Why is it when you need medication for a loved one that, it always goes wrong on a Friday afternoon when you’ve got the least amount of time to get it corrected or have to wait until Monday or call out-of-hours service?
You guessed it, we had an issue with trying to get medication for Mum. A prescription was written for Mum by Urology in the hospital in an effort to resolve Mum’s issues with her catheter (a whole other story!).
Mum’s catheter isn’t working properly. She’s suffering from urinary tract infections (UTIs – a common side effect of catheters) causing bladder spasms resulting in urinary incontinence.
Medications & Dementia
She’s been prescribed Mirabegron (brand name Betmiga), which can help by inhibiting involuntary contractions of the bladder. After picking it up late Friday, I discovered the instructions say, “Swallow whole, do not chew or break”.
I called the pharmacy and queried them. I explained that Mum had dementia and chewed medicines and asked if it was okay to take them. He checks and confirms that because they are prolonged-release tablets, you can’t chew them due to their special coating.
So here we are again, Friday night, without the meds mum needs. No point in trying out of hours as the pharmacy will be closed before they can process it, so have to wait til tomorrow.
The first thing the following day, I called 111, where out of hours is now. Unfortunately, mirabegron is only sold in prolonged-release form, no liquid or dissolvable format, and the pharmacist can’t prescribe an alternative without a doctor’s prescription. They referred me back to the out-of-hours service.
Getting Scolded by GP Out of Hours Service
The doctor calls but isn’t happy to prescribe new medications, telling me this is an emergency line (I thought it was out of hours!), not a prescription line (even after I explained I went to the pharmacist first). He would do this as a one-time thing, but next time I would have to wait until Monday.
He basically scolded me for prioritising my mum’s care. I explained to him that Mum had bed sores that were continually getting worse because of the incontinence. I wasn’t going to argue too much because I wanted the medication. So I held my tongue, and he prescribed Solifenacin (Vesicare brand), which wasn’t in prolonged release format.
I asked if this was one of the safest forms for people with dementia, and he said he’d prescribed the lowest dose because it was basically one of the drugs that could affect those with dementia.
Studies have been done that show a link between an increased risk of dementia and anticholinergic drugs that are used to treat urinary incontinence. But there are also mixed results from other studies.
They can increase confusion, cause dry mouth, constipation etc. Most GPs will advise of their concerns, especially with the elderly, before prescribing. The drug prescribed for Mum, Solenancin, is an anticholinergic drug.
I haven’t found studies showing the impact of these drugs on those already with dementia and whether they increase the rate of atrophy in the brain or not. But given that there is some link, I would expect that it could speed up or worsen existing symptoms, and that’s why doctors are cautious in prescribing them, weighing up the risks vs the benefits, especially for long-term use.
Mirabegron isn’t an Anticholinergic Drug
The original drug that was issued, Mirabegron, isn’t an anticholinergic and doesn’t cause dry mouth or constipation (they do have side effects but less than other drugs).
The population that would need urinary incontinence drugs are primarily (not all) elderly, and if, like my Mum, you have dementia with swallowing issues, then side effects like dry mouth & increased constipation are very relevant & something you want to avoid.
So why is the only non-anticholinergic drug for urinary incontinence available in tablet prolonged release format in the UK? It’s not manufactured in any other format (except for kids) – I guess the market is too small.
I don’t have the answers, and costs are obviously a factor (in the US, this drug costs around $480 for a month, in the UK, it costs £29).
It’s sad to have to choose between taking or not taking a drug that can help with incontinence issues but possibly worsen cognitive decline.
What are your thoughts? And, like me, do you always have to run around like crazy to get a prescription filled for your loved one?
Til next week
Here’s Kikki in her element