Can donepezil and memantine be given with quetiapine 25mg for frontotemporal dementia during 6 months of international travel?

Donepezil and Memantine with Quetiapine for Frontotemporal Dementia During International Travel

Donepezil should not be given to patients with frontotemporal dementia (FTD) during international travel as it may worsen behavioral symptoms, while memantine and low-dose quetiapine can be used with careful monitoring. 1

Medication Considerations for FTD

• Donepezil (an acetylcholinesterase inhibitor) has been shown to worsen behavioral symptoms in patients with frontotemporal dementia, with studies demonstrating increased disinhibited or compulsive behaviors that resolved upon discontinuation 1
• Memantine may be considered for FTD patients, though evidence for significant cognitive improvement is limited, with some studies showing only trends toward benefit 2
• Low-dose quetiapine (25mg) can be used to manage behavioral symptoms in FTD patients during travel, but requires close monitoring for side effects 3

Travel-Specific Medication Management

• For international travel lasting 6 months, medication timing should be adapted to the local time at arrival to minimize disruption to treatment schedules 4
• During long-haul flights, medications should be taken shortly before dinner and then at arrival to help with transition to the new time zone 4
• Ensure all medications are carried in adequate supply for the entire 6-month period, with proper documentation for customs purposes 4

Behavioral Management During Travel

• The presence of a caregiver who will accompany the passenger with cognitive impairment is highly recommended for international travel 4
• Book direct flights when possible, or allow sufficient time for transfers if connecting flights are necessary 4
• Request special assistance at departing and arriving airports, including wheelchair assistance if needed 4
• Book seats at the aisle next to the caregiver, preferably close to lavatories 4

In-Flight Considerations

• Ensure appropriate hydration during the flight while avoiding alcohol consumption, which may alter cognitive function and trigger anxiety, disinhibition, or delirium 4
• Avoid excessive caffeine consumption due to its diuretic effects 4
• Take small quantities of food multiple times during the flight rather than large meals, as gastric emptying is reduced during flight 4
• Use ear plugs or eye shades to improve comfort during the flight 4
• Accompany the patient to lavatories and provide assistance as needed 4

Precautions and Contraindications

• Donepezil should be avoided in FTD patients as it can cause behavioral worsening in this specific dementia subtype, unlike its beneficial effects in Alzheimer's disease 1
• If the patient has previously been on donepezil, it should be discontinued prior to travel to avoid exacerbation of behavioral symptoms during the trip 1
• Monitor for extrapyramidal symptoms when using quetiapine, even at low doses 3

Pre-Travel Planning

• Conduct a pre-travel assessment to identify risk factors for in-flight complications related to cognitive impairment 4
• Consider the timing of travel carefully; avoid travel shortly after hospitalization when patients may be at increased risk for acute mental distress 4
• Prepare documentation for medical clearance if required by the airline, including Special Assistance Form (SAF) and Medical Information Form (MEDIF) 4
• For frequent travelers with stable conditions, consider requesting a Frequent Traveller's Medical Card (FREMEC) 4