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 The Anti-psychotic Navane 
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Joined: Fri Jul 21, 2006 1:05 pm
Posts: 51
Location: Houston, TX
Post The Anti-psychotic Navane
Hello,

My mother was put in a psychiatric hospital two days ago for uncontrollable crying and suicidal thoughts. They have started her on Cymbalta for the depression, and want to start her on the anti-psychotic called Navane. I've never heard of it. Does any one here have any experience with this.
By the way, Mom had started taking Ambien CR two weeks ago to help her sleep at night. I think that may have caused the sudden increase in depression. She has been depressed for a long time, but not suicidal.
Thanks for any help you can give.

Jennifer


Fri Feb 09, 2007 11:26 am
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Joined: Fri Jul 21, 2006 1:05 pm
Posts: 51
Location: Houston, TX
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There is a God, and he answers prayers and questions. After I made the first post asking about Navane, I opened another forum and found a list of definite anti-psychotic drugs for LBD posted by Robin earlier this week. I immediately call the hospital and told them absolutely no anti-psychotics until I am consulted. Unfortunately, I also just learned that a medical power of attorney does not give me final approval on meds. I need guardianship for that. I guess that's my next step? Thank God for these boards and every one on them.
Jennifer


Fri Feb 09, 2007 11:43 am
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Joined: Mon Feb 05, 2007 3:43 am
Posts: 215
Location: Seattle, WA
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Jennifer:

So sorry you're experiencing this; you may want to touch base with the lawyer that drafted your DPA-Healthcare. Ours is explicit in that it specifically authorizes us to approve or decline any medical care for Cal, including medication. We do not have a guardianship, and wouldn't want one when this structure is working well for us.

Navane is related to Taractan and Fluanxol, all of which are incredibly old as antipsychotics go - I think Navane has been marketed for about 45 years. As you've discerned, it's a neuroleptic antipsychotic and is probably not appropriate in people with LBD.

Navane is specifically found on the list of "Medications LBD Patients Should Never Take", from the recent symposium held in South Florida. The list was composed by Dr. Jay Van Gerpen, director of the Movement Disorder Clinic, part of the Ochsner Clinic in New Orleans.

The logic behind this list is that every drug on it has, among other things, profound anticholinergic effects. There seems to be wide scientific consensus that people with LBD should avoid drugs with anticholinergic effects at all costs. I cannot find the citation I am looking for at the moment, which discusses other irrational drug choices for people with LBD, but it includes anticholinergic antihistamines such as Benadryl, drugs for overactive bladder, and several others.

I don't know if your mom is being treated by a neurologist with a special interest in LBD, but consider referring to the article at http://www.lewybodydementia.org/AR0504BFB.php - Dr. Boeve is a respected neurologist at a leading institution, and we found, prior to even thinking Cal's problem was LBD, that we had coincidentally adopted his management suggestions and dramatically improved Cal's daily life. He makes specific drug treatment suggestions for each common category of symptoms, explaining the rationale for each, at
http://www.lewybodydementia.org/Boevelink.php ,
starting around page 14. I would highly recommend sharing this document with the clinicians involved in your mom's care.

We were at the same place with Cal in late September of this year; suicidal ideation, poor sleep, impaired cognition, paranoia, the whole nine yards. Adjusting antidepressants didn't do diddly. Getting the right combo of acetylcholinesterase drugs, psychostimulants, atypical and antidepressant, along with a couple minor tweaks in the rest of the mix has turned things around.

The beauty of psychopharmacology is that there's usually another drug out there, in a same or different class, to treat a particular symptom. It's just tricky finding the right one.

Your mileage may vary, but our psychiatrist is quite fond, in the aged, of using two amino acids for depression with sleep problems. You might remember l-tryptophan, which was banned as a supplement due to a contamination problem in the early 90s. l-tryptophan metabolizes in the body to 5-HTP, which is then metabolized to serotonin. She suggests 50 mg of 5-HTP at bedtime, along with 250 mg of l-tyrosine. Tyrosine is a precursor to dopamine, norepinepherine and epinepherine, a group of molecules known as catecholamines that are also important neurotransmitters. The combo seems well-tolerated and safe, and might be worth discussing with your prescriber as well.

Much patience is required - I totally understand how incredibly frustrating this can be.

Eric

_________________
Cal is not the real name of a real 84 year old with DLB. I don't speak for LBDA, nor do I have clever initials behind my name, so information is provided without warranty. Caveat everybody. I blog at http://PragmaticCaregiver.blogspot.com


Fri Feb 09, 2007 3:50 pm
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Joined: Mon Feb 05, 2007 3:43 am
Posts: 215
Location: Seattle, WA
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Found it - I didn't think I was losing my mind; Robin posted the "treatment" section of the paper here.... in the "Treatment" section of Feb '07 Article on DLB posting in this forum....but it has mysteriously disappeared. Fortunately for my mental health, it remained cached in Google.

I'm exercising fair use rights, and posting an even *smaller* subsection of the paper, published as "Dementia with Lewy Bodies" , Semin Neurol 2007; 27: 042-047
DOI: 10.1055/s-2006-956754, D Weisman and I McKeith. This definition of fair use (a quote of less than 10% of the word count from a work of prose) is consistent with international standards for copyright and is intended for an educational purpose.

Quote:
It is common to find a patient on an AChE
inhibitor while also maintained on a centrally acting
anticholinergic agent, such as diphenhydramine for sleep,
other antihistamines for allergy, meclizine for dizziness or
vertigo, oxybutynin for bladder control, or a highly
anticholinergic tricyclic (such as amitriptyline) for depression
or chronic pain. A careful review of medications,
including over-the-counter agents, is essential to avoid
pharmacological contradictions.


(emphasis mine) - note that it's not contra-indications - it's *contradictions*.

Eric

_________________
Cal is not the real name of a real 84 year old with DLB. I don't speak for LBDA, nor do I have clever initials behind my name, so information is provided without warranty. Caveat everybody. I blog at http://PragmaticCaregiver.blogspot.com


Fri Feb 09, 2007 6:18 pm
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