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Up to 50% of LBD patients cannot tolerate certain medications and may have a paradoxical reaction to them. A paradoxical reaction constitutes an outcome that is opposite from the outcome that would be expected from the drugs known actions. There are several categories of medicines that should be avoided or closely monitored while taking them. Some of the reactions to these meds can be irreversible. Please consult your loved ones doctor with any questions or concerns before giving over the counter medicines and with any unusual behaviors seen on any of the following medicines:
- Thioridazine (Mellaril, Melleril)
- Haloperidol (Haldol Haloperidol LA, Haldol Decanoate, Peridol)
- Chlorpromazine (Thorazine, Largactil)
- Perphenazine (Trilafon, Etrafon, Triavil, Triptafen)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
Often these antipsychotic medicines will make the dementia behaviors and aggression worse. With our dad, he would become very aggressive when he was given Haldol and Seroquel, which were given to “calm” him down. His delusions and hallucinations were heightened when he was on ANY antipsychotic.
Acetylcholinesterase Inhibitors like rivastigmine (Excelon) and donepezil (Aricept) are often the first medications that are prescribed for LBD and other dementias to help confusion, hallucinations and cognition. The acetylcholinesterase inhibitors are actually thought to work better for LBD patients than Alzheimer’s and other dementia’s early in the disease. In early LBD, the neurons are still alive and kicking, but are having trouble communicating with one another (this is how rivastigmine works - it slows the breakdown of the neurotransmitter acetylcholine in the brain, so there’s more available for communication between neurons). In our case, where LBD was a late diagnosis, the rivastigmine did not work to improve symptoms and seemed to make our dad more lethargic and with increased hallucinations.
Diphenhydramine (Benadryl, Tylenol PM, Advil PM) needs to be strictly avoided, as they can make the symptoms of LBD worse and increase confusion and progress the dementia.
Patients who have dementia with Lewy bodies and undergo surgery may develop aggravated postoperative cognitive dysfunction or postoperative delirium. Many patients with dementia with lewy body respond poorly to surgery and anesthesia, and their conditions may worsen if they have other medical complications along with dementia.
Benzodiazepines, including lorazepam/Ativan, diazepam/Valium and alprazolam/Xanax are sometimes prescribed for anxiety and agitation, but they may cause sedation, confusion, unsteady gain or paradoxical agitation in people with LBD. Low and cautious dosages, and as-needed use (instead of scheduled use) are advised. Please show this to your doctor as many do not know. www.Lbda.org