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My 97-year old mother has been taking Aricept (10 mg. once daily) and original Namenda (10 mg. twice daily) in generic form for about eight years. She is now in the advanced stage of Alzheimer's Disease. Can I safely discontinue one or both of these drugs at this point. My understanding is that the symptomatic relief they provide does not last long. I have continued dispensing these drugs for fear that mom might decline more rapidly without them and because they are covered by her Medicare Part D Drug Plan. On the other hand, less medication is always better than more. I welcome all comments on this subject.

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Mom takes memantine (Namenda generic) and donepezil. Doctor says it will not improve her memory or cognitive ability but could keep it from declining as quickly. She has taken these meds for about 3 years now and there is still decline but who knows if it would have been worse without the meds. Some days are better than others. The aphasia is the worst part along with a huge decline in memory.
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Reply to texasrdr22
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i feel i am losing my husband a little more each day. i still give him aricept and namenda. any little help is worth it. why can't these researchers find a cure. i feel sometimes that there is a cure. but the pharmaceutical company do not want to give the medication because they would loose millions of dollars. what a shame
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Reply to frustratedfaye
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At 97 I would contact her doctor and ask if you need to titrate the meds down and then discontinue them. Studies and research don’t support any benefit for people after a certain time if no improvement in symptoms are noted. I wouldn’t give any medication that doesn’t appear to improve symptoms. 
Good luck!
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Reply to Shane1124
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my husband age 75 has been on aricept and celexa for 7 months and he is now better than he was 5 + years ago in terms of mood, anxiety, agitation and memory. I have no idea how long this will last but for this moment it is a miracle.
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Reply to manatakei
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There are television ads for these 2 meds every day. Watch them.
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Reply to Llamalover47
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All of this information is very helpful. Still, I feel as if I'm not sure which way to go. Are these typical Alzheimers meds ever prescribed for someone with Vascular Dementia?

I'm consulting with a Geriatric Psychiatrist in a couple of weeks with my cousin, who has severe dementia. She's done quite well with her anxiety on Cymbalta and small dose of Seroquel at night, but lately is overly worried about where her long deceased parents are. She looks for them a lot in her wheelchair and is distressed.

I wonder if the psychiatrist will prescribe Namenda. She has never taken it. She is receiving Palliative care and my goal is to keep her as comfortable and content as possible. Quality, not quantity. If a med will help her distress, I'm for it, but, I guess, I've just never heard many good things about it or Aricept. I'd rather limit her meds if possible.

Does the doctor lay out the options and then let you decide? I'm her Healthcare POA. Will he give me the chance to think it over? I just don't want to be pressured into a med that could have bad side effects, that could then make her decline more.
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Reply to Sunnygirl1
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Go to Namenda's site
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Reply to Llamalover47
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My Mother Who suffered from Alzheimer's just hated taking med's. Hence I seriously thought of not giving Mam all the tablets since why prolong the suffering when death will be the outcome, but then I asked Myself WHO AM I TO PLAY GOD, so I began crushing the tablets into powder and mixing in yougart before I gave to Mam. Mother passed away last June from Heart failure at 87 years, three years after being diagnosed with this awful disease of the Brain. Rest in peace.
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Reply to Johnjoe
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My MIL was on Namenda for 3 years. When she declined to the point of needing nursing care, where she was barely walking, her elder care doctor recommended removing all medications to be under hospice care. Even though Alzheimers is progressive, the response of decline was dramatic. She stopped walking and speaking. She used to be anxious and agitated which is why she was put on Namenda but when speaking stopped she did not demonstrate those problems. She occasionally smiles and only recognizes 2 people. She is still able to eat. That was more than 2 years ago and she is still alive. You may want to look at it as quality of life rather than quantity of life. As many people posted, some of those behaviour signs may return but in MIL's case it did not. She just had a rapid decline. Her 4 children still feel this was the best choice. All were on board with the decision.
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Reply to MACinCT
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Are most people using the namenda XR? I am not -- it is very expensive. Just curious.
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Reply to Luv2Travel
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My mother (age 90) was taken off Namenda last winter after about six years. She is still on Donepezil. Seroquel was added at about the same time to control agitation and aggression. Neither her caregivers or I have noticed any significant change in cognitive function since the Namenda was discontinued. The Seroquel has helped to calm her (most of the time), and the dosage has gone from 25mg per day to a total of 75 mg per day in three doses. At this point, my goal is to keep her calm and relatively happy and not worry so much about cognitive decline because there is not much left to lose.
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Reply to akdaughter
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My mom has advanced dementia (85). She's been on exelon patch 3 years (skipping it makes a huge difference). She's been on seroquel at night starting at 25 mg for a couple of year, then 50 mg for a year, and now 100 mg at night. Seroquel at night makes a huge difference. If she gets overly stressed or agitated, we give her 25 mg of seroquel and she calms down, has a little nap, and feels allot better. A year ago we added namenda. I can't tell any difference but both primary doctor and neurologist think it works well with the other drugs that think it's important to continue. I'm continuing only because they both keep current with all studies and I trust their opinion.
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Reply to Luv2Travel
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Exelon is FDA approved for Parkinson's dementia hence the dramatic improvement. Other antipsychotics are extremely dangerous for use with the elderly and may result in stroke and death.

I found this reference and hope it is helpful.
Dementia and behavioral disorders
In the case of elderly patients affected with dementia, every antipsychotic treatment must be prescribed at the lowest effective dosage and for the shortest period possible. The severity and frequency of symptoms and the global functioning and quality of life, as reported by caregivers, must be always monitored during treatment.17,18,48

Based on the results of the Clinical Antipsychotic Trials of Intervention Effectiveness – Alzheimer’s Disease (CATIE-AD), the role of atypical antipsychotics in influencing cognitive performance in patients with Alzheimer’s is still debated. Some trials show that risperidone reduces the Mini-Mental State Examination scores in a statistically significant way compared with placebo, which is not the case with olanzapine and quetiapine. On the contrary, other trials indicate that quetiapine and olanzapine are responsible for greater cognitive decline. The samples of individual clinical trials are not enough to determine whether the cognitive decline varies with antipsychotic use; however, this decline has been evident for all the molecules compared to placebo.34

Risperidone has been found to be very effective in the treatment of some behavioral disorders such as agitation, aggression, and wandering in patients with dementia (off-label use).10,17,29,49–51 Behavioral and psychological symptoms of dementia may be both the consequence of cognitive impairment and bipolar disorder comorbidity that of an existing bipolar diathesis, which change the clinical expression of dementia.52 Agitation often worsens some types of dementia and atypical antipsychotics are often effective, even if their use is off-label. A review performed in 2012 comparing the efficacy of off-label use of atypical antipsychotics in dementia suggested that olanzapine, aripiprazole, and risperidone have a moderate-to-high efficacy in agitation.53 Furthermore, risperidone is indicated in dementia and secondary psychoses.

Although the use of antipsychotics for dementia is off-label, antipsychotics are probably the best option for short-term treatment (6–12 weeks) of severe, persistent, and resistant aggression.54 Serious adverse events are a major contraindication to long-term therapy, thus suggesting that dosage be decreased and treatment interrupted whenever sufficient control of behavioral symptoms has been obtained.

Acute onset of confusion and delusions often occur in elderly hospitalized patients and may be effectively treated with second-generation antipsychotics. On the contrary, haloperidol has long been considered the drug of choice for treating agitation and aggression. At present, olanzapine, quetiapine, and risperidone show the same efficacy profile in acute stages of disease, without inducing the neurological effects of haloperidol. Ziprasidone and aripiprazole require careful use in acute stages since they are associated with a higher risk of arrhythmias.
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Reply to Moonflower
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My Mom started the Exelon patch for Parkinson's dementia almost 3 years ago. The improvement was dramatic. As cognitive issues increased the dose was upped from 4.6 mg to 9.5 mg before long. I tried holding the medication for a few days a couple times and that was a mistake. At this time her dementia and psychosis are so troubling that I thought it was time to discontinue her Exelon as it might be adding to her agitation. Her Neurologist said NO last Friday. In his experience the problems get worse when Exelon is stopped. He instead increased her patch to the highest dose, 13.3 mg. It's only been a few days but we've had a better week. (I should add that her antipsychotic was also increased slightly and 25 mg Seroquel was added at bedtime).
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Reply to dmasty
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Good morning, like doctors, pharmacists have their own opinions regarding medication performance. Speak with a few of them to gain other perspectives.

Depending on which drug they are taking, patients are usually prescribed between 3mg-20mg each day. The cost of a generic version of Namenda (20mg/day) is typically a little more than of the generic version of Aricept (10mg/day), and seems to be less effective for most patients. The generic versions of Razadyne and Exelon are usually more expensive, but this varies depending on insurance coverage and where the drugs are purchased. Aricept, Razadyne, and Exelon work in the same way in the brain, while Namenda works through a different system. That is why doctors sometimes hope that adding Namenda to Aricept or the other drugs might have an added benefit for patients with moderate or severe dementia.

There is no cure for most types of dementia and treatments are not very effective. Current drugs merely delay decline and help reduce symptoms. Patients with mild Alzheimer’s disease won’t benefit from Namenda but will cost them money and could cause side effects. Some side effects of Namenda are dizziness, confusion, headache, sleepiness, constipation, vomiting, pain (especially in the back), and coughing. More serious side effects are rare but include shortness of breath and hallucination.2

A study by Lon Schneider and his colleagues from the University of Southern California Keck School of Medicine examined available evidence on the effectiveness of Namenda in patients with mild Alzheimer’s disease. 3 The researchers conducted a meta-analysis, meaning they pooled and analyzed data available from several different clinical trials, in order to evaluate a larger number of people. They analyzed data from three clinical trials that included 431 patients with mild Alzheimer’s disease and 697 patients with moderate Alzheimer’s.

All three clinical trials randomly assigned patients to either receive Namenda or a placebo, and neither patients nor investigators were aware of who was receiving the drug and who was not.3 This is called a “double-blind” study and it prevents bias based on expectations that a drug will improve the outcome being measured. In this case, investigators measured patient’s cognitive functioning, behavior, and ability to perform activities of daily living. They also measured “impression of change” in the patient according to the patient’s clinician and caregiver. Four different scales were used to measure these outcomes and then scores were compared between the Namenda and placebo groups.

The study concluded that Namenda was not effective in patients with mild dementia.3 This was true when they looked at each trial separately and also when they pooled data from the three studies and analyzed that.

Among patients with moderate Alzheimer’s disease, the effect of Namenda was very small.3 Looking at the trials separately, only one of the three trials found any statistically significant improvement for patients taking Namenda compared to patients taking placebo. Even that improvement was for only one measure – a subjective measure of the doctor or caregiver’s impressions of the patients’ behavior. When the data were combined, there was a statistically significant effect on cognitive functioning and impression of change. However, these differences were small—about half the impact of drugs like Aricept, Exelon, or Razadyne, which are commonly prescribed to treat Alzheimer’s symptoms.

A 2014 study found that male military veterans with mild or moderate dementia did not benefit from Namenda, whether taken alone or together with vitamin E.7 However, vitamin E taken alone did slow the progression of mild to moderate Alzheimer’s. Several other studies have also suggested that vitamin E can provide a moderate benefit for Alzheimer’s patients.4 However, high levels of vitamin E may be dangerous, sometimes increasing the chances of heart failure and death.5 For more information on vitamin E, please visit here.

More recent meta-analyses have evaluated Namenda for dementia ranging from mild to severe, based on randomized controlled trials. These have found a significant benefit of Namenda compared to placebo for patients with dementia ranging from moderate to severe for cognitive function, behavioral disturbances, and ability to function in activities related to daily life dementia, but not for patients with milder dementia.6 7 8

None of the current treatments for dementia will radically improve patients’ memory or thinking, nor will they stop the progression of the disease. However, Namenda may help moderate or severe dementia, while Aricept, Razadyne, or Exelon may help patients with dementia ranging from mild to severe.

This article was updated in 2016.

Forest Receives Non-Approvable Letter for Expanded Namenda Indication. Drug Industry Daily, Vol. 4 No. 145. July 26, 2005. ▲
National Library of Medicine. Medline Plus. Mema
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Reply to Moonflower
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Good morning, like doctors, pharmacists have their own opinions regarding medication performance. Speak with a few of them to gain other perspectives.
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Reply to Moonflower
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Namenda and Seroquel have helped my mother tremendously. She was staying awake for 39 hours at a time, all the while keeping us awake too. Her pulse rate at times was 146. She also has Narcissistic Personality Disorder. She caused all of us to be at each other's throats. She would sit there and smirk while the chaos ensued. She treated me like her personal slave. She implied that we were stupid. Every day. My husband and I had to see cardiologists because we began having heart problems. We were perfectly fine until she moved in with us. She was brutal. Her doctor said to put her in a nursing home. I had promised her that I never would. However, she was tearing my family apart psychologically and damaging our health. Namenda and Seroquel were the last resort. We were DONE. After six weeks on the medicine she became a much nicer person. She goes to bed on time and sleeps. We are not walking zombies anymore. The constant trouble making and arguing is gone. Along with her Alzheimer's medicine, she is taking diazepam 2mg and melatonin at night. You must do what you feel is right for your loved one. All I know is, we have a drastic change for the better.
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Reply to LadyMiller
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My father has been on namenda and galantamine, both for memory, and it doesn't seem to be helping but the geriatric psychiatrist does not want to remove them because data seems to suggest that they will then decline more rapidly or have a negative reaction..Geriatric internist agrees.. So we are doing as above, and keeping him on meds ....
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Reply to LeahMo
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To get control of my mother's wild violent combative outbursts and get her hallucinations under control, she is on an antipsychotic which is wonderful. She sleeps more but is happier when she's awake. We got around medication refusal by crushing it up and mixing it into vanilla ice cream then covering with chocolate sauce. She gets her sundaes twice a day and loves them!
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Reply to Mellie1951
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Just saw my husband's neurologist yesterday. No drugs, no way, just bad side effects, and they will not prevent the disease from progressing. Heck, at 97 yrs. your mother is bound and determined to reach 100! My best to you both.
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Reply to ferris1
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Same here. Mom's been on both for years plus an antidepressant. When I brought up weaning her off one or all three meds last year at this time, or at least trying a new antidepressant (since she has these occasional wild outbursts of anger and her physically attacking me), I got the same story line from her internist, who claims there is more recent data saying not to take them off the meds, but I frankly don't believe her. I'm not wild about seeking out a geropsychiatrist at this point, and the internist is just no help other than pushing investigational meds which do nothing but put money in her pocket. I'd almost rather have mom lose some of her physical skills and be calmer without the meds but don't know if that would happen. She has gone 3-4 days at a time without the above three meds because she will refuse to take her pills sometimes (I do manage at least to get her blood pressure and thyroid meds down her most days), and I did not notice much change without them.
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Reply to anonymous144432
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I have done like gladimhere. My wife, age 80, began signs of AD soon after a hip replacement in 2001. She has been taking Namenda and Aricept for years. I have also heard that it's help does not last. But, who really knows? I plan for her to continue these medications until a better drug is developed.
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Reply to JimmyW
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If it isn't broke... i did the same with my mom, she had been taking namenda for years but I did not stop it since we had no way of knowing whether it was helping her or not. So, she kept taking it.
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Reply to gladimhere
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