If you have an elderly parent, grandparent, or loved one suffering from Alzheimer's disease, you may have experienced sudden, agitated, and angry outbursts. You may also be troubled by the sight of them verbally abusing each other, flailing their arms, and moving around without staying in one place. You may also feel helpless at times like these, unable to figure out what to do. Today, we are talking about a medication that can help control these behaviors.
What is this agitation that occurs in Alzheimer's disease?
Alzheimer's disease is not just a disease that causes memory loss. The changes that occur in the brain with this disease can also cause significant changes in a person's behavior. Agitation is one of the main symptoms.
Simply put, this is what happens:
- Being verbally aggressive: constantly yelling, cursing at others.
- Being physically aggressive: hitting others, pushing them, throwing things at them.
- Restlessness: Pacing, restlessness, restlessness.
This condition is a great stressor for the patient and for those like you who care for him. Various medications have been used since ancient times to control this type of behavior. However, they have a high risk of side effects. However, there are now modern medications that have been approved for this purpose, with fewer side effects. Rexulti is one such medication.
How does this medicine called Rexulti work?
Rexulti is a third-generation antipsychotic drug. Okay, does this word sound a bit complicated? Let's keep it simple.
Our brains control emotions, behavior, and thoughts through chemical messengers called neurotransmitters . Dopamine and serotonin are two of the main messengers. In Alzheimer's disease, these messengers can become unbalanced. Rexulti works by helping to restore the balance of dopamine and serotonin in the brain. This can improve mood and behavior.
The most important thing is that this is not like older drugs, and because it works more delicately with brain chemicals, there is less risk of severe side effects like tremors and muscle stiffness.
How should I use this medicine?
Rexulti is a once-daily pill. It can be taken before or after meals.
Your doctor will usually start you on a very low dose . Then, depending on how your body responds to it, other medications you are taking, and how well your liver and kidneys are working, they will gradually increase the dose. The maximum daily dose is about 3 milligrams.
The most important thing is to take the medicine at the right time, at the right dose, as your doctor tells you. Taking the medicine consistently every day will give you the best results. It can take a few weeks or a month for the medicine to show its effects. So, don't stop taking it halfway, thinking, "There's no difference yet." Never stop taking the medicine or change the dose without consulting your doctor.
How do you know if the medicine is working?
You may notice some positive changes in your loved one's behavior after a few weeks of starting the medication. These changes will become noticeable gradually.
| Good changes can be seen |
|---|
| - Decrease in yelling and cursing. |
| - Decreased physical agitation. |
| - Providing more support when caring for the child (e.g., feeding, bathing). |
| - Some improvement in sleep. |
| - Showing interest in being with family or participating in other activities. |
| - Overall, it makes it easier to care for the patient. |
How long you need to take this medicine varies from person to person. Some people may benefit from it in the short term. Others may need to take it for a long time. This will be decided by your doctor. If you don't see any improvement after a few months, tell your doctor about it.
Side effects and how to manage them?
Like any medicine, Rexulti can cause side effects in some people. However, not everyone gets them. Let's take a look at some of the most common side effects and what you can do about them.
| Common side effects | How to manage |
|---|---|
| Weight gain, drowsiness, dizziness | To control weight gain, eat more vegetables and fruits. Do simple exercises like walking daily. If you feel sleepy, ask your doctor and take medication before going to bed at night. If you feel dizzy, do not get up suddenly from sitting or lying down. |
| Akathisia (restlessness) | This may occur early in the treatment. Walking and light exercise may help reduce this. Limit tea and coffee as they can increase this effect. |
| Cold-like symptoms | These usually subside within a few days. If they persist, tell your doctor. |
| Dry mouth, constipation | If your mouth is dry, drink plenty of water. Constipation can be prevented by eating fiber-rich foods (spinach, kale, fruits) and drinking plenty of water. |
Very important: In addition, if you experience any severe symptoms such as high fever, muscle stiffness, severe confusion, or unusual, uncontrollable movements, immediately inform your doctor or go to the Emergency Department (ETU) of the nearest hospital.
What tests should be done during treatment?
When prescribing this medication, your doctor may order some blood tests to monitor certain things in your body. This is done to see if the medication is right for you and if there is a risk of side effects.
- Weight and waist circumference: Weight is monitored before and during treatment.
- Complete Blood Count (CBC): Checks the level of white and red blood cells in the blood.
- Fasting blood tests: Check cholesterol and sugar (blood glucose or HbA1c) levels.
- Blood Pressure: Check regularly.
- AIMS test: This is not a test, but an observation by the doctor. It checks for abnormal body movements (tardive dyskinesia).
Can this cause interactions with other medications?
Yes, this is a very important point. Some other medications you are taking may increase or decrease the effectiveness of Rexulti. If the effectiveness is increased, the risk of side effects increases. If it is decreased, the medicine will not be as effective.
For example, some antifungals (e.g., fluconazole, ketoconazole), antibiotics (e.g., clarithromycin), and antidepressants (e.g., fluoxetine, paroxetine) may require dose adjustments when taken with this medication. There may also be problems with some medications for epilepsy (e.g., phenytoin).
Therefore, tell your doctor about all the medications your loved one is taking. This means not only Western medications, but also Ayurvedic medicines, traditional medicines, vitamins, herbal products, etc. This will help the doctor plan a safe treatment plan.
Take-Home Message
- The disruptive behaviors caused by Alzheimer's disease are a challenge for both the patient and caregivers, but there are treatments available.
- Rexulti (Brexpiprazole) is a specific medication prescribed by a doctor to control this condition.
- Take the prescribed dose at the prescribed time as directed by your doctor. Do not stop taking the medication or change the dosage for any reason without consulting your doctor.
- Be aware of side effects. If you experience any unusual symptoms or if the side effects are bothersome, tell your doctor immediately.
- It is very important to tell your doctor about all other medications (including Ayurvedic and traditional medicines) that your patient is using.
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