Hi folks. Have any of you had a problem with an exelon pill dosage wearing off during the day prior to the next dose? I'm trying to figure out whether my LO's precipitous decline in cognition in the evening is due to sundowning or to a lack of exelon in her bloodstream. I think the effect of her 3.0 mg dose in the morning may only be lasting about 8 hours and we have a bad time up until she goes to bed. I've tried the exelon patch to give her a steady dosage but her skin reacted to it (at least she thought it did). So, no patch.

I know the obvious solution is to try changing her dosage schedule and see if it makes a difference, but it isn't easily done. She tries to memorize all of her pills and when she is given them and will get anxious and refuse medications if there is a change. Also, when there is a med change she becomes hypersensitive to the possibility of side effects. However, I make changes when I think it is worth the improvement. Any experiences out there? Thanks. AnnieN

Annie, that's a good question and I wondered that about Derek's Exelon patch, as well. I always put it on him at bedtime and wondered if his agitation and increased delusions in the evening were due to it wearing off, so I changed the schedule and tried it in the morning for two weeks. Didn't make a particle of difference! Results may vary .

I would think like everything else in this illness it could be different with each person, I have no experience with the patch as it wasn't out yet when my husband took Exelon and his dosing was in the am and then at 4pm.

To me, the obvious solution is to try the patch as it delivers a steady supply of medication throughout the day.

Irene, when your husband took the exelon pill in the am then at 4:00 pm, did you notice any drop in cognition in the evening? Did he ever exhibit sundowning?

Robin, I can't put the patch on her. She thinks that the patch (or it actually does) creates a burning sensation every 10 minutes that gets progressively worse. Real or delusion, it doesn't matter. I had to remove it. She takes a 3.0 mg pill in the morning and a 1.5 mg pill before bed.

Thanks for your responses.

Annie,
I did notice some agitation late afternoons but I really don't think it had anything to do with the exelon but again I am not real sure, we did start seroquel at that point for that very reason, he was in bed by 7 each night, I did think that the seroquel helped !

I guess the only way to know if a higher dosage will help is to try it. Can you give her 4.5mg in the morning? Maybe since it's the same medication, she won't be as concerned about it?

Or what about adding liquid Namenda? Can that be added into a morning beverage? I don't know how it tastes.

Many, many people with dementia do sundown, as you know, so that wouldn't be surprising.

Really, I'm rather amazed that she is so aware of the meds she's taking.

Annie, our meds are named differently here in Ireland so I'm not sure if this will be a solution for you, but this is what we do for Dad. He is very similar to your LO, as he is lucid enough to notice med changes. What we do is crush his pills and put them in his breakfast - either his porridge, or mix it in the butter on his bread. He has never noticed. You could still give the regular meds, and just hide the new dose until you figure out if it works. We also have to put liquid ebixa in his tea - he refused all new medication and his doctor prescribed the liquid. I know how difficult it can be when you are trying to get them to take meds, believe me. Good luck, and let us know how you get on.
Ger

Annie,
Is there a reason that she isn't at full dosage yet ? Is this a recent change in medications? I know when we started it had to be gradual and finally met the full dose of 9 mg so each dose he toolk every day was 4.5 -2x's a day.

Irene, we have tried to increase her dose to 3.0 mg in the am and 3.0 mg before bed and both times she was really out of it (slow, bumping into things, confused etc.) in an overdrugged sort of way the next day. She was taken off the increased dose. She is only 116 pounds and has always been extremely sensitive to medications. Usually we start her off at 1/2 the beginning dose of a med and I don't think she has ever been able to stand the normal doses of meds. She is also a retired nurse and very intelligent, sometimes seemingly normal in conversation, although at the same time she can't remove her shirt to get dressed for the night or figure out how to use the toilet by herself. She has the greatest sense of humor and can crack a joke in a heartbeat.

Like everyone else, we're muddling through this as best we can. Ger, thanks for the suggestion. AnnieN

Isn't it fascinating how our LOs can be so out of it and yet so dead-on with other things? I always found it fascinating that my had such acute long term memory and could remember just about anybody, but think he hadn't eaten in days when it might have been 5 min. earlier that he had a meal, and such. It's amazing that your mom has such a sense of humor. It seems like with many of our LOs that is one of the first things that goes. Enjoy those lucid moments, and may you have many more of those with your mom.
Glad to see you posting lately - you've been a stranger for a while! Lynn

BTW, liquid Ebixa = liquid Namenda.

It just goes to show , how different they all are! You might not be abe to get the dose higher if the reactions are so bad.

Its nice that she still has a great sense of humor, enjoy it !