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The People’s Pharmacy: Calming Alzheimer’s patients

Q: My wife has late-stage Alzheimer’s disease. She is now in a memory-care facility. They often give her sedatives to calm her agitation.

I have read that such drugs are dangerous, especially for older people with dementia. Is there anything that might be safer?

A: You are right that strong sedatives such as aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) come with scary warnings: “Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.”

A new study offers some hope for calming agitation without such dire consequences. Investigators gave 220 people with Alzheimer’s disease either a placebo or a combination of quinidine and dextromethorphan (Nuedexta).

Both drugs have been used for decades. Dextromethorphan is the active ingredient in many OTC cough medicines (the DM in Robitussin DM, for example). Quinidine is prescribed for irregular heart rhythms.

The study showed a significant drop in agitation and aggression (JAMA, Sept. 22/29, 2015). This is an off-label use of Nuedexta.

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Q: I’ve been suffering badly from recurring cold sores for years. I’d only get a day or two between outbreaks most of the time.

I found L-lysine helped, but I had to take high dosages to get the benefit. It also caused weird side effects like serious constipation, so I didn’t want to take it every day for prevention.

My doctor prescribed acyclovir cream. It helps a lot.

I’ve got a routine that has the healing time down to only three days. The second I think I’m getting a cold sore, I put ice on it. I’ve had a pulsing spot become a hardly noticeable scab instead of a gross blister. The acyclovir ointment helps too, along with L-lysine.

A: Acyclovir (Zovirax) was the first antiviral drug approved for treating herpes labialis, the medical term for cold sores. It has been available as a topical ointment since 1982. The pills were first sold in 1985. Both formulations are now available generically at a substantial discount from the brand-name price.

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Q: I was prescribed prednisone for sinusitis. It was a nightmare. I gained weight, and my face puffed up. I had strange dreams when I could sleep, which was rare. I became irritable and aggressive. Things that wouldn’t normally bother me made me want to scream. I wish my doctor had warned me about these side effects in advance so I would have been better prepared.

A: Prednisone is a corticosteroid used to ease a variety of inflammatory conditions ranging from asthma and severe poison ivy to arthritis and lupus.

As useful as it can be for serious health conditions, there is a long list of troublesome side effects. Some of the most common include fluid retention (edema), insomnia, irritability, mood swings, disorientation, high blood pressure, loss of potassium, headache and swollen face. Long-term complications may include muscle weakness, osteoporosis, cataracts, glaucoma and ulcers.

Prescribers and pharmacists should warn patients what to expect so they do not suffer as you did. For more information on corticosteroids and nondrug options for inflammation, we offer our Guide to Alternatives for Arthritis. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. AA-2, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: peoplespharmacy.com.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated program can be heard on public radio. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.” Submit questions via their website: peoplespharmacy.com.