Concerns About Medication Overdose in Elderly Patients with Anxiety and Insomnia

Q: Concerns About Medication Overdose in Elderly Patients with Anxiety and Insomnia

Hello： The medication dosage should be adjusted based on the patient's constitution and condition. <br>It is recommended to return for a follow-up visit and discuss the adjustment of medication type and dosage with the attending physician. <br>Wishing her a speedy recovery.

Is there a concern about the possibility of overdose with my mother's current prescriptions?

Hello Doctor: My mother was hospitalized at a medical center in southern Taiwan in early February for the treatment of hyponatremia, during which she also experienced symptoms of insomnia and anxiety.
After discharge, her mobility and ability to care for herself significantly declined (she is unable to walk independently), so we decided to take her to Kaohsiung Chang Gung Memorial Hospital for further evaluation.
She was diagnosed with "demyelinating-related disorders" and was advised to rest at home.
Due to the accompanying symptoms of insomnia and anxiety, the physician prescribed several medications, prioritizing emotional stabilization and sleep improvement.
However, I am concerned whether a 75-year-old can tolerate the numerous medications (she is also on original blood pressure and blood sugar medications).
After taking the medications, she still experiences frequent awakenings, talking to herself, and hand movements during the night, and her sleep remains fragmented.
In the morning, she also presents with generalized weakness, so I am seeking your advice! The prescribed medications are as follows:
Before bedtime:
1.
Uleditin 2mg - 1.5 tablets
2.
Yuran 1mg - 2 tablets
3.
Propranolol 10mg - 1 tablet
4.
Seroquel 25mg - 1 tablet
Before meals:
1.
Propranolol 10mg - 1 tablet
After meals:
1.
Yuran - 0.5 tablet after breakfast, 0.5 tablet after lunch, 1 tablet after dinner
2.
Mirtazapine 30mg - 1 tablet
Thank you!

chyiyenyen, 40~49 year old female. Ask Date: 2017/06/03

Dr. Li Zhengfeng reply Psychiatry

Hello: The medication dosage should be adjusted based on the patient's constitution and condition.
It is recommended to return for a follow-up visit and discuss the adjustment of medication type and dosage with the attending physician.
Wishing her a speedy recovery.

Reply Date: 2017/06/03

More Info

When it comes to managing anxiety and insomnia in elderly patients, particularly those who are 75 years old and have multiple health concerns, there are several important considerations regarding medication use. Your mother's situation, involving a complex medication regimen, raises valid concerns about potential medication overdose and the overall impact on her health.

Firstly, it’s crucial to understand that elderly patients often have different pharmacokinetics and pharmacodynamics compared to younger adults. This means that their bodies process medications differently, which can lead to increased sensitivity to drugs and a higher risk of side effects. Factors such as decreased liver and kidney function, changes in body composition, and the presence of multiple comorbidities can all contribute to this increased sensitivity.

In your mother's case, the combination of medications prescribed for her anxiety and insomnia, alongside her existing blood pressure and blood sugar medications, necessitates careful monitoring. The medications listed, including Mirtazapine, Propranolol, Seroquel, and others, can have sedative effects, which may compound the risk of excessive sedation, confusion, or falls, particularly in an elderly patient.
The specific symptoms you described—such as easy waking, self-talk, and hand movements—could be indicative of several issues, including possible side effects from the medications, underlying neurological conditions, or even a reaction to the combination of drugs. For instance, Seroquel (quetiapine) is an atypical antipsychotic that can cause sedation and may also lead to extrapyramidal symptoms, which could explain the hand movements.
Moreover, the presence of low sodium levels (hyponatremia) can also contribute to confusion and altered mental status, which may be exacerbated by the medications. It’s essential to ensure that her sodium levels are monitored and managed appropriately, as this can significantly affect her overall cognitive function and mood stability.

Given these complexities, it is advisable to have a thorough discussion with her healthcare provider about the current medication regimen. Here are some steps you can take:
1. Medication Review: Request a comprehensive review of all medications she is taking, including dosages and the rationale for each. This can help identify any potential interactions or unnecessary medications that could be contributing to her symptoms.

2. Monitor Side Effects: Keep a detailed log of her symptoms, noting any changes in behavior, mood, or physical capabilities. This information can be invaluable for her healthcare provider in adjusting her treatment plan.

3. Consider Non-Pharmacological Interventions: Explore non-drug therapies for anxiety and insomnia, such as cognitive-behavioral therapy (CBT), mindfulness practices, or gentle physical activities like tai chi or yoga, which can be beneficial for both mental and physical health.

4. Regular Follow-ups: Ensure that she has regular follow-up appointments with her healthcare provider to monitor her response to the medications and make adjustments as needed.

5. Educate on Signs of Overdose: Be aware of signs of potential overdose or adverse reactions, such as excessive drowsiness, confusion, or unusual movements, and seek medical attention if these occur.

In conclusion, managing anxiety and insomnia in elderly patients requires a careful and individualized approach, particularly when multiple medications are involved. Open communication with healthcare providers, vigilant monitoring of symptoms, and consideration of non-pharmacological options can help optimize her treatment and improve her quality of life.

Similar Q&A

Understanding Insomnia in the Elderly: Causes and Treatment Options

There is an elderly person at home who often complains about insomnia. He has been treated at your hospital for diabetes and has discussed this issue with his attending physician, who prescribed sedatives for him. However, he still cannot sleep. Later, sleeping pills were prescri...

Dr. Ouyang Wenzhen reply Geriatrics
Hello, may I ask how old your elder is this year? If they are quite elderly (for example, over 70 years old), the dosage of sleeping medication should be reduced by half, even if they are experiencing insomnia. If they have been taking sleeping medication for more than six months...

Understanding Sleep Disorders: Anxiety, Medication, and Health Impacts

After several consecutive nights of not being able to sleep fully and only resting with closed eyes, I consulted a psychiatrist. The doctor diagnosed me with anxiety-induced sleep disorder and prescribed Lexapro, Remeron, and medication to alleviate anxiety, but they have been in...

Dr. Ding Shuyan reply Psychiatry
Hello, there are many causes of insomnia, which are often manifestations of psychological stress or underlying health issues. Based on your age and the description of your problem, it seems you have not experienced significant insomnia over the past few decades. Therefore, you ca...

Understanding Medication Use for an Elderly Relative's Mental Health

Consulting a physician: My mother-in-law is currently 82 years old. She previously received treatment at the Tzu Chi Hospital in Tanzi for mental health issues. Two years ago, other family members transferred her to China Medical University in Taichung. Shortly after the transfer...

Dr. Gu Zhenting reply Pharmacology
1. Indications for each medication are as follows: 1. Quetiapine: Used for the treatment of schizophrenia, depressive episodes in bipolar disorder, manic episodes, and mixed episodes. It can be used as an adjunct treatment for major depressive disorder (MDD) patients who do ...

Managing Anxiety and Medication: A Guide for Mental Health Patients

Hello Doctor: Thank you for your previous response! I have been seeing a psychiatrist for three weeks now, but I feel like there hasn't been much change. My lower back continues to hurt, my neck is still uncomfortable, my sleep is not very stable, and I sometimes experience ...

Dr. Tang Xinbei reply Psychiatry
Dear A-Rong, It seems that your distress is due to taking many medications without noticeable improvement. With your current medications, it generally takes more than ten days to see significant effects. Are you concerned that continuing this way might lead to dependence or addi...