Notes for: Central nervous systemLast edited [10/12/2021 11:31:41]
‘Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness’ recommends that patients at risk of suicide, including all patients with a recent history of self-harm, who are treated with psychotropic drugs should receive modern, less toxic drugs and/or supplies lasting no more than 2 weeks.
Notes for: Drugs for DementiaLast edited [14/12/2012 16:21:38]
NICE Guidance on donepezil, galantamine and memantine for the treatment of Alzheimer’s disease (amended September 2007) recommends:
Donepezil, galantamine, and rivastigmine are recommended for the adjunctive treatment of moderate Alzheimer’s disease in those whose mini mental-state examination (MMSE) score is 10 - 20 points under the following conditions:
Alzheimer’s disease must be diagnosed in a specialist clinic; the clinic should also assess cognitive, global, and behavioural functioning, activities of daily living, and the likelihood of compliance with treatment;
treatment should be initiated by specialists but can be continued by general practitioners under a shared-care protocol;
the carers' views of the condition should be sought before and during drug treatment;
the patient should be assessed every 6 months and drug treatment should normally continue only if the MMSE score remains at or above 10 points and if treatment is considered to have a worthwhile effect on the global, functional, and behavioural condition.
Patients receiving acetylcholinesterase inhibitors for mild Alzheimer’s disease can continue treatment until they, their carers, or their specialist consider it appropriate to stop.
Healthcare professionals should not rely solely on the MMSE score to assess the severity of Alzheimer’s disease when the patient has learning or other disabilities, or other communication difficulties.
NICE does not recommend memantine for moderately severe to severe Alzheimer’s disease except as part of well designed clinical studies; patients already receiving memantine can continue treatment until they, their carers, or their specialist consider it appropriate to stop.
Acetylcholinesterase inhibitors should also be considered for people with mild, moderate or severe Alzheimer’s disease who have non-cognitive symptoms and/or behaviour that challenges causing significant distress or potential harm to the individual. This would only be if a non-pharmacological approach is inappropriate or has been ineffective and antipsychotic drugs are inappropriate or have been ineffective.
Last edited [14/12/2012 16:22:20]
MHRA Drug Safety Update (Jun 2010) advises:
Symptoms of rivastigmine overdose include nausea, vomiting, diarrhoea, hypertension,and hallucinations; bradycardia and/or syncope, associated with malaise or falls, may also occur.
In case of suspected overdose, all rivastigmine patches should be removed immediately and no further patch should be applied for the next 24 hours.
It is important to instruct patients and caregivers on the proper use of the transdermal patch, particularly that:
Only one patch should be applied per day to healthy skin on the upper or lower back, upper arm, or chest
The patch should be replaced by a new one after 24 hours, and the previous day’s patch must be removed before application of a new patch to a different skin location
Application to the same skin location within 14 days should be avoided to minimise skin irritation
The patch should not be cut into pieces