Expert: Michalene Peticca - 12/27/2011

Question
My father was on the exelon patch for over 3 years. He started to decline and we felt the patch was not effective any more. He was getting red welts on his back and was very uncomfortable and complaining of itchy skin constantly. We asked the doctor and discontinued the patch. Now my sister and niece feel we made a mistake as he did seem to go downhill very quickly after we stopped it. However, he also had spinal stenosis and had become incontinent and was unable to stand up. We had a care giver who would pick him up to put him in his wheelchair or he would have been bedridden.I feel very proud of the care we were able to provide and that we were able to keep him home until he died peacefully in his sleep. However, I feel guilty when they say maybe we should not have stopped the patch. Can you give me information on when/if exelon should be discontinued? Does it lose effectiveness? Do patients decline rapidly when its stopped or would this have happened anyway?

Answer
Hi Diane,

I am very sorry on the loss of your father.  I am sure it was a long road of several illnesses for him and a long road for your family as well.

Although i am not a physician, i have been aware of several folks that have been allergic to the Excelon patch.  Much like you described the symptoms your father experienced.  

To give you some peace of mind, please remember that all of your dad's illnesses were progressive; that is, he was not going to "get better" with any amount of medication.  Therefore, the question i would ask your sister is that if your dad were having painful welts and itching and he was unable to control those symptoms, why would you continue to let him suffer through that?   

Yes, perhaps taking him off the Excelon patch made him progress faster in his diseases.  We see that a lot with the use of Namenda when someone is taken off it.   But again, is the continuation of life for our own selves or the quality of your father's life?    It is a really deep thought, and one i've pondered many, many times.

I think you made the right decision Diane and i applaud your courage to give your father peacefulness and great care in his last few days.  

Best Regards,

Michalene Peticca, MA