There's a website where you can check interactions between the drugs that you're taking:
http://www.drugs.com/drug_interactions.php
You should read this:
Quote:
Interactions between your selected drugs
1. risperidone and divalproex sodium (Moderate Drug-Drug)
MONITOR: Coadministration with risperidone may alter the serum concentrations of valproic acid, although data are conflicting. The mechanism is unknown but may be related to risperidone displacement of valproate from plasma proteins. In one pediatric patient, serum valproate level rose from 143 mg/L to 191 mg/L five days following the addition of risperidone, necessitating a 43% dosage reduction of valproic acid. The level declined to 108 mg/L within 3 days and stabilized thereafter. In another patient, the addition of risperidone was associated with a drop in serum valproate level. The combination has also been associated with the development of edema in one patient. In contrast, a group of investigators found no difference in the mean valproate serum concentration-to-dose ratio (C/D) in 4 patients treated concomitantly with risperidone compared to that of 172 patients who did not receive risperidone. In two of the four patients, serum valproate concentrations measured on occasions when they were not taking risperidone also indicate no change in valproate C/D. Another group of investigators compared trough serum valproate levels in 45 patients, 29 of whom received concurrent treatment with atypical antipsychotics, and found no significant difference among those receiving divalproex with risperidone versus those receiving divalproex alone or with olanzapine.
MANAGEMENT: Until further data are available, clinicians may consider monitoring the pharmacologic response and serum valproate levels more closely whenever risperidone is added to or withdrawn from therapy. Ambulatory patients should be made aware of the possibility of additive central nervous system effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them.
*2. risperidone and donepezil (Moderate Drug-Drug)
GENERALLY AVOID: Due to opposing effects, agents that possess anticholinergic activity (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; class IA antiarrhythmics especially disopyramide; carbamazepine; cimetidine; ranitidine) may negate the already small pharmacologic benefits of acetylcholinesterase inhibitors in the treatment of dementia. These agents may also adversely affect elderly patients in general. Clinically significant mental status changes associated with anticholinergic agents can range from mild cognitive impairment to delirium, and patients with Alzheimer's disease and other dementia are especially sensitive.
MANAGEMENT: Drugs that possess anticholinergic activity should generally be avoided in patients with Alzheimer's disease or other cognitive impairment, regardless of whether they are receiving an acetylcholinesterase inhibitor. For patients requiring treatment for adverse effects of acetylcholinesterase inhibitor therapy (e.g., gastrointestinal intolerance, urinary problems), an agent without anticholinergic properties should be used whenever possible. Otherwise, a dosage reduction, slower titration, or even discontinuation of the acetylcholinesterase inhibitor should be considered. In patients who are already receiving an acetylcholinesterase inhibitor with anticholinergic agents, every attempt should be made to discontinue the latter or substitute them with less anticholinergic alternatives. Caution is required, however, since anticholinergic withdrawal may occur. Seizures have been reported following abrupt discontinuation of anticholinergics during acetylcholinesterase inhibitor therapy.
*3. risperidone and escitalopram (Moderate Drug-Drug)
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
*4. divalproex sodium and escitalopram (Moderate Drug-Drug)
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
5. donepezil and escitalopram (Minor Drug-Drug)
Coadministration with inhibitors of CYP450 2D6 and/or 3A4 may increase the plasma concentrations of donepezil, which is primarily metabolized by these isoenzymes. In a 7-day crossover study in 18 healthy volunteers, the potent CYP450 3A4 inhibitor ketoconazole (200 mg once daily) increased the mean peak plasma concentration (Cmax) and systemic exposure (AUC) of donepezil (5 mg once daily) by approximately 36% each. The clinical relevance of these increases is unknown.
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I'd be concerned about 2., 3., and 4. (above) given the behavior you're seeing in your Mom.
I'd sit down with your pharmacist and also with ALL of your Mom's doctors and discuss this. I've learned one thing in all my intereactions with doctors concerning drugs -- they don't know a darn thing about interactions. They just don't have the time to learn this stuff. That's why I always-always get the paper handout that comes with all meds and I always discuss any reactions first with my pharmacist.
When my Mom got sick (colorectal cancer), I had to go to South Carolina and authorize surgery and then move her here to Massachusetts. My Mom had never taken drugs, other than aspirin for headaches and a brief time with diet pills during the 50s. She was actually to the point where she was taking a knife to the nurses and conspiring with people to get her out of there.
Her blood gasses were off after the airplane flight. But, I think it was the drugs. The drug they used for the surgery caused a major depressive/suicidal reaction in me also.
I'd start with the drugs. It looks like you're going to have to figure this out for yourself.
Read this, too (the second one):
http://alzheimers.infopop.cc/eve/for.../171100662/p/2
I hope you can find what you need to make your Mom (and you) more comfortable. I know how hard it is to watch helplessly while they destroy your Mom's personality
Hugs.
Barb