And it gets worse......my friend is in Central America-on extended vacation and just wrote me a desperate message. She has forgotten to give her husband the Exelon for a week.....only has 6 mg capsules on hand. Any suggestions on how she is to start him back on the 1.5 mg dose (bid) and continue to work him up to his previous optimal dose of 6 mg (bid) ? I doubt the capsules can be "quartered". Tho, I'm not familiar with Exelon. John Lennon once said......"Life is what happens...while you're busy making other plans."
Sue in WV

Sue,

I'll pass this by an SAC member and hope to have an answer for you tomorrow, but hopefully someone here can relate their experiences too.

Thanks,
Angela

Hi Sue,
This is not an easy thing to do but the capsules have to be opened and quartered and then mixed with something like a applesauce or pudding this is how they did Jim's meds at hospice, its not an exact science but I am sure it will work, if this person had trouble with stomach issues starting exelon in beginning I am sure it will happen again, this also happened when Jim was taken off exelon in rehab and we put him back on. Good luck to your friend!

The downside is that this drug is rapidly excreted - hence the reason it has to be taken twice a day. So you probably have to start back from scratch again.

That said, you might not have to start from 1.5. Since the biggest risk is nausea and vomiting, which is easily detected without lab studies or medical care, and it reverses pretty quickly when the drug is discontinued, I'd try 3 mg and see what happens.

As for dividing capsules. I empty them out onto a flat surface and divide them with a razorblade in what looks like illicit drug abuse. It's the most accurate way I've found to do it.

Eric

Thanks for the quick responses. My buddy and I thought all would be lost----for a while.
Angela, I'll be quite interested to see how the SAC responds. This will be good info to "keep on file" for future reference.
Irene, never thought Jim's hospice would be splitting his capsules up. I just didn't think that was done when in capsule suspension. So, this is encouraging.
Eric, she will be familiar with the ol' razor blade on a mirror technique. There's something to be said for "a checkered past". So, you divide Cal's caps up??? Why?
Sue in WV

We've had a couple agents where we've wanted to move doses more slowly than the marketed forms would permit - we always prefer capsules to tablets for ease of swallowing, but they're not always available in the same doses, and they're admittedly less dividable. Thus, we'll, um, improvise.

Eric, Who Has Hidden More Zyprexa In Food Than He'd Care To Admit

Sue,

As promised, here's the feedback from one of our LBD experts:

"If the patient was tolerating the 12 mg a day previously, there shouldn’t be a problem to just resuming the medication."

Hope that helps!
Angela

He started the Exelon at his normal dose 2 days ago and....no problems. Steel guts this one!
Sue