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Medications are prescribed for many reasons, usually for labeled indications but other times off-label. Knowing why medications are prescribed is essential to help understand the continued need for therapy as well as to determine payment responsibility in this time of Medicare Part D risk. 

Namenda (memantine) is well known for its labeled use in treating cognitive decline in patients with moderate to severe Alzheimer's disease. However, its off-label, and potentially related, uses may be less known; for example in managing symptoms such as those in vascular dementia. Recently is has also been used off-label to prevent cognitive decline in patients receiving Whole Brain Radiation Therapy (WBRT)^1–2.

Ketamine is currently enjoying a surge in popularity. Though the year 2017 is still young, a PubMed search of articles with “ketamine” in the title limited to 2017 showed that there’ve already been 106 such publications released this year. Practical Pain Management named oral ketamine for pain management as their Practical Clinical Advance of 2016.

Earlier this year, I delivered a webinar called “What’s So Special about Ketamine? A Review of Its Uses at the End of Life” to a national audience of our hospice partners. Judging by both the volume of attendees and questions and comments I’ve received, it’s clear to me that many end-of-life practitioners are indeed very interested in ketamine, but why?

Ketamine, brand name Ketalar, or “Special K” as it’s known when used illicitly (along with many other creative nicknames), is more than 50 years old. Although originally synthesized in 1962, it wasn’t until 1970 that the FDA approved its use as a disassociative anesthetic, which remains its...

^{(Photo by Derek Gavey, CC BY 2.0)}

There is a lot of buzz about the “opioid epidemic” our nation is currently facing, but haven’t opioids always been popular? According to the Centers for Disease Control and Prevention (CDC), the number of deaths due to opioid overdoses has more than doubled since the year 2000 ¹. In fact, in 2014 alone, 61% of overdose-related deaths were due to an opioid.