The Silent Killers: Blood Pressure, Cholesterol and Diabetes

Did you know that every hour, a man, woman or child dies from heart disease and stroke in Ireland? High blood pressure, high cholesterol and high blood sugar are major reasons for these premature deaths. High blood pressure, high cholesterol and high blood sugar (an indicator of diabetes) are mostly symptom-less, however they are known “silent killers” as if high they greatly increase your risk of death or serious disability from the likes of heart attack, angina, stroke and other coronary illnesses.

High Blood pressure-The Silent Killer

High blood pressure is often called the silent killer with many people not realising they have it until it is too late, for example after they have suffered a stroke or heart attack.

Cardiovascular disease (CVD) is the leading cause of death worldwide, with two-thirds of cerebrovascular disease (eg Stroke) and half of ischaemic heart disease (eg Angina) being attributable to high blood pressure.  In Ireland in 2000, CVD was the number one cause of death and was responsible for 41% of all deaths. High Blood Pressure (BP) affects up to 50% of middle-aged and older people. High BP has no symptoms so routine checks are essential, especially on those over 50.

Trials have shown that achieving a target blood pressure of 140/90 mmHG achieves a 42% reduction in stroke, a 14% reduction in coronary events such as myocardial infarction (heart attack) and a 21% reduction in cardiovascular deaths. There is evidence that high BP can predispose individuals to the development of cognitive impairment and dementia in later life.

All adults should have their blood pressure measured routinely every 5 years. According to the 2003 European Society of Hypertension classification of blood pressure values, optimal blood pressure is less than 120/80 mmHG.

High Cholesterol- The Silent Killer

The amount of cholesterol present in the blood can range from 3.6 to 7.8 mmol/litre.  A level above 6 mmol/litre is considered high, and a risk factor for arterial disease. A Total Cholesterol level of below 5.2 mmol/litre is recommended to prevent heart disease. Evidence strongly indicates that high cholesterol levels can cause narrowing of the arteries (atherosclerosis), heart attacks, and strokes.  The risk of coronary heart disease also rises as blood cholesterol levels increase.  If other risk factors, such as high blood pressure and smoking, are present, the risk increases even more.

High cholesterol is not a disease in itself, but it is linked to serious conditions, such as cardiovascular conditions (disease of the heart and blood vessels), angina, stroke, and mini-stroke, known as transient ischemic attack (TIA).  A high level of cholesterol in your blood, together with a high level of triglycerides, can increase your risk of developing coronary heart disease.

Coronary heart disease is caused by narrowing of the arteries that supply the heart with blood.  This narrowing of the arteries is called atherosclerosis.  Fatty deposits, such as cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery.  This build up, known as plaque, usually affects small and medium sized arteries.  The flow of blood through the arteries is restricted as the inside diameter is reduced.  Blood clots, which often happen in the coronary arteries during a heart attack, are more likely to develop when arterial walls are roughened by the build-up of fatty deposits.

Uncontrolled Diabetes: The Silent Killer

The Diabetic Federation of Ireland estimate there are over 200,000 diabetics in Ireland and that over half of these have no idea they have diabetes. Diabetes is one of the leading causes of death in the world. It is now reaching epidemic proportions mainly due to our increasing sedentary lifestyle and poor diet. According to the World Health Organisation, there were 30 million diabetics in the world in 1985, today there are approximately 230 million diabetics and this figure is expected to rise to 330 million in 20 years’ time if we do not take action. 

Diabetes mellitus (Type 2 Diabetes) is a condition that occurs when the body can't use glucose normally. Glucose is the main source of energy for the body's cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. Insulin helps glucose enter the cells. It does tend to run in families bur being overweight is a major factor for Type 2 Diabetes. Untreated diabetes can lead to serious complications therefore early treatment is essential. Complications of untreated diabetes include heart disease, stroke, eye problems, erectile dysfunction, kidney disease, loss of feeling and sensation due to nerve damage, gangrene in the foot.

Do you know your numbers?

When was the last time you got your:

·         Blood Pressure Checked?

·         Cholesterol Checked?

·         Blood Sugar (Diabetes) Checked?

·         Body Mass Index Checked?

High blood pressure, high cholesterol and high blood sugar (an indicator of diabetes) are mostly symptom-less, however they are known “silent killers”. Screening could save your life.

Happy New Year, Healthy New You!

Many New Year resolution involves getting healthier; this is your chance to get your new year off to a good start by finding out what some important indicators are. Don’t wait until it is to late; book your free health checks today!

What? Free Health Checks

Checking what? Cholesterol, Blood Pressure, Diabetes, Body Mass Index

When? Saturday January 23^rd 2016

Where? Whelehans Pharmacy

How? Tel 044 9334591 to book your free screening

Places are limited and it will be popular so book your free place at 04493 34591 now to avoid disapointment. It will only take you 15 minutes and results are instantaneous. Our health checks are not meant as alternative to check up from your GP. If your cholesterol, blood pressure, blood glucose or BMI are high then we will refer you to your GP for full screening and follow up.

Free health checks at Whelehans Pharmacy, 38 Pearse St, Mullingar (Opposite the Greville Arms Hotel). Tel 04493 34591. www.whelehans.ie or info@whelehans.ie. Find us on Facebook

Weight, body mass index and waist circumference

Have you been inspired by RTE’s “Operation Transformation”? Committed to making a positive change in 2016? An important part of getting started on the path to real change is to understand where you are now, starting with this question….Do you know your numbers? Knowing your own vital numbers gives you your starting point.

As part of our commitment to helping you be healthier in 2016, Whelehans have teamed up the Operation Transformation team to offer you the opportunity to have your BMI, weight and waist measurements measured at no charge by a qualified nutritionist.  Next Saturday 9^th January, we host a “Do you know your numbers” weight management event with Nutritionist Aisling Murray at Whelehans Pharmacy. Our nutritionist will offer free BMI, weight and waist measurements as well as nutrition advice in one to one consultations. Simply call Whelehans at 04493 34591 to book your free check.

Body Mass Index (BMI)

Many experts recognise body mass index (BMI) as the most accurate way to determine if you are a healthy weight for your height by providing a numerical rating. Recent medical research uses BMI as an indicator of an individual’s health status and disease risk.
Below are the ranges for BMI values for adults:

Category	BMI	Health risk
Underweight	Less than 18.5	Osteoporosis, infertility and lung disease. Recommended to speak to a GP.
Healthy Weight	18.6 – 24.9	Low risk of a weight related disease.
Overweight	25.0 – 29.9	type 2 diabetes, high blood pressure, heart disease, stroke, gallbladder disease and certain cancers.
Obese	Greater than 30	Higher risk of all the above diseases.

 BMI doesn’t tell the whole picture (like where on the body you are carrying weight and what that weight is eg. Muscle, tissue or fat). BMI is just an indicator to follow. BMI is beneficial for assessing a person’s risk of disease, such as heart disease and diabetes and can give an indication of how likely you are to develop these diseases. BMI is only suitable for someone who participates in light exercise.

Waist Circumference

Carrying weight around your stomach compared to elsewhere on the body, is directly linked with an increased risk of certain chronic diseases such as type 2 diabetes, heart disease and certain cancers. The reason carrying weight around your stomach (trunk region) makes you more susceptible to chronic diseases are due to the hormones which are produced as a result and they have a negative impact on our bodies.

How to measure your waist?

To measure your waist, you need to find the bottom of your rips and the top of your hips. Your waist is located in the middle of these two points (for the majority of people this will be around the belly button). A measuring tape is then wrapped around your bare skin or a light shirt. Make sure to be relaxed, exhale and then measure your waist. A common mistake regularly made is assuming your waist is where your trousers sit.

The table below indicates your risk of ill health depending on your waist measurement. These measurements refer to adults only. 

 

Waist measurement	Men	Women
Healthy Range	36 inches or less	31 inches or less
Overweight range	37- 40 inches	32 – 35 inches
Obese range	40 inches or over	35 inches or over

Overweight range

Regardless of your height or build, if your waist measurement is over 32 inches as a woman and 37 inches as a man you are considered to be in the overweight range. This doesn’t necessarily mean an individual is obese; what it indicates is that the person is carrying excess weight around their middle and are at an increased risk of diseases such as type 2 diabetes, heart disease and certain cancers. If you are in the overweight range, making healthy lifestyle changes, improving your diet and increasing exercise will help reduce or prevent any further increases in your waist.

Keeping the weight off longer term

Once you know your numbers you have the benchmark you need to set your own goals and targets. To help you achieve all you want to, have you thought about taking advantage of a professional nutrition service? If you have been thinking of doing something about your weight or diet for a while, perhaps it is time to take advantage of the nutrition service at Whelehans where you can get the comprehensive support and information you need to help you reach your target weight.

Whelehans Nutrition Service is now at a special weekly rate of only €10 per week. Your private and confidential one to one appointments with our qualified nutritionist Aisling Murray Bsc are held in our purpose built consultation room within the pharmacy. Aisling, will help you each step of the way to reach your goals through a mix of weekly weight checks, support along with professional dietary and nutritional advice.

Take the first step on the path to a new you in 2016, call 04493 34591 now for more information or to book your free place at our free weight managment event next Saturday January 9th. With the first installment of Operation Transformation airing on RTE on Wednesday January 6th at 8:30pm, our event will be popular and with places limited, be sure to call quickly to secure your place

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591. Email queries to info@whelehans.ie.

The myths about alcohol and hangovers (uncovered)

With Christmas and New Year’s party season well and truly underway I thought it would be a good time to discuss facts about alcohol and dispel some of the myths we have about alcohol. Alcohol is safe if drank in moderation. Alcohol releases endorphins in the brain which is why it makes us feel good (and why it is so addictive); it also affects the area of the brain that causes inhibition which is why it makes us talk more and feel more relaxed. In this article I only discuss the short term effects of drink. There are also many long term health dangers of heavy drinking. According to Dr Conor Farren, a consultant who deals with alcohol addiction in St Patrick’s hospital in Dublin, abuse of alcohol can cause 63 different diseases to our body.

What causes a hangover?
The unpleasant symptoms experienced during a hangover are mainly caused by three factors. (1) The diuretic effect of alcohol that causes the drinker to pass more urine and thus become dehydrated. (2) The toxic effects of by-product of alcohol metabolism (acetaldehyde) (3) Depletion of vitamin A, vitamin C, the B vitamins (especially vitamin B6), magnesium, potassium and calcium. Co-geners are another cause of hangovers. These are impurities created during the fermentation of some types of alcohol. Low quality wines and dark drinks tend to have high levels of co-geners. A general rule of thumb is the darker your drink, the worse the hangover. Certain chemicals added to some drinks such as preservatives and sweeteners also make the hangover worse.

The symptoms of hangovers
Symptoms of hangovers can include some or all of the following class of symptoms:

Constitutional: Fatigue, weakness, and thirst. Pain: Headache and muscle aches. Gastrointestinal: Nausea, vomiting, and stomach ache. Sleep and Biological Rhythms: Decreased sleep including decreased deep sleep which means the sleep you do get does not leave you refreshed. Sensory: Dizziness and sensitivity to light and sound. Cognitive: Decreased attention and concentration. Mood: Depression, anxiety, and irritability. Sympathetic Hyperactivity: Tremor, sweating, and increased pulse and blood pressure.

How long will a hangover last?
Hangover symptoms usually begin within a few hours of the drinking session ending when the blood alcohol concentration (BAC) begins to fall. The symptoms usually peak at the time when the person’s BAC returns to zero. Hangover symptoms can last from a few hours to up to 24 hours. Some binge drinkers develop a tolerance for alcohol which means they do not get hangovers, however their performance at work or other areas of their life will be affected.

Is there a cure for hangovers?

There is no cure for a hangover. Apart from drinking in moderation (or not drinking) there is no guaranteed way of preventing one. Hangover cures are generally a myth. Dehydration is the main culprit; three times as much fluid is lost than is taken in while drinking alcohol because of the diuretic effect alcohol has on the kidneys; this is because alcohol inhibits a hormone called anti-diuretic hormone (ADH). The symptoms of a hangover can be reduced by rehydrating with water before going to bed. The best way to deal with “the morning after” symptoms is to rehydrate by drinking plenty of fluids. You can replace lost fluids by drinking bland liquids that are easy on the stomach such as still or sparkling water and isotonic drinks. Water also helps dilute the leftover byproducts of alcohol in the stomach. Adding salt and sugar to water helps replace the sodium and glucose lost the night before. Many believe that fatty or fried foods the next morning will ease the symptoms; however this is more likely to irritate an already delicate stomach. Over the counter painkillers can help with headaches and muscle cramps. Sugary foods may help reduce trembling. An antacid may ease an upset stomach. Food helps slow the absorption of alcohol so it takes alcohol longer to reach your blood stream, thus reducing the risk of becoming intoxicated and your hangover may not be as bad. Lining the stomach with a glass of milk before drinking may slow down the absorption of alcohol very slightly. Replenishing vitamins and minerals lost may help as alcohol robs our body of many vitamins and minerals. Some people believe that taking a supplement such a vitamin C or B complex supplement can help.

Why do hangovers get worse as we get older?

Many of us have heard people saying (or said it ourselves) that hangovers get worse as you hit your 30’s or 40’s compared to when you were in your early 20’s. Is this just our imagination? There is truth in this and there is a scientific explanation. Our body uses the enzymes alcohol dehydrogenase (ALDH) and aldehyde dehydrogenase (ADH) to break down alcohol. As we get older, these enzymes reduce in efficiency meaning that it takes longer for the body to get rid of the toxic byproducts of alcohol such as acetaldehyde which leads to longer and more unpleasant hangovers.

Happy New Year to all readers from all at Whelehans Pharmacy, 38 Pearse St, Mullingar.

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

 This article is shortened for this health blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie

Westmeath is among the worst counties for overuse of antibiotics

The HSE revealed earlier this year that Westmeath is among the worst three counties in Ireland for overuse of antibiotics. Pharmacist Eamonn Brady from Whelehans Pharmacy Mullingar explains that “antibiotics do not work for colds and flus and should be reserved for more serious infections”. Eamonn explains that “Antibiotic resistance still remains a major European and global public health problem and is, for a large part, caused by misuse of antibiotics. Antibiotic resistance is considered to be one of the biggest future threats to world health; already diseases which were considered curable such as tuberculosis and malaria are getting resistant to antibiotics and could become incurable in the future if we don’t tackle antibiotic overuse”.

One in four people still think an antibiotic cures a cold

Eamonn explains that a “2013 HSE survey revealed some worrying findings. It was revealed that one in four people in Ireland still wrongly believe that antibiotics prevent colds developing into more serious illness or that they speed up the recovery from colds. The HSE explain “Antibiotics have truly transformed modern medicine and are appropriately used to treat or prevent bacterial infections. However, we are all in danger of taking antibiotics for granted and we all have a role to play so that we don't return to the pre-antibiotic era. Before antibiotics were available, common injuries such as cuts and scratches that became infected sometimes resulted in death or serious illness because there was no treatment available. Thankfully, this does not happen anymore as we have antibiotics available to treat these infections. However a casual attitude to antibiotics is damaging their effectiveness”.

Under the weather?

European Antibiotic Awareness Day is an annual event to raise awareness on how to use antibiotics in a responsible way that will keep them effective now and in the future. To mark the occasion, Pharmacists are collaborating with GP’s and the HSE on a public campaign; this campaign is being launched today, Wednesday 18 November. The campaign is being supported by the HSE website www.undertheweather.ie and is being promoted as the place to go for sensible, practical advice on common complaints. Most young mothers, when discovering their child is ill, search online for advice. This website will give practical advice on what to do and when to seek help from the pharmacist or GP.

What to do if you have cold or flu

Pharmacist Eamonn Brady explains that “antibiotics are now becoming ineffective to many infections leading to the development of superbugs such as MRSA. Infections such as tuberculosis are now re-emerging because the bacteria are developing resistance because of our overuse of antibiotics. The best way to prevent this problem is for all of us to only use antibiotics when we really need them. Many infections are viral so an antibiotic should not be prescribed. Your GP or pharmacist can explain which infections need and which don’t need antibiotics” Pharmacists give the following advice if you have a cold or flu, “Stay at home and rest if necessary. Drink plenty of water or soft drinks. Take paracetamol to reduce your temperature if feverish or if you are in any discomfort. You may wish to take other remedies, but be aware that they may contain paracetamol - do not exceed the maximum daily dose of paracetamol by combining different products - ask your pharmacist. Ask your pharmacist about other remedies you can safely take to relieve your symptoms. If you are concerned that your symptoms are getting worse or you are not better in a few days, phone your GP surgery for further advice. Finally, personal hygiene precautions such as hand washing regularly prevent the risk of infections spreading and will protect you and others.”

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Buccal Midazolam Directions- Quick-Guide (For Epileptic Seizures)

What is midazolam?
Midazolam belongs to a group of medicines called benzodiazepines. It is a relation of diazepam. It has traditionally used for sedation. Midazolam can be used to treat a number of different conditions, including seizures. It is prescribed for some but not all epileptics (eg) if a person has a history of longer seizures (also known as fits). If a seizure lasts for more than five minutes, it may be difficult to stop unless treatment is given. It is therefore important that rapid treatment is given to stop the seizures and therefore prevent status epilepticus. Status epilepticus is a condition where a person has a seizure (convulsion or fit) or a series of seizures that last for 30 minutes or more, without a complete recovery of consciousness.

How is buccal midazolam given?

The midazolam solution should be placed against the sides of the gums and cheek so that the medicine is absorbed directly into the bloodstream. This is known as the buccal or oromucosal route. Administer slowly. If the medicine is swallowed accidentally, it might not work as quickly. Nowadays, Buccal Midazolam is prescribed mainly in an easy to use pre-filled syringe eg. Epistatus Pre-filled syringe or Buccolam pre-filled syringe.

Using Buccolam^® pre-filled oral syringes or Epistatus^® pre-filled oral syringes

·         Check the dose and expiry date of the pre-filled syringe provided.

·         Remove the oral syringe from the packaging.

·         Place the syringe into the side of the person’s mouth, between the gums and teeth.

·         If possible, divide the dose so you give half into one cheek and the remaining half into the other cheek.

·         Slowly push the plunger of the syringe down until the syringe is empty.

·         Watch for any breathing difficulties.

·         Confirm that the seizure has stopped.

 

·         Dispose of syringe safely

If the patient is going to a hospital or a medical professional after administering, it is good practice to send the used syringe with the patient so the medical professional can see exactly what has been administered. Also, t aim to record the time the buccal midazolam was administered (this is important in cases where further doses need to be administered).

Never use another person’s Buccal Midazolam for a person it is not prescribed for

Only administer Buccal Midazolam that is specifically prescribed for that patient. NEVER use another person’s buccal midazolam for a patient it is not prescribed for.

How long does it take to work?            

Buccal Midazolam takes a few minutes to work so the seizure is likely to continue for a few minutes after administering. Some of the midazolam may flow out of the side of the mouth (especially as the patient is undergoing seizures); however once the majority stays in the mouth then the patient will get sufficient amount into the bloodstream to work.

When to administer?                               

1^st Dose: Administer if a seizure lasts for five minutes (as the majority (75%) of seizures will expire within five minutes and buccal midazolam may cause severe drowsiness)

The amount of midazolam buccal liquid used depends on weight and age. The dose for children over 10 years and adults is 10mg (1ml)

·         For younger children, doses come in 2.5mg, 5mg and 7.5mg; administer the dose the doctor prescribes

·         The doctor will prescribe the correct dose based on the child’s age and weight so you do not have to worry about picking correct dose. Simply use the buccal midazolam labelled for that patient

2^nd Dose: ONLY GIVE A 2^ND DOSE IF ADVISED BY PRESCRIBING DOCTOR AND AFTER THE ADVISED TIME PERIOD. For adults (and some children), a second dose may be given 10 minutes later if no response is apparent and the patient is breathing normally. If the patients’ breathing becomes shallow, call an ambulance and do not administer a second dose. If a response is not seen after a further 5 minutes, call for assistance. Ambulance staff may repeat the dose if deemed appropriate.

 What to do if a seizure starts again: Generally a 3^rd dose is not advised without medical supervision. An ambulance should be called if seizures continue. The maximum recommended dose in 24 hours is 20mg for adults (or less for children). Please follow the advice given by the initiating specialist.

What are the side effects of buccal midazolam?

• Drowsiness and sedation – recovery is usually fast.
• Amnesia or short-term memory loss – the person may not remember having had a seizure.
• Breathing difficulties – the person is unlikely to have breathing difficulties if midazolam is given at the correct dosage. If breathing difficulties do develop, seek medical assistance.
• Restlessness, agitation and disorientation – these can occur but are usually rare.

Storage
Keep midazolam at room temperature (not in a fridge). Store away from bright light or direct sunlight and away from heat. Always double check expiry date (written on side of pack) and get a replacement prescribed by your GP if nearing expiry.

 It is good practice to have a trained first aider on hand if a person is undergoing a seizure

Disclaimer: This is a general guide; individual patients will have more specific guidance depending on their type of epilepsy and seizure history. Always follow the prescribing doctor’s advice. If a person is prescribed Buccal Midazolam, it is good practice to have written administration instructions or protocol specific for that patient (eg) When to administer? Can a 2^nd dose be administered? After how long?

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591. Email queries to info@whelehans.ie. Find us on Facebook.

Thank you: Thank you Great Ormond Street Hospital (London) for some of the Buccal Midazolam guidance in this health blog

Dementia

Dementia is an umbrella term used to describe various conditions which damage brain cells and lead to a loss of brain function over time. Dementia causes a progressive decline in a person’s mental functioning. It is a broad term, which describes a loss of memory, intellect, rationality, social skills and normal emotional reactions. The symptoms of dementia develop gradually over a period of years. The progression of these diseases is largely unpredictable for each individual.

Facts in brief

Dementia has a life changing physical, emotional and mental impact on the affected person and their primary carer and family. There are more than 100 conditions that cause dementia. While the risk of dementia increases with age, it is not a natural part of ageing. Dementia affects approximately one in 20 of people aged over 65 years. This rises to one in five in the 80 plus age group. While it is comparatively rare, dementia can affect younger people. There are approximately 3,800 people under the age of 65 with Younger Onset Dementia in the Ireland. A person with dementia will live for an average of four to eight years, depending on their age at diagnosis. Alzheimer's disease, the most common cause of dementia in Ireland, accounts for more than 50% of all cases; the second most common form is vascular dementia, which may be preventable.

Risk Factors
The risk factors for Alzheimer's disease include increasing age being female, family history, head injury, Parkinsons, hypothyroidism, exposure to dietary aluminium, cardiovascular disease, smoking and high alcohol intake

Health maintenance

As Alzheimer’s disease progresses, various conditions develop that may lead to death, such as septicemia, pneumonia and upper respiratory infections, nutritional disorders, pressure sores, fractures, and wounds. In the early stages of Alzheimer’s disease, health maintenance activities should be encouraged including exercise, the control of high blood pressure and other medical conditions, annual immunization against influenza, dental hygiene, and the use of eyeglasses and hearing aids as needed. In later phases of the disease, it is important to address basic requirements such as nutrition, hydration, and skin care.

Diagnosis

There is no straightforward test for Alzheimer’s Disease so diagnosis is difficult, particularly in the early stages. Diagnosis is usually made by excluding other causes such as infection, vitamin deficiency, thyroid problems, brain tumour, depression and the side effects of drugs which all can produce similar symptoms. Diagnosis involves a variety of medical assessments and observations. Assessment usually includes a mini mental state examination (MMSE). Specialists can only make a probable diagnosis. However, clinicians with experience in memory loss are able to diagnose AD to within 80-90% accuracy.

Medication

Medication can slow down progression of AD but is not a cure. Medication should be used in conjunction with non-drug treatment options. For more information on non-drug options, call into Whelehans or discuss with your GP. Four drugs are approved for treatment of dementia in Alzheimer’s Disease (AD) in the UK and Ireland. These are donezepil (ARICEPT^®), galantamine (REMINYL^®), rivastigimine (EXELON^®) and memantine (EBIXA^®). The first three are cholinesterase inhibitors and memantine is a NMDA receptor antagonist. All of these drugs must be started under specialist care. All these drugs now have less expensive but equally effective generic equivalents. These treatments can help improve a person’s memory and enable the person to retain new information for longer. The most common side effects are nausea, vomiting, diarrhoea and anorexia. These can be a particular problem because many people with AD loose weight. However,these side effects wear off after a few weeks in most people. 

Studies have demonstrated modest improvement in cognitive symptoms with cholinesterase inhibitors. Some studies demonstrated a beneficial effect for up to two years after starting treatment. There are no studies of longer periods of medication but most patients can expect that, in time, they will stop responding to treatment as the disease progresses. If the effect wear off, some prescribers recommend a ‘drug holiday’, for example the drug is stopped for six weeks and then started slowly again.

Donepezil has demonstrated in the short term (six months) a beneficial effect on mood and behaviour. Rivastigmine is licensed to treat dementia in Parkinson’s disease. Exelon 4.6mg/24hr transdermal patch and Exelon 9.5mg/ 24hr transdermal patch have been recently launched. The initial dose is 4.6mg/24hr for a minimum of four weeks, and if tolerated, can be increased to 9.6mg/24hr which is considered the recommended effective dose. The rivastigmine patch is considered to have fewer side effects than the capsule version.  Of the four drugs available memantine is the only one licensed to treat moderate severe AD.

There are no guidelines to recommend one drug over another. Donepezil and modified release galantamine only need to be taken once a day which is convenient. Rivastigimine and memantine need to be taken more often though memantine is often given as a single dose in the morning (ie) 2 x 10mg memantine tablets in the morning. There is also insufficient evidence to support the use vitamin E in AD. Further studies are required to test the benefits of Ginkgo biloba.

This article is shortened for this Health Blog.. More detailed information and leaflets is available in Whelehans or check www.whelehans.ie

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie