Amitriptyline and Dementia


An 81 year old male presents with worsening confusion over a period of about 3-6 months.  The primary provider is considering an Rx for Aricept as she feels that this is Alzheimer’s dementia in the mild to moderate stage.

What do we do as pharmacists? One of the major things we can help with when it comes to polypharmacy is ruling out drug induced causes of new symptoms.  Confusion can be an adverse effect of many medications.  In this particular scenario, the medication most likely to cause confusion was amitriptyline.  The patient had been on the medication for several years however.

Amitriptyline is highly anticholinergic which can contribute to confusion.  TCA’s can also have benefits for numerous diagnoses like depression, fibromyalgia and neuropathy.  The patient was originally placed on amitriptyline for neuropathy.  In this case, with the worsening confusion, it was determined that the amitriptyline would be tapered down and discontinued.

Neuropathy and symptoms of pain did not seem to worsen with the discontinuation of amitriptyline.  Symptoms of dementia did not seem to improve either.  As pharmacists we are geared towards helping identify drug related problems, but at times, we must realize that everything isn’t always medication related.

The end result in this case was that we were able to discontinue an unnecessary medication and not impact the patient’s well being in a negative manner.

Enjoy the blog?  Over 4,000 healthcare professionals have subscribed and received a free gift! Why haven’t you?

 

4 Comments

  1. Nadine Halawa

    great example

    Reply
  2. grant cleveland, pharmd

    As far as tricyclics go, nortriptyline (Pamelor) has a more favorable risk benefit profile.

    Reply
  3. Awais

    Great work Eric! Just keep it coming.

    Reply
    • Awais

      However if you could be a bit more detailed in patient’s hx that would be more helpful in understanding the case.

      Reply

Submit a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Written By Eric Christianson

March 19, 2017

Free PDF – Top 30 Medication Mistakes

Enjoy the blog?  Over 6,000 healthcare professionals follow the blog, why aren't you? Subscribe now and get a free gift as well!

Categories

Free PDF – Top 30 Medication Mistakes

Enjoy the blog?  Over 6,000 healthcare professionals follow the blog, why aren't you? Subscribe now and get a free gift as well!

Buy on Amazon

Categories

Explore Categories