He has dementia, some kind of adrenal insufficiency (possibly secondary Addisons disease) or NIADH which causes him to need cortozone to maintain salt, and other cardiac and pulmonary issues. Many of these drugs reduce cortisol which, to me, seems counterproductive to the drugs he's taking for his blood pressure. They said Ativan wasn't keeping him asleep. They tried Haldol but the next day dad was upset by dreams that scared him. Now they are trying Seraquel. Today I researched these and it seems that most do lower cortisol, so I'm concerned. When I question the issue with cortisol being lowered, the hospice nurse acts like they never heard of it being a problem. (They are only giving him the hydrocortisone and fludrocortisone because his cardiologist said he needs it for blood pressure). I feel like they don't know what they are doing. Anyone have any suggestions for what drug might be useful? I realize none of us are doctors and will take your suggestions and further research them before I suggest anything.

cwillie May 2021
I doubt you are going to find the perfect drug that does everything you want without any negative side effects. For what its worth my mom slept better with mirtazapine, which is an antidepressant (prescribed off label) rather than an anti psychotic.

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