View unanswered posts | View active topics It is currently Wed Apr 23, 2014 11:25 am



Reply to topic  [ 11 posts ] 
 Help with nausea whilst on exelon 
Author Message

Joined: Thu Feb 08, 2007 9:46 am
Posts: 6
Location: London, UK
Post Help with nausea whilst on exelon
First time on the sight and wondered if anyone has any ideas as to whether my mum who has just increased to the full dosage of exelon could take anything else to help with the nausea? She has only been on it for 5 days but it hasn't got any better as yet?


Wed Apr 04, 2007 5:27 am
Profile

Joined: Mon Feb 05, 2007 3:43 am
Posts: 215
Location: Seattle, WA
Post 
The biggest thing is how much food is consumed with the dose; ideally, it's at least a few hundred calories, including fat, protein and carbs. The difference in how Exelon is absorbed with and without food is quite dramatic, and the right meal/snack will blunt the peak blood level by about 30%, which is where the nausea comes from, while it simultaneously encourages the drug to stick around longer at a therapeutic level.

If she's already getting a substantial snack/meal with the dose, you might try going back to the previous dose for a week or two and then trying again to up-titrate. Check with the prescriber, but most would probably be OK with an approach like that.

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


Wed Apr 04, 2007 2:01 pm
Profile WWW

Joined: Thu Feb 08, 2007 9:46 am
Posts: 6
Location: London, UK
Post 
Thank you very much for the reply I will check and adjust. Can I just say how nice it is to have a resource to me and my family that I did'nt realise was available. It can be lonely trying to help someone you love >> Thanks


Wed Apr 04, 2007 3:36 pm
Profile

Joined: Mon Feb 05, 2007 3:43 am
Posts: 215
Location: Seattle, WA
Post 
I went back and looked, and my original guess as to their intended "meal or snack" size was kinda... low.

I'm astonished as to how much food they're expecting people to pack away, twice a day, with this stuff:

Scrambled eggs and toast.
Bowl of oatmeal or cereal.
Soup and a sandwich.
Chicken with rice and vegetables.
Cheese and crackers.

I ran a quick nutrient analysis on four of the five "suggestions" from the Exelon website (the chicken one has too many variables) - here's what I came up with:

two eggs, scrambled, with one piece white toast and 1 tsp. butter = 300 calories, 21 grams fat, 16 grams protein

oatmeal, 1 cup, with 1/2 cup whole milk: 220 cals, 6 fat, 10 protein

soup, vegetable, prepared as per label, 1 cup, sandwich with two slices white bread, 1.5 ounces of turkey breast, one slice swiss cheese, 1 T. mayo, 1 leaf lettuce, one slice tomato: 456 calories, 23g fat, 21g protein

two ounces cheddar cheese, eight Ritz crackers: 345 calories, 25g fat, 16 g protein

So rather than a couple hundred, they seem to be targeting closer to 300 calories, which, in Cal's case, can be a bit of a struggle. It might be helpful to use something like Boost or Ensure (try the high-protein varieties) to get a heftier load of food in there to delay absorption.

As a lark, I looked at a Snickers bar - 280 calories, 14 grams of fat, 4 grams of protein. Wouldn't be the worst choice...

Eric, Who Has *Always* Considered Snickers Therapeutic

_________________
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


Wed Apr 04, 2007 4:43 pm
Profile WWW
Post Re: Help with nausea whilst on exelon
bevbutt wrote:
First time on the sight and wondered if anyone has any ideas as to whether my mum who has just increased to the full dosage of exelon could take anything else to help with the nausea? She has only been on it for 5 days but it hasn't got any better as yet?


Hi Bev,
Welcome to the LBD forums, I see that you have already recieved some good advice, Food is important with Exelon VERY! Every dose I gave my Husband I gave him a good size portion of oatmeal and it did help and in time he was able to tolorate it.
My Question to you is you say she is getting max dose in 5 days??Do you mean 12mg? Seems to me a short period of time to increase like this!
I am glad you are finding the forums so informative, I hope you get a chance to look through old posting , there is much info there too!
Good Luck!


Wed Apr 04, 2007 7:25 pm

Joined: Thu Feb 08, 2007 9:46 am
Posts: 6
Location: London, UK
Post help with nausea
Thanks for the good info you have sent. My mum has increased to the max of 12mgs and had been on this for 5 days after having previously been on 2 x 4.5 mgs. Since I posted the reply the doctor has suggested going on 1 4.5mg am and 1 6mg pm. She has been doing this for the last couple of days and seems much better. She has also been incresing the food intake with the tablets. We will need to wait now for another 2/3 weeks I think beofre she tries 2 x 6mgs again.

Many thanks


Tue Apr 10, 2007 10:40 am
Profile
Post Re: help with nausea
[quote="bevbutt"]Thanks for the good info you have sent. My mum has increased to the max of 12mgs and had been on this for 5 days after having previously been on 2 x 4.5 mgs. Since I posted the reply the doctor has suggested going on 1 4.5mg am and 1 6mg pm. She has been doing this for the last couple of days and seems much better. She has also been incresing the food intake with the tablets. We will need to wait now for another 2/3 weeks I think beofre she tries 2 x 6mgs again.

Many thanks[/quote

Dear Bev,
I am glad your Mother seems to be doing a bit better on the meds, it is a rough med on some, I know we had to do much med adjusting before we got to max dose.


Tue Apr 10, 2007 11:31 am
Post 
Some general tips for using the cholinesterase inhibitors (aricept, razadyne and exelon) in LBD.

1. Start low and go slow. There is no need to rush up to the maximal dose - this is the main reason that people do not tolerate the medications. Titration to a new dose should proceed no faster than every 4 weeks. With each dose increase there are likely to be recurrence of GI upset but this should subside.

2. Taking the meds with a fatty or protein meal. Tea and toast is not going to do it. Fats and proteins delay emptying of stomach contents into the small intestine (where the medications are largely absorbed). This decreases the peak blood levels where the nausea, vomiting or diarrhea are likely to occur. Examples of things I recommend are cottage cheese, yogurt, eggs, pudding or ice cream (depending on the meal and time of day). There are very few people who cannot take the medications using this approach.

3. One or two days of an upset stomach does not mean that someone cannot take it. I encourage patients and families to wait it out for 3-5 days (unless of course the symptoms are severe). If someone cannot tolerate the higher dose, I go back down on the dosage and re-challenge them at a later date.

Hope this is helpful


Wed Apr 11, 2007 10:29 am

Joined: Thu Aug 24, 2006 12:03 pm
Posts: 79
Post 
I have been reading the comments about food intake and Exelon. Thank you for all the information. My husband, (PE because I don't like to type out his hyphenated name all the time) has been on exelon for about 2 years and has benefited from it tremendously. He'd be a real basket case if he didn't have it. But I am slightly worried about his losing weight, having gone to the Dr's yesterday and finding out he's lost over 10 pounds in the last 6 months. We live in France and "eat French" every day, and it seems I provide an adequate food regime. It's true sometimes in the evening, he doesn't feel like eating (it would be supper for the US) and manages to have a yogurt or the like.

Is the weight loss something to worry about, is it inevitable with LBD, does it have to do with taking Exelon or any meds like Modopar? It's true the Dr. didn't say much about it. Should I try to fatten him up? I am grateful for any advice. And thanks again. Dinny Wolff


Wed Apr 11, 2007 12:48 pm
Profile
Post 
Weight loss is always problematic - as weight declines, protein levels in the body also decline and this suggests a diminshed immune system. THis puts LBD (and other individuals) at an increased risk of infection (pneumonia in particular).

The cholinesterase inhibitors can cause anorexia (aricept maybe more than the others).

My suggestions are first to find out what the patient likes to eat and give it to them - I am generally less concerned about things like serum cholesterol at this stage. If he likes ice cream, give him ice cream. If he like blueberry croissants, then give him those.

You also try to add in dietary supplements - these are usually protein shakes - in the US products like sustical, ensure or boost. Find out what flavor he likes and give it to him whenever he wants. The trick is these supplements have to be served cold or else they kind of taste like baby formula (my kids have always been big fans of strawberry Sustical).

There are also medications that can increase appetite such as Megace but all meds of course have side effects and are not usually the first choice. Another med that I have used in extreme cases and helped is Marinol (THC, the active component of marijuana) but this was very hard to write for because of all the red tape - I offer this only as an extreme example.

Lastly, some patients as they become more impaired may simply need to be fed via a G-tube or J-tube to get sufficient calories.

As always these are general suggestions and you should speak with your healthcare provider for specific recommendations for your loved ones.

Hope this was helpful


Wed Apr 11, 2007 12:59 pm

Joined: Mon Feb 05, 2007 3:43 am
Posts: 215
Location: Seattle, WA
Post 
I vote for regular consumption of fine rich French cheeses and duck confit and goose liver and all those other epicurean delights.

That's actually been something we've worked on as Cal's weight has waxed and waned (he lost interest in food for awhile). We've had to sneak in additional calories where possible to simply get him stabilized - he's been disinterested enough that he's lapsed into ketosis a few times. (Hey?!?!? - Who opened the nail polish remover?). This has been much better since the meds got optimized, but we still watch out for it.

Part of the sneakiness for us is that we make sure that we're getting maximum caloric density into every bite when he's in a bad way - a snack like pudding (made with half-and-half) rather than applesauce, the sandwich gets butter *and* mayo rather than just light mayo, etc.

One other opportunity is to make sure that at least some of the beverages are caloric. It's an easy way to get in 200 calories a day or so.

E

_________________
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


Wed Apr 11, 2007 1:37 pm
Profile WWW
Display posts from previous:  Sort by  
Reply to topic   [ 11 posts ] 

You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
cron
Powered by phpBB © 2000, 2002, 2005, 2007 phpBB Group.
Designed by STSoftware for PTF.
Localized by MaĆ«l Soucaze © 2010 phpBB.fr