The Link Between Dementia, Alzheimer’s and Common Meds

The Link Between Dementia, Alzheimer’s and Common Meds

If you are 60+, stop taking these drugs now

The evidence is piling up that many common meds can increase or possibly cause dementia and Alzheimer’s (a type of dementia) in those who are 60+. Generally, these are OTC drugs used for sleep, allergies, motion sickness and diarrhea and some prescription anxiety drugs. A list is below.

What do they have in common? They are all anticholinergic medicines (pronounced “an-ti-koh-luh-nur-jik”, hear it here.

Multiple studies have identified this problem with anticholinergic medicines, but they were small studies. The latest study, in JAMA Internal Medicine, reviewed nearly 60,000 patients with a diagnosis of dementia and compared them to 225,574 control patients (no diagnosis of dementia).

How does this difficult-to-pronounce medicine work? From the same study in JAMA: “This broad group of drugs acts by blocking the neurotransmitter acetylcholine in the central and peripheral nervous system and includes some antihistamines, antidepressants, and medications for gastrointestinal and bladder disorders. These medicines can have short-term adverse effects, including confusion and memory loss in older people, but it is less certain whether long-term use increases the risk of dementia.”

“There are so many alternatives to these drugs,” says Dr. Sarah Berry, a geriatrician and assistant professor of medicine at Harvard Medical School, quoted in a recent article. For example, selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa) or fluoxetine (Prozac) are good alternatives to tricyclic antidepressants. Newer antihistamines such as loratadine (Claritin) can replace diphenhydramine or chlorpheniramine (Chlor-Trimeton). Botox injections and cognitive behavioral training can alleviate urge incontinence.

Want to check the meds you’re taking right now? Use the ACB on-line calculator (anticholinergic cognitive burden scale), which ranks these drugs according to the severity of their effects on the mind. It’s a good idea to steer clear of the drugs with high ACB scores, meaning those with scores of three. Many thanks to Dr. Rebecca King and Steve Rabino, who developed the calculator and leave it online, free for anyone to use.

Here is the promised list of drugs to avoid (source: Drugs.com):

Antihistamines

brompheniramine
carbinoxamine (Arbinoxa, Karbinal ER, Palgic)
chlorpheniramine (Aller-Chlor, Chlor-Trimeton)
clemastine (Tavist Allergy)
cyproheptadine
dexbrompheniramine (Ala-Hist IR)
dexchlorpheniramine (Polaramine, Polaramine Repetabs)
dimenhydrinate (Dramamine)
diphenhydramine* (oral) (Advil PM, Aleve PM, Allermax, Bayer PM, Benadryl, Excedrin PM, Nytol, Sominex, Tylenol PM, Unisom)
doxylamine (Aldex AN, Unisom, Nytol Maximum Strength)
hydroxyzine (Vistaril, Atarax)
meclizine (Antivert, Bonine, D-Vert, Dramamine Less Drowsy)
promethazine (Phenergan)
pyrilamine (an ingredient of combination cold medicines)
triprolidine (Histex, Zymine, Tripohist)
* Use of diphenhydramine in acute allergic reactions may be appropriate; many OTC sleep agents have diphenhydramine as an active ingredient, be sure to check labels.

Antiparkinsonian Agents*

benztropine (Cogentin)
trihexyphenidyl
* In general, these agents are not recommended for prevention of extrapyramidal symptoms with antipsychotics. In addition, more-effective agents are available for treatment of Parkinson’s disease, especially for older individuals.

Muscle Relaxants
cyclobenzaprine (Amrix, Fexmid, Flexeril)
methocarbamol (Robaxin)
orphenadrine (Norflex)
antiarrhythmics
disopyramide (Norpace, Norpace CR)

Antidepressants

amitriptyline
amoxapine
clomipramine (Anafranil)
desipramine (Norpramin)
doxepin
imipramine (Tofranil, Tofranil-PM)
nortriptyline (Pamelor)
paroxetine (Brisdelle, Paxil, Paxil CR, Pexeva)
protriptyline (Vivactil)
trimipramine (Surmontil)

Urinary Incontinence

darifenacin (Enablex)
fesoterodine (Toviaz)
flavoxate (Urispas)
oxybutynin (Ditropan, Ditropan XL)
solifenacin (Vesicare)
tolterodine (Detrol, Detrol LA)
trospium (Sanctura, Sanctura XR)

Antipsychotics*

chlorpromazine
clozapine (Clozaril, FazaClo, Versacloz)
loxapine (Loxitane)
olanzapine (Zyprexa, Zyprexa Relprevv, Zyprexa Zydis)
perphenazine
thioridazine
trifluoperazine
*Boxed warnings exist about the use of antipsychotics in the elderly with dementia. Antipsychotics are not approved for use in psychotic conditions related to dementia. Antipsychotics may increase the risk of death in older adults with dementia-related conditions.

Antispasmodics

atropine (excludes ophthalmic [eye] agents)
belladonna alkaloids
clidinium-chlordiazepoxide (Librax)
dicyclomine (Bentyl)
homatropine (excludes ophthalmic [eye] agents) (Tussigon)
hyoscyamine (Anaspaz, Levbid, Levsin, NuLev)
methscopolamine (Pamine, Pamine Forte)
propantheline
scopolamine (excludes ophthalmic) (Transderm Scop)

Antiemetics

prochlorperazine (Compazine)
promethazine (Phenergan)