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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Marie1 on November 30, 2001, at 7:01:04
Hi Cam.
Hope you don't mind giving me your opinion on this. :-)
My father-in-law, who has mild Altzheimer's visited us over Thanksgiving holiday. Earlier on the day he arrived, he had a doc app't for Altz. and was put on Aricept, 5mg to be taken at bedtime. That evening he became very nauseous and vomited. He blamed it on the Aricept, which he shouldn't even have taken yet, but said he had. He fully recovered the next day and continued to blame being sick on his new meds. Something he said made my husband suspicious as to how many pills he had taken, so he decided to count them, knowing they were a brand new prescription. When he poured them out we saw that there were both 5 and 10 mg. pills in the bottle (different size and color)! I forget what the exact count was, but it turns out that my f-i-l must have taken 2 pills the previous day, and they both must have been 10 mgs. My husband called the dispensing pharmacy and was told "not to worry, 20mgs/day is still a proper dosage for Aricept"!!! Can you imagine any scenario where this isn't the big deal we think it is? Is there any legitimate justification for mixing both mgs. together in the same bottle? The directions clearly stated 5mg. at bedtime. My other concern (besides his ability to self medicate) is - he is turned off to this med since he blames it for making him sick, but we really have no proof that's what did it. In your opinion, is 20 mg. of Aricept, taken by a smallish man (about 140 lbs.) for the first time, on top of 1 beer, apt to make him sick? I hate for him not to take this drug if it's probably not responsible for making him sick. My f-i-l isn't interested in taking any legal action against the pharmacy, but I was really wondering what your reaction is. Sorry for the length of this post!Marie
Posted by Cam W. on November 30, 2001, at 14:38:13
In reply to Question for Cam, posted by Marie1 on November 30, 2001, at 7:01:04
Marie - Aricept can can fairly bad vomitting; this is why the dose is titrated upwards slowly. If your f-i-l hasn't been taking the drug regularily and hasn't titrated the dose upward, 20mg would make him very nauseous.
The mixing of the pills in a bottle is fairly common, once they leave the pharmacy. The new bottle of meds is poured into the old bottle by the patient. If your f-i-l hadn't been titrating up religiously and regualrily, and then was given the 10mg tablets (thinking they were the same as the last dose - 5mg) then, yes, he would become very sick to his stomach.
People with Alzheimer's become confused easily. They need simple instructions for their meds and simple ways to take them. I recommend that all patients taking more than 2 drugs more than once a day, or patients that have any sort of memory problems, use aids to compliance. Dosettes™ are good, but blister packs are better. Blister packing can tell one, at a glance, whether a med has been taking, or not. Most pharmacies can blister pack medications into a 7-day card, at no extra cost. I would recommend blister packs for your f-i-l. This will help him and his caregiver(s) to see if the meds are being taken properly. Your f-i-l will probably have to start at the beginning, in regards to taking Aricept. Tell his doctor what happened and perhaps as for a slower upward titration of dose. Also, ask the doc to write on the prescripton that your f-i-l's meds be blister packed. Aricept does work well to bring back cognitive function in those with Alzheimer's, but you have to get over the start-up side effects first.
I also question the pharmacist not picking up on the fact that there were a number of 5mg tablets left. This could mean that you f-i-l hasn't been taking his Aricept regularily. When one increases the dose under these circumstances, the start-up side effects reappear with a vengeance. Besides 20mg of Aricept is a fairly high, but not unheard of, dose. It takes slow titration to get to this level, though.
I hope that this is of some help. - Cam
Posted by Marie1 on December 1, 2001, at 9:56:57
In reply to Re: Question for Cam » Marie1, posted by Cam W. on November 30, 2001, at 14:38:13
Thanks, Cam. That was very helpful. So it probably was the Aricept that made him sick.
I didn't make it clear that this was his *first* experience taking Aricept; it was the *pharmacy* that mixed the pills together. Is there any legitimate reason for them to do that? I'm especially concerned because my f-i-l lives (alone) in Ohio; we're in Virginia. We tried getting him to move in with us last year, but his girl friend talked him out of it. This is a very bad situation and it appears even the pharmacy can't be trusted.
Your idea about the blister pack is perfect. I'll see what I can do to have it prescribed that way. Thanks again, Cam.Marie
> Marie - Aricept can can fairly bad vomitting; this is why the dose is titrated upwards slowly. If your f-i-l hasn't been taking the drug regularily and hasn't titrated the dose upward, 20mg would make him very nauseous.
>
> The mixing of the pills in a bottle is fairly common, once they leave the pharmacy. The new bottle of meds is poured into the old bottle by the patient. If your f-i-l hadn't been titrating up religiously and regualrily, and then was given the 10mg tablets (thinking they were the same as the last dose - 5mg) then, yes, he would become very sick to his stomach.
>
> People with Alzheimer's become confused easily. They need simple instructions for their meds and simple ways to take them. I recommend that all patients taking more than 2 drugs more than once a day, or patients that have any sort of memory problems, use aids to compliance. Dosettes™ are good, but blister packs are better. Blister packing can tell one, at a glance, whether a med has been taking, or not. Most pharmacies can blister pack medications into a 7-day card, at no extra cost. I would recommend blister packs for your f-i-l. This will help him and his caregiver(s) to see if the meds are being taken properly. Your f-i-l will probably have to start at the beginning, in regards to taking Aricept. Tell his doctor what happened and perhaps as for a slower upward titration of dose. Also, ask the doc to write on the prescripton that your f-i-l's meds be blister packed. Aricept does work well to bring back cognitive function in those with Alzheimer's, but you have to get over the start-up side effects first.
>
> I also question the pharmacist not picking up on the fact that there were a number of 5mg tablets left. This could mean that you f-i-l hasn't been taking his Aricept regularily. When one increases the dose under these circumstances, the start-up side effects reappear with a vengeance. Besides 20mg of Aricept is a fairly high, but not unheard of, dose. It takes slow titration to get to this level, though.
>
> I hope that this is of some help. - Cam
Posted by Cam W. on December 4, 2001, at 0:16:13
In reply to Re: Question for Cam » Cam W., posted by Marie1 on December 1, 2001, at 9:56:57
Marie - There is no reason for the pharmacy to mix the two strengths together. In Canada, you are not allowed to mix two different drugs, or strengths of drugs, together in the same bottle. I would call this a mistake.
Pharmacists do make mistakes, including me; but they should own up to there mistakes immediately. If a pharmacist says that he/she has never made a mistake, it is their first day, or they are lying.
The pharmacy can still be trusted, but do make sure that they have "fessed up" to the mistake. If try to cover it up, I would contact the store's management &/or the pharmacy licencing board. It is human to make a mistake, but it is criminal not to admit to it.
For your f-i-l to be taking 20mg of Aricept a day, he would have had to build up to that dose over the course of a couple of months. Since this was his first prescription, no wonder it made him sick. It might be wise to let his doctor know what happened with the Aricept. It may explain to him/her why your f-i-l is hesitant to stay on Aricept.
I hope everything works out. - Cam
Posted by Marie1 on December 4, 2001, at 5:37:50
In reply to Re: Question for Cam » Marie1, posted by Cam W. on December 4, 2001, at 0:16:13
This is the end of the thread.
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