Drug interaction for hospice patient

[sonofadyingman]

(TLDR at the end of post) Hi there, this is a question about pain management in a hospice case (having to do with drug interactions). I'm here for my father. He has had a second, very serious relapse of sepsis- he has an abcess on his cervical spine, cervical spine stenosis, and staph vegetation on his heart valves. Hospital said he is not a candidate for surgery, so they sent him home. He's on IV antibiotics for 5 weeks, then it's oral antibiotics for the rest of his life (but they have essentially sent us home for hospice, at this point. He is 73, and before this he was in very good shape other than chronic pain (6'8", had sciatica surgery, hip replacement, etc). He is currently taking oxycodone, seroquel for anxiety, acetaminophen, gabapentin for pain, trazodone for sleep, and his Adderall (as well as trying Marijuana for the pain). All of these are prescribed (minus the pot, but it's legal in our state). He is currently having horrific spasms in his left groin area (tendon or muscle), but he's in agony and can't sleep through the night. It's constant pain, the oxy doesn't help, the Tylenol doesn't help. We have been told by his sister (a nurse) to see if he can take lorazepam as a muscle relaxant to see if it helps the spasming. Of course the sites I've visited say there are serious drug interactions with lorazepam, but there are also serious drug interactions between the ones he's on (ex: oxy and seroquel). If we tried to give him 0.25 MG of lorazepam, would it be too dangerous?

TLDR/ If my father is prescribed and is taking oxycodone, seroquel, acetaminophen, adderall, gabapentin, trazodone, and Marijuana, is it too dangerous to try 0.25mg of lorazepam for excruciating muscle spasms?


Thank you so much, we really appreciate it.

 

[Parabolan]

I believe you should leave these decisions to a medically trained professional.

 

[negrogesic]

Probably not especially dangerous but who knows.

What's the adderall prescribed for, out of curiosity? And at what dose?

 

[G_Chem]

I’d say when talking end of life care, I think trying .25mg is worth the risk. That dosage should be safe unless he’s on a large amount of oxycodone.

-GC

 

[Snafu in the Void]

Seroquel for "anxiety"? Antipsychotics are well known to be relatively dangerous in the elderly and significantly increases all-cause mortality in elderly patients, but I'm not sure how that figures into the equation if he's coming home for hospice.

It's very possible the spasms are being caused by one of the meds he's on, but I'm no doctor.

 

[Rachrach]

First, you need to speak to a trained medical professional who is familiar with him & your family. That said, just a couple of subjective observations...

Seroquel is never prescribed for anxiety. Gabapentin IS. It can be prescribed for light to moderate pain but I cannot imagine that being the case in Hospice. It is used in lieu of opioids by medical professionals who are anally retentive about opioids. In Hospice that is never a concern, even with the elderly. Seroquel is an anti-psychotic. If he has no history of serious mental illness he should be getting it. I am subjectively aware that in the "Third World" anti psychotics are prescribed for pain, as absurd as that is. It IS fantastic with neuropathic pain,

As for .25 of Lorazepam? It is common in Hospice but almost always for anxiety, in differing strengths. In that strength there should be no interactive issues. Anti spasmodics are what he apparently needs.

Again, speak to a trained medical professional familiar with him and your family.

 

[Keif' Richards]

I'll echo the fact that this is definitely a conversation for your medical team and not so much for us. I see nothing wrong at all personally in trying a low dose of Lorazepam (Ativan) to see if that helps.

There are drugs known specifically as antispasmodics that you may want to ask the medical providers about. There are several with different mechanisms of action and such as Hyoscamine, Atropine and Clidinium to name a few. There are other drugs with a more addictive profile like Carisoprodol (Soma) and the previously mentioned Benzodiazepines. Baclofen is a potential, tizanidine among a litany of other things that your /.loved one could try.

Almost forgot, Cyclobenzaprine (Flexeril) could also be effective.

 

[sonofadyingman]

Probably not especially dangerous but who knows.

What's the adderall prescribed for, out of curiosity? And at what dose?

Adderall for ADHD, he usually just takes 15mg a day but he hasn't been using it much since he came home from the hospital. Thank you

 

[sonofadyingman]

First, you need to speak to a trained medical professional who is familiar with him & your family. That said, just a couple of subjective observations...

Seroquel is never prescribed for anxiety. Gabapentin IS. It can be prescribed for light to moderate pain but I cannot imagine that being the case in Hospice. It is used in lieu of opioids by medical professionals who are anally retentive about opioids. In Hospice that is never a concern, even with the elderly. Seroquel is an anti-psychotic. If he has no history of serious mental illness he should be getting it. I am subjectively aware that in the "Third World" anti psychotics are prescribed for pain, as absurd as that is. It IS fantastic with neuropathic pain,

As for .25 of Lorazepam? It is common in Hospice but almost always for anxiety, in differing strengths. In that strength there should be no interactive issues. Anti spasmodics are what he apparently needs.

Again, speak to a trained medical professional familiar with him and your family.

I know, I'm not sure why he was prescribed seroquel for anxiety/sleep, but apparently it helps him... I think he wanted to steer clear of more addictive medications, due to substance abuse in the family. And yeah, I'm prescribed lorazepam for anxiety... the only reason I came here is because our medical provider is atrocious (and it's the best in the area), and it's horrible watching him suffer. I'll be holding off, since we managed to get him a virtual appointment for tomorrow. Thank you so much for your response

 

[sonofadyingman]

Seroquel for "anxiety"? Antipsychotics are well known to be relatively dangerous in the elderly and significantly increases all-cause mortality in elderly patients, but I'm not sure how that figures into the equation if he's coming home for hospice.

It's very possible the spasms are being caused by one of the meds he's on, but I'm no doctor.

I responded just now to a different reply pointing this out, but yeah... I don't know why they prescribed it for anxiety/sleep. I was prescribed Ativan for my anxiety, but I guess it worked for him, until these 2 rounds of hospitalization. But yes, you bring up a good question about the spasm being caused by a medication- I'll try to remember to bring that up. We managed to get him a vitual appt. For tomorrow. Thank you so much