Possible over medicating... I (son) joined hoping to help my Mom

[morpheus]

Hello,

If I were to list the number and quantity of medications that my Mom is taking, may I have some opinion on whether or not she is over medicated?

I apologize asking something of the forum as a first post, but her condition is getting worse daily, and I really could use some insight from people who have some experience.

[MSer102]

Bless you for being such a good and caring son!

If you don't have anywhere else to ask, here is probably as good a place as any. There are some MS veterans here who have collected some medical knowledge.

But we need to know as much information as possible along with just a list of medicines. Things like...

Does your mother have MS? Does she have any other health conditions - lupus, heart disease,high blood pressure, diabetes, asthma, fibromyalgia, epilepsy, depression, etc. Sometimes the number of diseases accounts for how many medicines a person is taking and why.

Have you been in touch with any of her doctors and asked them about her medicines?

Have you talked with your mother about her medicines? What did she say? Does she think she might be taking too many medicines, does she have any concerns about what or how she is taking them or does she thing that everything is OK?

How old is your mother? How long has she had MS? How many different doctors is she seeing? How well does she understand and get along with them?

Are her medicines all prescribed or is she getting some of them "unofficially"? Is she taking them as they were prescribed to be taken or is she using her own "schedule"?

When you say that her "condition is getting worse daily" what does that mean? What are her symptoms and what are you noticing and how is it getting worse? Her symptoms can help to identify what might be caused by her health conditions and what might be caused by medications.

This is important: no matter what opinions you might get here they are only opinions from people who aren't doctors and don't know anything about your mother other than what you tell us. Ultimately you must tell her doctors whatever you tell us here and you must get all of your medical information from her doctors.

So if you are willing to do that, then ask away.

[morpheus]

Thank you so much for the reply.

She has no other major medical complications besides MS.
She has struggled with restless leg syndrome for as long as I can remember.
Her MS was previously mis-diagnosed as a stroke. That epsisode / attack (please excuse my terminology if incorrect) was in 1996, and it wasn't up until about 2 or 3 years ago that MS was thought to have cause the health issue in 1996 and since then, her mobility has been greatly affected.

She just turned 59, and in the 2 years since her diagnosis, has gone from an active woman to one that cannot move her right side.

The lack of mobility started when she started seeing a doctor for what were MS symptoms and @ the same time she started taking Pramipexole (generic mirapex) for her restless legs.

Since then, she has accumulated a drug list that is very extensive, imo (in comparison to me, who is narcoleptic and my father, who has had a heart attack)... each of us having done as much internet research on our own conditions and medications as possible.

She now takes:

-copaxone
-baclofen
-pramipexole
-ampyra
-tyzanadine
-gapepentin

and it seems, @ least to me, and I apologize for implementing hunches over medical advice from her doctor, that each time she visits the doctor, he sends her home with either a new medication or a higher dose of a current one.

Her general demeanor seems different as well, almost as if she if foggy if that makes sense..

Maybe it is hard for me to accept that MS is having as drastic affect in the short time she has had it, but I feel it is time to open my big mouth @ least and ask for some opinion if it could also be some overmedicating.

I would be happy to answer any questions that may help and thanks in advance for the reply and help.

[AlaskaAnn]

You rock as a kid. Carry on young man. Another question is how many doctors does she have prescribing medication? Are they all coming from the same pharmacy?

[Marco]

morpheus - thank you for looking after your mom.

You can got to websites like drugs.com and go to their interactions checker. Enter all the drug information and the website will give you an opinion of adverse side effects or other concerns. You can print out the results and schedule and appointment with her GP to discuss them.

You could also schedule a "medication review" with your local pharmacist. Then you could both go and talk to them about her medications and your concern. Each pharmacy has slightly different policies, but many offer this service free of charge to their patrons.

Thank you again for looking out for your mom and let us know how things go.

[rdmc]

Good for you for being interesting and concerned.

What happens with MS is that a lot of the times we have varied symptoms and different meds are prescribed to deal with different symptoms. It's not unusual at all.

As to drug interactions, I can't give you much info about that...but as far as the drugs she's been prescribed, I can at least tell you what symptoms they are meant to correct.

Copaxone is a DMD, not meant to deal with any symptoms but to try to slow down the progress of the MS. Many MS patients are on one form of DMD or another. Copaxone has been around for quite awhile and is thought to have less side effects than some of the others, like the interferons.

Baclofen and Tizanidine are anti-spasticity meds that help control the spasticity that is another very common symptom with MS. When one isn't handling the spasticity, sometimes doctors prescribe both. I will say that these drugs are well known for causing drowsiness.

Ampyra is to help with walking coordination and walking speed.

Gabapentin or Neurontin is for pain caused that is neuropathic. It's actually an anti-epileptic medicine but is used quite often for nerve pain, another very common symptom. This med too can cause drowsiness.

The only med I'm not familiar with is pramipexole. I'm not sure how that fits in the MS picture.

I have, at one time or another, taken the meds your mom has been prescribed. None are "unusual" meds to treat MS symptoms...that being said, as with so many MS meds, they tend to cause drowsiness, and that may be what you're observing.

Your mom's dr. has no way of knowing how she's reacting to these meds, so you, or she, will need to discuss the issue with the neuro.

P.S. as to coming home from the dr. with a new medication...well that's what happens with MS sometimes. You go to the neuro with a new symptom or new complaint and they try to address it the best way they can. Sometimes it's through PT or other therapy, but often it's a new med to try to relieve the symptom.

[22cyclist]

Morpheus: Again, thank you for taking care of your mom, and dad. Your mom's medications have no interaction red flags. Some of them, however, will make her very sleepy. The baclofen and tizanodine can cause significant fatigue/drowsiness. The gabapentin can also cause sleepiness. If taken at the same time a cumulative effect can be expected.

Sometimes with MS, people's personalities do change, or they are not the same as they used to be. This can be due to lesions in certain areas in their brains, or it can be due to pain they are experiencing. If you notice a change that is there all the time, then the change may be part of the prior more than the latter. She can't help this. I hope for both of you, you will come to an understanding with each other.

I hope things get better for both you and your mom. I will be praying for you both.

Take care
Lisa
Moderation Team

[Fed Up]

morpheus;

It is time to make an appointment to see the M.D.with YOU present and ALL these medications. And a very serious conversation!

This is not a conversation you want to have on a phone!


You Go You morpheus...ALWAYS suspect the drugs first! fed

[misslux]

It doesn't seem all that much to me for a person with MS to take since they all serve very specific functions. But definitely go with her to appointments if she is willing to have you there.

[misslux]

She just turned 59, and in the 2 years since her diagnosis, has gone from an active woman to one that cannot move her right side.

I forgot to comment on this part. Everyone's MS is different so it is difficult to compare. Some people have very little issues with mobility but some do. I went from being a pretty active person (walked everywhere) to having reduced mobility requiring a cane and brace due to hemiparesis on my right side in about two years as well.

[MSer102]

As pointed out, you'll have to discuss your mother's medications with her doctors. But also as pointed out, almost all of the ones you listed are common in people with MS.

The only one that isn't is pramipexole. But none of the MS medicines does exactly what it does, so there's a place for it if your mother has restless leg syndrome. Some people with MS also have restless legs and take a medicine specifically for it. Most of the people who have restless legs don't have MS and there isn't a known direct connection between MS and restless legs. It's possible to have both and they might be indirectly related.

Also as pointed out, baclofen and tizanidine are both muscle relaxers to help with spasticity. They both do the same thing but some people don't get enough relief from using only one so the neurologist prescribes both of them. They can both interact with pramipexole because some of the function is overlapping. Adverse reactions of the medicines can lead to weakness and sleepiness.

But they won't lead to weakness on just one side so if your mother is weaker on one side it isn't because her medications are causing it. They might be making it worse but they wouldn't cause it on only one side of the body. That's where it's important to talk with your mother's doctors to establish whether cutting back on one medication might send her back to the original state of spasticity or restless legs that caused the doctor to add or increase the medication in the first place.

I'll change the subject here somewhat. Copaxone is a very good medicine. I just read that it is the most widely prescribed MS treatment medicine in the world. One of the reasons is that it has so relatively few side effects.

The trade off to that low number of side effects is that it also has one of the lowest statistical rates of effectiveness of all of the MS treatment medicines. If your mother has developed serious mobility problems it might be that the Copaxone isn't effective enough for her and that changing to a different medicine with higher statistical effectiveness - but also higher risks and side effects - might be more helpful.

It might also be that your mother has had MS for so long that she has transitioned into what's called secondary progressive MS that doesn't respond well to treatment medications anymore. In that case changing to a different medicine might give her greater side effects without giving her more effectiveness to make them worthwhile so changing medicines might not be helpful at all. This is another very important question to ask her neurologist.

It might seem that your mother's mobility has gone downhill pretty quickly since she was diagnosed. But if she has really had MS misdiagnosed as a stroke since 1996, she has really had MS for quite a long time and possibly longer than even that. If that's the case, that "rapid" progression to disability was 15 years in coming so it isn't really that fast or unusual at all.

And at that point an MS treatment medicine might not be that helpful anymore. That's what I was talking about when I said that she might be in the secondary "progressive" phase and why you really have to talk to her neurologist about where she is in the disease and what treatments are most appropriate.

So all told, your mother's list of medications looks like the same list a lot of other people with MS are taking. In general, not unusual, not excessive. If every visit to the doctor resulted in a higher dose or a new medicine it was in response to problems your mother told her doctor she was having.

As pointed out, several of the medicines do have the side effect of causing drowsiness and possibly brain fog. So that's something to discuss with your mother's doctors. She might be overmedicated in that sense, but it's also possible that cutting back on the medicines will leave her undermedicated in other respects, leaving her spastic and in pain which is how she started on the medicines in the first place.

So it will take good discussions with her doctors to figure out what adjustments might be made in trade off to try to improve some things without hurting other things. Your mother might think more clearly if some of her medications were adjusted, but the pain and spasticity might become unbearable.

Or she might just be emotionally worn out or might be showing the effects of brain damage from MS that might benefit from even more medication to help with her demeaner and state if mind. There's no way to know without working with her doctors.

[Kimba22]

Hi Morpheus,

Welcome to MSWorld. I hope this site helps your family with your mom's MS journey.

My first symptoms were in 1996, so that would be the same time as your mom. I have transitioned into Secondary MS, so the same is very plausible for your mom. Even though she has only been dx'd 2 years, like MSer102 said, she's had MS 17 years.

Copaxone doesn't contribute to your mom's fogginess, but the other meds probably do. MS itself can also contribute to "cog fog."

I had some major issues with spasticity (basically, it's when your muscles tighten and won't relax ... this can be quite painful). My neurologist did consistently increase my dose of Baclofen, Tizanidine, and Gabapentin (this med can also help spasticity). I remember that foggy feeling. And it just kept getting worse each time my dosages were increased. (I eventually had to stop Tizanidine, because it made me too dizzy to function. Instead, Valium-another drug used to help spasticity-was added). Eventually, the fog lifted as my body adjusted to these medications. But, that's my body. Some people never can adjust.

It's possible your mom could be a candidate for a different means of delivering antispasticity medication to her body (via an Intrathecal Baclofen Pump), if she isn't getting adequate relief from oral medication. With this, a liquid form of medication is delivered directly into the spinal fluid. It's much more effective (with a smaller amt. of medication) and side effects, like drowsiness, are then avoided. This may or may not be the solution for your mom, but it might worth inquiring about. There is a process of evaluation for that, and it does involve surgery. But it proves beneficial to many MS patients, myself included.

It could benefit all of you if your mom is willing to have you and/ or dad accompany her to her appt. Not only could you express concerns, but her dr. can explain the role of her medications.

Best wishes,

[morpheus]

Thanks you guys very much for all of the detailed replies. My Dad is very active in terms of communication with her neurologist and is always in the exam room during visits.

I guess it is difficult to treat spasms without affecting mobility, it is just tough for me to swallow that one or more of her medications are potentially helping one symptom, but adversely reacting another.

It is disappointing, yet comforting to hear that her medications don't seem out of the ordinary for a "typical" MS patient.

I have a lot of reading to do, and want to thank you guys for providing this forum and the information included to help people like me, my Mom and Dad and eachother.

[Kimba22]

Hi Morpheus,

Glad our responses have helped you better understand your mom's list of medications.

Something else that might be contributing to your mom's fogginess is an insufficient amount of sleep. With her restless legs and symptoms from MS, plus the medication Ampyra, she may not be sleeping well.

A side effect of Ampyra is insomnia. I could only take the morning dose, as the evening dose made it too hard to sleep.

You came to a great site to learn about MS. Don't hesitate to ask more questions! You can also learn a lot by searching the various forums, as well.

Wishing you and your family well,

[Marie12]

Thank U young man, U r a wonderful son, & very smart 2

Thank U 4 helping your mom. U R a wonderful son. U will receive very important info on this message board. #1 like was posted, U need to enter your mothers meds, including vitamins and aspirins, on drugs.comWebsite. That was very helpful to me. I won't go into all the details, but that website really helped me.

And I also liked the post, go to the dr with your mom and have all, all the meds listed that your mother takes, give one to the nurse, dr, & keep one for yourself.

All this stuff is too much for one person to keep track of, your mother does really need you.

I know it is a lot for you to do, but you can ask for help for your mother. That has been difficult 4 me, because I was always the one giving the help. Thank U 4 helping your mother. Your help does more than even U can realize