Managing Medication Side Effects in Elderly Stroke Patients

Medication consultation

Hello, my father is 75 years old.
In April 2013, he underwent surgery for cancer, during which he experienced thrombosis and a stroke, resulting in weakness on the right side.
After more than two years of rehabilitation, he can walk slowly.
He did not see a neurologist until August of this year when he fainted at home and was sent to the hospital.
Upon re-evaluation by a neurologist, an MRI showed no new brain injuries.
Last Thursday, October 1st, the doctor prescribed Syntam (Sitagliptin) 1200 mg, to be taken twice daily after breakfast and dinner (this is the first time he is taking this medication).
He has been on it for a week now and is experiencing excessive drowsiness and lethargy.
He keeps saying he hasn't slept well and wants to sleep.
When he sleeps, he dreams (but cannot remember the content of the dreams).
He lies down all day wanting to sleep, and even his favorite local dramas and political commentary shows make him want to sleep after watching for just 20 minutes.
He feels he hasn't had enough sleep and hasn't been able to rest properly (he has not experienced such excessive sleepiness in over two years).
Since his original doctor is no longer in practice, he has to wait until next Thursday, October 15th, for a follow-up appointment.
Therefore, I would like to inquire if it is possible to reduce or discontinue the medication?

Vivian Lo, 40~49 year old female. Ask Date: 2015/10/08

Dr. Jiang Junyi reply Neurology

Hello, based on your description, Piracetam has a mild pharmacological profile.
Syntam (Piracetam) 1200mg: The drug's prescribing information states that Piracetam acts on the central nervous system by regulating neurotransmission, promoting neuroplasticity, and protecting neuronal metabolism.
Its effects on hemodynamics include enhancing the deformability of red blood cell membranes, inhibiting platelet function, reducing plasma viscosity, and improving microcirculation.

Side effects associated with Nootropil include nervousness, agitation, insomnia, anxiety, tremors, and euphoria.
A small number of patients have reported fatigue and drowsiness.
The incidence of these symptoms in clinical trials was less than 2% and was more common in elderly patients with a daily dosage exceeding 2.4 grams.
Most cases resolved spontaneously after dose reduction.
Gastrointestinal side effects (nausea, vomiting, diarrhea, and abdominal pain), headaches, and dizziness have also been reported, but the incidence of these symptoms did not significantly differ from that of the placebo in clinical trials.
Other symptoms such as dry mouth, increased libido, weight gain, and skin allergic reactions have been occasionally reported.

Currently, it is recommended to reduce the dosage by half and observe the effects.
I suggest you consult a neurologist for discussion and treatment.
Wishing you good health and peace.
Dr.
Tao, Neurology, cares about you.

Reply Date: 2015/10/08

More Info

Managing medication side effects in elderly stroke patients is a critical aspect of ensuring their quality of life and overall health. In your father's case, it is essential to consider both the benefits and potential side effects of the medication he has been prescribed, particularly given his history of stroke and current symptoms.

Syntam (also known as Synthemax or similar formulations) is a medication that is often used to manage symptoms associated with neurological conditions. However, it can have side effects, especially in elderly patients who may be more sensitive to medications. The symptoms you describe—excessive sleepiness, lack of energy, and difficulty staying awake—are concerning and warrant careful consideration.

Firstly, it is important to recognize that elderly patients often have altered pharmacokinetics and pharmacodynamics, meaning that their bodies process medications differently than younger individuals. This can lead to a higher risk of side effects, particularly with medications that affect the central nervous system. Given your father's age and medical history, it is not uncommon for him to experience increased sensitivity to medications.

The excessive drowsiness and lethargy your father is experiencing could be a direct side effect of Syntam. While it is crucial to allow the medication some time to take effect, one week of significant drowsiness is a valid concern. It is also important to note that sleep disturbances, such as vivid dreams or difficulty achieving restful sleep, can be exacerbated by certain medications.

In managing these side effects, it is advisable to consult with a healthcare professional as soon as possible. Since your father's next appointment is not until October 15, you might consider reaching out to the prescribing physician's office for guidance. They may be able to provide recommendations over the phone or suggest an earlier appointment if necessary.
In the meantime, here are some general strategies to consider:
1. Medication Review: Discuss the possibility of reducing the dosage of Syntam or switching to an alternative medication that may have a more favorable side effect profile. It is essential to do this under the guidance of a healthcare professional.

2. Monitoring Symptoms: Keep a detailed log of your father's symptoms, including the timing and severity of his drowsiness, any changes in mood or behavior, and how these symptoms affect his daily activities. This information can be invaluable for the healthcare provider in making informed decisions about his treatment.

3. Lifestyle Adjustments: Encourage your father to maintain a regular sleep schedule, engage in light physical activity as tolerated, and participate in stimulating activities that he enjoys. This can help combat feelings of lethargy and improve his overall mood.

4. Hydration and Nutrition: Ensure that your father is well-hydrated and consuming a balanced diet, as dehydration and poor nutrition can also contribute to fatigue and drowsiness.

5. Safety Considerations: Given his history of stroke and current symptoms, ensure that his living environment is safe to prevent falls or accidents, especially if he is experiencing dizziness or excessive sleepiness.

In conclusion, while it is essential to manage the underlying condition for which Syntam was prescribed, it is equally important to address the side effects that are impacting your father's quality of life. Open communication with healthcare providers and careful monitoring of his symptoms will be key in finding the right balance in his medication management.

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