Profuse sweating with Detrol LA?

[Pharmer187]

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So I have this one patient in long term care on Aricept, Effexor, Lyrica, Gluconorm (Repaglinide) and Coversyl (Perindopril). She's a 92 year old lady, pretty with it, MMSE is 26/30.

Anyway, the doctor wanted to give her something on formulary for urinary incontinence without messing with her cognition too much. I suggest Detrol LA 2mg at bedtime. The doc agrees.

The next day she tells us that at bedtime she sweats so much that her whole bed is drenched. She stops it for a few days, and tries it again. Like clockwork, she sweats like a pig at night.

I'm really confused.I thought Detrol LA was supposed to PREVENT sweating?? It's not hypoglycemia at night. Obviously not menopause.

Does anyone know what kind of interaction is going on here????

 

[rxlea]

How are the medications dispensed? Make sure it's not a drug error first. At least that's what I would do.

 

[All4MyDaughter]

I know patients who have experienced sweating from Effexor. I don't know the last two brand names.

 

[All4MyDaughter]

Could also be an interaction between the Detrol and the Aricept. Since they oppose each others' action... bladder anticholinergics can worse cognitive function. But I would also question Aricept in a patient with a 26 on the mini-mental.

 

[Ackj]

Could also be an interaction between the Detrol and the Aricept. Since they oppose each others' action... bladder anticholinergics can worse cognitive function. But I would also question Aricept in a patient with a 26 on the mini-mental.

That doesn't explain the sweating. It could explain decreased cognition, except for the fact that they aren't experiencing that. Detrol = sweating, no Detrol = no sweating.

Is she a resident where somebody could check on her and get her temperature, etc? Maybe she is having a cognition issue and thinks she's sweating, or it gives her some kind of nightmares/hallucination. Confirming that she's actually sweating (rather than what she says) wouldn't be a bad place to start. If she actually is sweating, I'm not really sure.

 

[npage148]

It's cancer, she was always night sweating but now she just happened to associate it with a new pill.

Or it's from the effexor or hypoglycermia . Why is she taking lyrica BTW?

 

[rxlea]

It's cancer, she was always night sweating but now she just happened to associate it with a new pill.

Or it's from the effexor or hypoglycermia . Why is she taking lyrica BTW?

If she was already on the effexor, why would it suddenly cause night sweats?

Lyrica is probably for peripheral neuropathy?

 

[npage148]

If she was already on the effexor, why would it suddenly cause night sweats?

Lyrica is probably for peripheral neuropathy?

It's cancer, she was always night sweating but now she just happened to associate it with a new pill.

She's on a kinda weird med list, but that's besides the point

 

[rxlea]

She's on a kinda weird med list, but that's besides the point

but detrol = night sweats and no detrol= no sweats as someone pointed out.

Why is the med list weird? Edit: Effexor is a valid choice for depression in alzheimers/dementia patients...she's On diabetes meds plus ACE. Lyrica for peripheral neuropathy. I'm just a student so what am I missing here

 

[npage148]

It's all self-reported and now that she thinks it's the Detrol (right or wrong) so her opinion/experiences are not going to change.

All4mydaughter commented on the need for aricept in general. I might be mistaken but I don't think glinides are the best choice for monotherapy. What's lyrica doing to her mental status, along with the detrol. Can we just get away using effexor for neuropathy?

 

[rxlea]

It's all self-reported and now that she thinks it's the Detrol (right or wrong) so her opinion/experiences are not going to change.

All4mydaughter commented on the need for aricept in general. I might be mistaken but I don't think glinides are the best choice for monotherapy. What's lyrica doing to her mental status, along with the detrol. Can we just get away using effexor for neuropathy?

I was thinking effexor or nortriptyline to cover both depression and neuropathy... I think we need more PMH.

Also I've seen monotherapy with that glinide.

 

[npage148]

nortriptyline to cover both depression and neuropathy

Is that the best choice in a dementia patient?

 

[rxlea]

Is that the best choice in a dementia patient?

No. you're right. Grr that was covered in our lecture yesterday too 😛

I guess effexor is it. what about buproprion?

I know we're getting off track. Sorry.

 

[All4MyDaughter]

It's all self-reported and now that she thinks it's the Detrol (right or wrong) so her opinion/experiences are not going to change.

All4mydaughter commented on the need for aricept in general. I might be mistaken but I don't think glinides are the best choice for monotherapy. What's lyrica doing to her mental status, along with the detrol. Can we just get away using effexor for neuropathy?

Agree with all of this.

And glinides aren't really indicated for monotherapy. In any set of guidelines. They are alternative agents in the new guidelines my student is perusing right now. I guess they could be using them in place of a sulfonylurea because of lower hypoglycemia risk. At her age, I'd be worried about beta cell fatigue, depending on how long she's had diabetes. There is a lot we need to know about this patient.