I have a 95 yr old mother with severe knee osteoarthritis and restless leg syndrome and is in the early stages of dementia. She is currently on Gabapentin, (300mg x 2 daily); sertraline (100 mg) and alprazolam (0.25 mg) daily. We think some of her confusion and unclear thinking might be due to excess medications. She has had some depression/anxiety problems in the past and complains of pain in her legs/ankles. We do not want her to suffer however are concerned about the effect of current medications on her cognitive function. The thought is that switching from sertraline(Zoloft) to Cymbalta or Lyrica and eliminating the gabapentin and alprazolam might benefit her osteoarthritis pain while still helping her depression/anxiety problems. If she discontinued the sertraline (Zoloft) without tapering off and immediately began taking a low dose of Cymbalta or Lyrica would this work without the side effects from discontinuing the sertraline? The gabapentin does not seem to help with her pain or restless leg syndrome problems but probably contributes to confusion after she takes it therefore I see no reason to keep taking it. Any suggestions???
Can you discontinue sertraline (Zoloft) and immediately start taking Cymbalta or Lyrica?
- Asked
- 3 Feb 2013 by strombolie
- Updated
- 3 February 2013
- Topics
- cymbalta, lyrica, zoloft, depression, anxiety, dementia, osteoarthritis, restless legs syndrome, periodic limb movement disorder, gabapentin, sertraline, chronic pain, knee
Responses (6)
I will be interested to see how someone responds who has been on these med. I am familiar with them all. My mom is 90yrs old and is having dementia problems. She is taking gabapentin for neuoropathy in her legs from being diabetic. She is really confused now. So, I wonder if gabapentin could have something to do with it. She lives w/me and it is so hard seeing the change in her.
I have slowly tapered my dosage of Celexa and today, I am stopping that one and will start today on the Zoloft. Wish me luck. Thanks
Go for it. Let me know how you are doing.
Gabapentin will not cause problems or increase dementia. It is the dementia that is causing the problems.
Be sure that someone supervises her medication. People with increasing dementia are not reliable with taking their meds, and may skip, toss it, take two doses because they forgot. You can be very helpful that way.
Yes, the changes are very sad. Enjoy her life while you can. Pictures help as do stories from the past. Good luck to you and be sure you visit her physician when she goes.
Thank you for your input. Fortunately she lives in an assisted living facility where she has her independence in a private apartment but has a couple of meals a day provided. Until about a year ago she was managing all her drugs and supplements herself but she started to get confused and we arranged to have her medicines supervised and distributed by the nursing staff at the facility. That seems to work out pretty good but there have been some errors and miscommunication between the pharmacy, clinic and the assisted living staff. Unfortunately I am about 3 hours away (in good weather!) but stay in touch by phone and e-mail. I will be visiting her NP with her this week provided the weather is good.
I spent some time in a nursing home(old term) and there were errors. Too often they are understaffed with RN and the pay is poor so it is a job not many go for. Don't be afraid to file a complaint. It is often the only way to get improvement and they will be a lot more careful with your mom to avoid your complaint. I had to meet with administrators and it was amazing what they were thinking. And they had the highest rating in the area. Anyhow, go to the top of you must. Good luck. Karen
Stopping the sertraline and gabapentin without tapering will cause withdrawal symptoms like headache, diarrhea, and more confusion. Always best to taper off one antidepressant while starting on low dose of next. Also the gabapentin must be tapered. Tapering one at a time is also recommended, in case she has any adverse response you will know which is causing the problem. While Cymbalta is likely to help both the depression/ anxiety and pain, Lyrica is not. It will only possibly help the pain. You can NOT just stop the alprazolam as it can cause a seizure, it must be tapered if you are going to stop it.
Have you tried other means of helping to control the osteoarthritis pain? There are other medicines like Celebrex. Whether this appropriate for her condition can only be answered by the doctor. She may also benefit from support hose on her feet and legs especially if she is experiencing swelling. Physical therapy is another possibility. Gentle exercise is very helpful to OA sufferers.
She has permanent A-Fib therefore on warfarin, digoxin and diltiazem which can not be discontinued so Celebrex or any other NSAID is out of the picture. She has tried PT (not too helpful) and does go to exercise classes at her assisted living facility 2-3 times a week. The alprazolam is a very low dose (0.25 mg) and she takes this at bedtime to help relax her. It does a good job but only seems to last a few hours. She was taking it in the morning too but her NP took her off of it altogether (cold turkey!) a couple of months ago after she reported taking a tumble in the bathroom one night. ( I only noticed it when paying the pharmacy bill as it wasn't on there and questioned them.) I got them to put her back on at night as she wasn't taking Miraplex any longer (for RLS) and couldn't get her legs to quiet down at night. I don't think taking her off this again and possibly adding Miraplex again would be a problem.
I agree - pharmacists are usually better informed than doctors especially when it comes to multiple drugs and their possible interactions. In their defense, doctors, PA's and NP's are expected to see too many patients a day and often do not have the time to look up answers to medication questions. I find this website helpful as patients and caretakers need to be informed about the medications prescribed.
Amen to that!
I would recommend talking a pharmasist they know more about the medications than the doctors do. They will tell you when to start/ stop etc... I'am a 38 year old woman and have been taking Lyrica for only 5/6 months ..the side effects are numerous but one is very common amongst Lyrica users and that is confusion ..I'm constantly searching for a word to complete a thought when I'm speaking. I have an extensive word bank ..at least prior to taking Lyrica ..it's very frustrating! ! Just keep this in mind when you do decide to switch your mom to Lyrica. Please come back for support ..this is a great site ..with a lot of support and knowledge. Take care ...
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I am thinking the gabapentin might be the biggest contributor to her problems. A couple months ago her NP increased the dose to 3X a day and she realized how much it affected her and asked not to take the 3rd dose in the afternoon any longer. I'm sure at 95 yrs she has some age related dementia but we noticed that about 1/2 hr after taking her pills she is very confused, spacey and seems unable to understand simple conversation. It may be alright for her to take the gabapentin at night before bedtime but it seems she needs to get up after a few hours to walk (helps RLS symptoms) and we are afraid she may fall as she seems unsteady on her feet after taking these meds. I know the feelings you are experiencing when you see your relative change especially after a full and healthy life. My mother does not live with us but is in an assisted living facility which allows her a private apartment w/meals in the dining room and other activities.
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Within the past year we have arranged for the facility's nursing staff to order and dispense her medications and monitor her visits to her clinic for protime checks. (She is also on coumadin for permanent a-fib heart problems.) ... So many drugs for a little 108 # lady who never took any medicine until she was about 82 yrs old! Also as you age - your kidney function decreases therefore with some meds - doses that were ok for years become too much for you. I really appreciate the medicine interaction reference in this web site. Good luck with your mom.
Moma's was taking gabapentin 100mg 3 times a day. I started giving her one at around 7:00pm and then the other two around 10:30 to 11:00pm. Her feet would hurt and burn. This seem to help her and help her get thru the night. She got so she was waking up w/her feet burning. So far, taking the meds this way has helped her. So, I do think the medicine has side affects and it is better to take just at night. Seems like at night is when everything starts bothering you. Have you ever noticed, you can be so sleepy and get into bed and start thinking about everything and can't get to sleep. Bummer.
Yep - night time is the worst if you are in pain. Less distractions along with some diurnal hormone variations probably are the cause.