Ask a doctor on the topic of Internal medicine

Forgetfulness due to medication mix?

April 3, 2016 | 30,00 EUR | answered by Dr. med. Frauke Gehring

Hello,

My mother's memory (74 years old) has deteriorated significantly lately. Dementia is certainly a possibility. But I suspect it may also be due to an unhealthy combination of medications. Unfortunately, her doctor is not willing to listen. He doesn't spend much time and is grumpy.

Her memory has been declining rapidly since October 2014. She is now as forgetful as my father, who has been diagnosed with dementia since 2012.

She has been taking painkillers for fibromyalgia and disc herniations for years. She has been tolerating Valoron very well for years. But her heart problems are getting worse. She had a few small strokes years ago, which fortunately did not leave any lasting damage, but she also has asthma and heart arrhythmias.

These heart arrhythmias occur several times a day and are sometimes so severe that she has to lie down immediately to make the problem go away. Even when we are out, she has to lie down on the street if necessary. This burdens her a lot and she often fears leaving the house. She has a bulge in her heart or heart failure. Overall, her blood vessels are not in good condition even though she is not overweight.

Recently, she gave me her medications because I noticed that she was becoming very forgetful. When we talk on the phone, she forgets what we were talking about after 5 minutes. She notices her forgetfulness and suffers greatly from it. All her heart medications do not leave a good impression on me. I have researched the medications and believe that they are too much together. For example, some are all used for high blood pressure, and one wonders why you would need 3-4 different ones?

She has never had a heart attack. Please tell us what you think of the combination of these heart medications and if there are alternatives with fewer side effects? Maybe one medication is enough?

For example, I have read about Strophanthin. It is supposed to be a good alternative based on plants that is very effective. Would that be an alternative to the first 3 blood pressure medications?

She is currently taking the following medications:

Ramipril 5mg (2 x 1/2)
HIGH BLOOD PRESSURE

METOPROLOL SUCCINATE AL 95mg (1x in the morning)
HEART (ALSO HIGH BLOOD PRESSURE?)

Lercanidipine-Omniapharm 10mg (1/2 in the morning)
BLOOD PRESSURE

Eliquis 5mg (1 x in the morning / 1 x in the evening)
Prevent blood clots

___ She also takes:

RANITIDINE 300 (as needed 1x)
STOMACH

VALORON N Drops 100ml N3 (20 drops / 20 drops / 20 drops)
for pain, taken for years and well tolerated. Dependency is known to us.

L-Thyroxine Henning 50 mg (1x in the morning)
UNDERACTIVE THYROID

Laif 900 (1x in the morning)
highly dosed plant-based St. John's Wort extract, for memory loss
only for 1 week.

Dr. med. Frauke Gehring

Good day,

Strophanthin is poorly dosable and absolutely not an alternative to modern cardiac glycosides, which are also only used very cautiously, for example, only to slow down a rapid heartbeat in atrial fibrillation. Then as a second choice, and also in heart failure after other medications as a third choice. Other medications such as beta blockers (Metoprolol) or ACE inhibitors (Ramipril) are better tolerated and dosed and were surely prescribed to your mother not only for high blood pressure, but also for heart failure.

There are patients for whom a dual therapy is not enough. Whether Lercanidipine is still necessary, or whether too much of it is causing your mother to feel unwell at times, should be evaluated through a 24-hour blood pressure measurement and a 24-hour ECG.

Since she apparently has atrial fibrillation (which could probably only be stopped with a surgical procedure), she necessarily needs a blood thinner like Eliquis. Of course, the underfunctioning of the thyroid gland must also be balanced with L-thyroxine.

In this regard, I do not see any errors in the therapy. However, Laif is an antidepressant and by no means a medication for dementia! It would be more appropriate to consider Ginkgo here.

In summary, your mother needs a cardiological examination due to these episodes. Medically, one cannot accuse the treating doctor of errors or overtherapy. Depending on the severity of the heart failure, an important therapeutic component may even be missing without Spironolactone. Additionally, avoiding cholesterol inhibition, which would truly be life-extending and therefore obligatory after a stroke, is notable.

Warm regards, Dr. Höllering