He had good mobility before entering the hospital and now he can hardly walk!!! Cannot get up without assistance and they lost his hearing aids. He went in the hospital for agitation, hallucinations, and anger problems. He was diagnosed with vascular dementia a year ago. He was taking 50mg of Seroquel XR and a small dose of Mitrazatine for depression and had no mobility problems. Going on Zoloft from 100 mg to 200 mg in 2 days in my opinion is not appropriate!! What are your thoughts?
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If you have a problem with a prescription, for yourself or someone whose advocate you are. If it seems to you like a bad idea. If you have any worries about it, any concerns, if there's anything at all that you don't understand about why it has been prescribed or why that dose or what the prescriber is expecting it to do...
Ask The Person Who Prescribed It.
Not only will that person be able to explain the reasoning behind the prescription, but also if that person, after speaking to you, agrees that a different drug or a different dose might be better, that person can immediately amend the px.
There is no "they" about this. There is one doctor whose signature is on the px. Track him down.
Just reading through your summary again.
Diagnosed with vascular dementia a year ago. Any other health issues?
How old is he?
On 50mg of Seroquel + ? Mitrazatine.
These caused no mobility problems, but on the other hand they don't seem to have done much for his mental health if he was then hospitalised for "agitation, hallucinations and [behavioural issues]."
What kind of hospital?
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How is it going?
I've worked with all of these medications and across a multitude of diverse groups. Hopefully I can offer some help and reassurance.
I personally think the Zoloft is fine @ 200, but I'd take 100 mg in the am & the other 100 mg @ night to begin with. Keep in mind, I say this under the impression that he has major depressive disorder or something very similar? 200 is a high dose but fitting for someone prone to major depressive moods.
Trazodone is another medication I feel comfortable with. It's safe and effective for insomnia, so I'm assuming this is definitely only taken at bedtime? It's also non-habit forming, and the initial heavy sedative effects will subside fairly quickly if taken each night and not erratically. So, be sure to stay on schedule as much as possible to gain the most effective benefits from this medication. I'd not take it during the day whatsoever, to clarify.
Seroquel however? Oh my.... unless an individual is tested and diagnosed as schizophrenic (and I'd get a variety/team of doctors to confirm a schizophrenia diagnosis), no way I'd choose that as a first choice for antipsychotic behaviors. I don't recommend Seroquel for any type of bipolar disorder either, unless I want someone in a zombie-like state & that's not happening. There are much better medications for either disorder out there, with less side effects and much less sedating.
And, I might catch flack for this, but I'm just going to ask....I'm wondering why they'd not give him a low dose benzo instead, especially considering his state upon admission as well as for aftercare. Yes benzos are addictive, but it sounds like he needs the proper type and dosage. You can also take these as needed, thus they're not imperative and they will assist with the constant heavy sedative effect daily and problems such as immobility, bc you can start with a very low dose which I always encourage vs a moderate to high dose. So, that's a thought. If he needs to take a benzo to improve his quality of life, he needs it. There's way too much social stigma overload regarding benzos due to those who abuse them. But, without knowing his exact DSM diagnosis(es), I do hesitate to advise him to take this or any medication with absolute confidence. My info & advice is just based on the info provided.
So, one very important thing I'm not seeing is any of his diagnoses by a professional in mental health noted in the OP & instead, only behaviors exhibited, for the reasoning behind any of these medications. I know what they're prescribed for, but there are always exceptions & as such, doctors will prescribe a medication we associate with a particular disorder for one that is completely different. So, that info-what he's diagnosed with- would help in providing more definitive, clear advice from any of us on a personal level and based on our own experiences.
In the meantime, be vigilant, do your research, and hang in there! 😊
for depression. But then he started having hallucinations and paranoia to an extreme!! I won’t go into detail but it was bad. He was taken to the hospital where he stayed for 6 days. Before entering the hospital he could walk and get up on his own and do his ADLs. Now that I have him home he cannot get up without assistance, has trouble walking and I have to help him dress and eat.
Lack of mobility after a hospitalization is generally due to loss of muscles mass from lack of exercise. Most hospitals will have a PT work with patients during their stay to prevent this.
When is your dad's follow-up with his regular doctor scheduled for? As suggested above, check the medication regimen with his regular pharmacist immediately for any red flags.
Has Home Health Care been ordered? He should be getting in-home PT, etc.
Got to go now, sorry.
Per day is qd, =every day.
It is not q.i.d. (which would be an error, 4 times a day). The directions above say (1) qd. ??
One 200 mg. tablet of Zoloft, every day.
The problems with Zoloft and Trazodone being taken together, is that they can cause:
"Serotonin syndrome warning"
This drug can cause a life-threatening condition called serotonin syndrome. ... Your risk may be higher if you also take other drugs that have similar effects as trazodone, such as other drugs used to treat depression."
This includes Zoloft.
qd is every day, one Trazodone 100 mg. every day.
It is not q.i.d., which is an error, not meant to be 4 times a day.
Trazodone:
Usual Adult Dose for Depression:
Initial dose: 150 mg orally per day in divided doses; this may be increased by 50 mg orally per day every 3 to 4 days
Maximum dose:
-Inpatients: 600 mg/day
-Outpatients: 400 mg/day
Sometimes an initial starter dose can be higher, and not adjusted properly if the patient is stabilized and no longer a danger of becoming violent.
"But it is VERY common for medications — especially antipsychotics — to be prescribed “off-label” for this purpose.
This is sometimes described as a “chemical restraint” (as opposed to tying people to a chair, which is a “physical restraint”). In many cases, antipsychotics and other tranquilizing medications can certainly calm the behaviors. But they can have significant side-effects and risks, which are often not explained to families.
Worst of all, they are often prescribed prematurely, or in excessive doses, without caregivers and doctors first putting in some time to figure out what is triggering the behavior, and what non-drug approaches might help.
For this reason, in 2013 the American Geriatrics Society made the following recommendation as part of its Choosing Wisely campaign: “Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.”
I guess they wanted to squash any further agitation, hallucinations, and anger problems. With a dementia patient, that may actually be the only way to do it, but what about his liver.....this seems to me like a high price to pay for having someone be docile, and loss of mobility means continuous caregiver attendance. Maybe being a bit agitated isn’t so bad considering?
Was this a behavioral health hospital, or a regular hospital?
Speaks to whether he was stabilized on these meds or not.
He is 88 y. o.?
Is he a very large man?
Does he have a pre-existing mental illness in addition to vascular dementia?
Does he have an HMO (a medicare managed health plan)?
Sometimes they can offer a limited choice of treatments.
Talk to the pharmacist who filled the prescriptions immediately.
At the same time, re-check with the prescribing M.D. making sure the doses are as intended and not a mistake.
You have done this by now, correct?
It is very important that you do not withdraw the patient without the help of a doctor.
Then seek a second opinion, STAT.
Online, there is a geriatrician who has contributed to the AC forum.
Go to Leslie Kernisan, M.D., MPH website and enter "5 types of medications to treat difficult dementia behaviors."
An article that will give you more information.
Was this an unsafe discharge, as he likely cannot be left alone?
Zoloft 800 mg per day??? I'm not a pharmacist but that is a huge red flag that whoever is dosing him made a mistake.
The max dose for Seroquel (quetiapine) is 750 mg per day.
Seroquel is KNOWN to interact with trazodone, another red flag that whoever is dosing him made another big mistake.
I would immediately go to your trusted neighborhood pharmacist with all the prescriptions and get a consult. Any good pharmacist will not fill these prescriptions and tell you how to proceed.
I would make a formal complaint with your state medical board about the doctor who signed those prescriptions AND a formal complaint with your state health department and Medicare against the hospital and the hospital pharmacist who approved those prescriptions. This to me sounds like malpractice, and I am not one to use that term lightly.