Selective swallowing; any suggestions?

Conclusion

I mailed the Doc a letter, essentially a copy of my last post, which resulted in a telecon. She concurred with my results agreeing that crushing the tab was the only way and the effectiveness was compromised. My wife is in daycare 3 days/week and the Doc is in touch with the staff and the staff are particularly fond of my wife so the Doc gets a good picture of her declining condition. Putting that altogether resulted in initiating stopping the med. So it will get cut in half, crushed and administered at night for about 3 weeks or so then probably stopped. But I’ll may keep on with 1/4 tab for a while just to make sure its a good washout. 

I know some of you suggested stopping the med and my thinking was maybe but not so fast let’s study on it first. All that was done. My PSW is 88 next month and was diagnosed 11 years ago. I’m 84 in couple months. With secession of the Donepezil she will be taking 1 med, thyroid. I take none. AL has been suggested - I cannot at this time see the need nor bear the thought of it. All caregiving stories are not horror stories.

Thank heavens I started this thread - it has led to great things. 

The 10Mg Donepezil is to be taken at bedtime because it may induce among other things blood pressure variations which might best be tolerated during sleep. It is to be taken whole or dissolved on the tongue; both options control the absorption rate. Hence the special coating on the tab.

So a couple years ago my PSW (poor sweet wife) was found at day care to have blood pressure variance from 90 to 110. I worked on that many days trying to correlate the fluctuation with various activities like walking or eating or whatever. We finally gave up because no ill effects seemed to present.

I now believe Donepezil taken in the morning (whole tab at that time) caused that BP fluctuation. I further believe that crushing the tab upsets the absorption rate but not the general overall benefit of that med although that benefit may possibly be compromised somewhat. It certainly is a given that caregivers must bend the rules because so often there simply are no options.

Therefore I will continue at present to crush the tab and serve it in jam (home made) or even (ugh) yogurt or (yuk) pudding. Since I now (perforce) do all the cooking……………. Anyway I’ll continue to seek an alternative but not worry about it.

Thank you all for “listening to me” and your responses. My mind is now at ease and isn’t that the most important state for a care giver? I couldn’t a did it without ya. I hope this thread helps somebody else. 
 
-qm

Try putting it in applesauce. The speech therapist recommends that for swallowing difficulties.

There are two main reasons for not crushing medications or presenting them in liquid formulation.

1. Modified release formulations, designed to deliver the medication slowly.

2. Medications that need to get past the stomach to do their job - PPIs, for example.

With the Donepezil, I'm guessing it's the first reason that applies?

Two avenues to suggest.

a) Have you considered whether it might be time to reconsider the Donepezil? How confident are you that it is of worthwhile benefit to your wife?

b) In France, they use suppositories a lot more than we AngloSaxons (roughly speaking) do. You can't say this to most English-speaking people without blushes all round; but p.r. medications have so many advantages that it really is a shame we don't get over ourselves about it. I have just been to look: there is an 'oral jelly' form of Aricept, apparently; I can't find a suppository, just a lot of warning about drug interactions, but your friendly pharmacist will certainly be able to tell you if there is one.

And actually, that's not a bad rule of thumb for any practical medication problems - when in doubt, go to your pharmacist. If you're surprised by his/her answer, ask him/her to explain it.

I would agree if it can be dissolved on the tongue (ODT _ oral disintegrating tablet) that crushing is acceptable. I cannot find confirmation of that. I find no statement that this med is time release. I have ran across that head ducking technique before. It’s quite interesting. I believe she is past being taught anything. She’s 88; in her 11th year of dementia. 

I have concluded from much reading and cogitation that continuing this med would be preferable to dropping it. The Doc left that up to me. She has been on it for 11 years and therefore just dropping it, at least to me, is not an option. If crushing it for the last 6-7 months has effectively ended its affect then it’s too late and I’ll drop it. So it will continue till that is resolved. A bit OT here?

She eats ok, chews and swallows, my conclusion is she is able to swallow the tabs but doesn’t really grasp that is what’s required. She can drink OK like at the table but if I hand her a glass she may or may not know what it’s for or sometimes even know to grasp it. Requests to swallow or drink just might not and usually don’t “take”. Judging by other observations I believe in part she is mentally trying but the mssg isn’t getting thru. In that regard I find certain actions like putting her feet into her slippers, for example, require a preliminary trigger action. I definitely will try (ugh) yogurt and/or (yuk) pudding. :-)

Thanx for the comeback and if nothing else it has triggered me to more study. I find switching to a non-google search engine often is more productive - you don’t keep getting the same answer geared to ‘your interests’ ad nausem. Grr.:-)

Well! I just now B4 posting I found a site that said Donepezil ODT should not be crusht or chewed because that might increase the rate of absorption. Interesting. Gotta follow that up.

I would think that anything that can be dissolved on the tongue can be crushed. The selective swallowing should be evaluated though, she may be having problems with thin fluids and certain textures and would benefit from a modified diet.

How far gone is your wife in this desease. I think that there comes a time when medications like this no longer help once the person goes into the next stage. You may want to ask her doctor if he feels its still needed.

To get pills into Mom they used yogurt or pudding. Goes down easier than jelly. 😊

Has your wife had a swallow study by a speech therapist?

The speech therapist at my mom's nh taught my mom a technique by which she ducked her head down to facilitate swallowing. It worked amazingly well.