Dear Dr. Roach: I have a friend, age 56, who was diagnosed with Alzheimer鈥檚 disease a few years ago and has been taking Aricept, which has helped immensely. Now she has begun taking medical marijuana, supposedly to help her lungs at night from asthma. She takes the Aricept at dinner, then the pot about three hours later, in a capsule. What are the contraindications on the brain of taking this marijuana with Aricept? We are really concerned about this new pot use, but she seems to think it is just fine.
N.H.
Although your friend is taking the marijuana in capsule form, most people smoke it. Any lung irritant (marijuana smoking is a very powerful irritant) can worsen asthma or other lung diseases. Marijuana smokers are more likely to have asthma, despite a 40-year-old study that showed marijuana can make asthma better in the short term. In the long term, smoking marijuana is not a good choice for asthmatics.
I also found several studies looking at the effect of marijuana (or some of its components) in both prevention and treatment of Alzheimer鈥檚 disease, and the results are mixed.
Very low doses of THC (the most active psychoactive ingredient in marijuana) seemed to reduce beta amyloid, a protein that is found in the brains of people with Alzheimer鈥檚 disease. It also reduced brain inflammation. However, this is not strong evidence that marijuana can protect against developing AD, and only large-scale studies could produce a more definitive answer.
It is likely that there may be other effects of marijuana, especially at higher doses, that are not helpful.
In terms of treatment, one study showed no benefit of medical marijuana at all, while another showed improvement in some symptoms, specifically delusions, aggression and agitation, irritability, apathy, sleep and caregiver distress.
I could not find anything to suggest how marijuana might interact with donepezil (Aricept) or similar drugs.
听
Dear Dr. Roach: I would like to thank you for addressing the question regarding early pregnancy emesis (vomiting).
However, I believe that your column could help the women who suffer from hyperemesis by further explaining that although dangerous and perhaps seemingly intolerable, there are solutions for those with great resolve and good information.
I am mother to two wonderful young adults now (22 and 19), thanks I鈥檓 sure in large part due to a sister who was a registered dietitian interning at a research hospital in Baltimore where trial practices were being done on hyperemesis gravidarum patients, and an accommodating obstetrician who otherwise had run out of ideas. Until my sister suggested tube feeding at a very slow drip, the only solution for treating my case was what you hinted at: a constant cycle of IV rehydration.
R.F.
I thank you for writing. Mild cases of vomiting in pregnancy usually can be treated with the remedies I mentioned in my previous column, but severe and recalcitrant cases require more-aggressive regimens. In very severe cases, patients may require admission to the hospital. Intravenous medicines, too dangerous to be given at home, may be necessary.
The treatment you mention, tube feeding (usually by a nasogastric tube), sometimes can help treat the vomiting.
Feeding the patient by stomach is preferable to intravenous feeding, which has a much higher risk of complications, including infection and blood clotting. In most cases, symptoms improve dramatically between week 16 and week 20 of gestation.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
