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7 Common Brain-Toxic Drugs Older Adults Should Use With Caution

by Leslie Kernisan, MD MPH 9 Comments

Want to help keep the brain of someone you love working as well as possible?

Then you should take a look at this article which I published at NextAvenue.org:

7 Common Drugs that Are Toxic for Your Brain

In this article, I explain the brain health risks of using anticholinergics, and then I list seven types of drugs that older adults use surprisingly often. They include over-the-counter medications, as well as several commonly prescribed types of medication.

These are drugs that are on the Beer’s List and should be used with caution in older adults. However, I find that older adults are often prescribed these drugs! So it can be worthwhile for families to learn to spot these drugs, and minimize their use.

Why You Should Learn to Spot Anticholinergics

Anticholinergics are drugs that block acetylcholine, a key neurotransmitter in the body. This leads to lower brain function, which people often experience as drowsiness.

Sometimes that sedation is why people take the drugs, and a little sleepiness might sound benign. But when the brain is older, or otherwise vulnerable, these drugs can be problematic. In fact, they literally have the opposite effect of the drugs often used to treat Alzheimer’s. Donepezil (brand name Aricept), for example, increases acetylcholine by blocking the brain enzyme that breaks it down.

Research has linked anticholinergic drugs to increased risk of Alzheimer’s disease, and also to hospitalizations in older adults. And the American Geriatrics Society has cautioned older adults about them for years.

Who Should Avoid Anticholinergics?

You should especially avoid or minimize anticholinergics if you:

  • Are worried about your memory,
  • Have been diagnosed with mild cognitive impairment or dementia such as Alzheimer’s disease, or
  • Want to reduce your risk of developing Alzheimer’s.

What You Can Do to Reduce Brain Harm Due to Anticholinergics

For a list of seven very commonly used anticholinergics, including why they are usually prescribed, read my post on NextAvenue.org: 7 Common Drugs That Are Toxic For Your Brain.

For a longer list of anticholinergics that your older relative might be taking, I recommend this list, which specifies whether the drugs have “medium/high” anticholinergic activity versus “low.” You’ll want to focus on identifying and minimizing drugs in the “medium/high” category.

For more help identifying and reducing anticholinergic drugs, you can also ask your doctor or pharmacist.

If you find that your older relative is taking an anticholinergic drug, don’t panic. But do plan on reviewing the benefits and risks with the doctor soon. You may be able to reduce the dosage of these risky drugs, switch to a safer medication, or try a non-drug treatment instead.

 

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Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: alzheimer's, brain health, dementia, medications

« How We Diagnose Dementia: The Practical Basics to Know
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Comments

  1. Sharon Green says

    August 25, 2018 at 9:26 PM

    Hi Leslie thank you for your wonderful articles. Can any memory/neurological damage from cholinergics be reversed? I am a 52 year old and have been taking benadryl regularly for 20 years for idiopathic anaphylaxis and have recently noticed a marked decline in my memory, can i reverse some of the damage done?
    Thank you

    Reply
    • Leslie Kernisan, MD MPH says

      August 27, 2018 at 4:36 PM

      Congrats on being proactive in addressing your brain health. I’m not aware of any proven ways to reverse the “damage” from taking anticholinergics during one’s 30s and 40s, I don’t even know that we have a lot of research on the long-term effects of anticholinergics on the brain at that age.

      What we do know is that the hormonal changes associated with perimenopause and menopause do affect women’s memory, and may have implications for later cognitive aging or other more significant forms of cognitive decline. There has also been a lot of research done on the effect of estrogen on cognition, but for now, it’s not clear to me how one might determine whether to give a woman estrogen (what kind of estrogen is given gets tricky) to protect and improve cognition:
      Estradiol and cognitive function: Past, present and future

      I don’t personally provide medical care to women who are as young as you are, but if you are concerned about your memory, you may want to consult with someone who does specialize in menopause and women’s health, they might be able to give you more specific advice, or perhaps even enroll you in a trial. I would also recommend getting evaluated for other common contributors to subjective and objective memory problems in people your age, as there are other medical problems that can affect memory and brain function.

      If you can manage without taking benadryl, or with less of it, that’s probably safer for your brain. Good luck!

      Reply
    • Brandon Heller says

      February 12, 2020 at 12:56 PM

      I hope you are still getting notifications on this comment. I’m 57 now and took Benadryl intermittently in my 20s and 30, but began taking it daily when I started taking care of an elderly relative who was a smoker. That made my allergies go wild. I’ve been having problems with recall and short term memory. I’ve cut out 3/4ths of my Benadryl but just replaced it with Claritin. I’d also been taking Trazadone at night, but I just cut that in 1/2. I also take Seroquel but stopped that 2 months ago now. My mood has brightened and I can think and remember things better already. My guess is that my brain functions better just from having more choline active. I started researching this subject in December which was the first time I learned about the dangers of anticholinergics such as Benadryl. I have chronic pain and major depressive disorder and when I’m depressed I can’t sleep. That’s why I take Trazadone, Seroquel, and Benadryl nightly. My Dr is aware I’ve been taking these meds long term but hasn’t warned me. I hope you’re doing well and can give an update.

      Reply
      • Nicole Didyk, MD says

        February 15, 2020 at 5:20 PM

        Hi Brandon, I’m glad you found the article informative. It’s great that you are taking an interest in your medications and your brain health, which is important at any age.

        I see many patients in my practice that are living with pain and major depression, and the medications used to treat these conditions can have anticholinergic side effects. Despite that, many people need to be on some anticholingeric medications long term, in order to be able to manage their symptoms.

        The approach that I use in working with my patients is:
        1. Try to find an alternative to an anticholinergic medication that has more favourable properties
        2. Try to use the lowest dose possible of an anticholinergic medication
        3. When symptoms have been well controlled for a while, try to reduce the dose or discontinue the medication
        4. Optimize other treatment modalities, such as exercise, counselling, developing a strong support network, and eating healthy foods

        Thanks again for reading the article, and best of luck to you.

        Reply
  2. rosa Santos says

    October 22, 2018 at 4:12 PM

    Hello, my father of 74yrs old was walking perfect and holding a cup perfectly three months ago. He had a shoulder replacement 4 months ago. Now he has no sensation in his hands, and not hold a cup, or be able to eat properly. He can not even stand up by himself or walk he has fallen 15 times. He suffers from mild Dementia and is on Donepezil. He also suffers from arthritis and recently had an Mri of his back and fold some sciatic on his lower back. Our main concern is why did all of a sudden in a short period of time he lose his ability to walk and use his hands. We are worried and sadden that he is going through this. We have little sources 🙁

    Reply
    • Leslie Kernisan, MD MPH says

      October 22, 2018 at 5:18 PM

      Sorry to hear about your father’s condition. It does sound worrisome. It is quite common for older adults to experience some delirium and confusion related to surgery, and this can take weeks or months to fully clear up. Being bedbound for a few weeks can also leave older adults with very diminished strength, which can lead to falls.

      However, all of this isn’t usually associated with losing sensation in the hands or becoming unable to hold a cup. Those are true neurological changes, and so I would recommend asking your usual health provider for help evaluating them. It might also make sense to see a neurologist. Good luck!

      Reply
      • rosa Santos says

        October 23, 2018 at 5:47 AM

        Thank you so much. We are planning to talk to his MD and suggest and refer my dad to see a neurologist. Thank you again. Have a beautiful day.
        R. Santos

        Reply
  3. Dale Ash says

    March 8, 2020 at 5:37 PM

    I am a 73 year-old physically active male. My only prescription medicationI is 100mg/25 mg of Lozartan HCTZ in the morning, After discovering the risks of dementia from anticholinergics four months ago I weaned myself off of 50 mg of Doxepin after taking it for 25 years for insomnia. I’ve tried several “natural sleep aids” and followed the gamut of environmental and behavioral strategies, but still can’t remain asleep more than 4-5 hours. No problem getting to sleep, but pain from chronic sciatica and the need to urinate contribute to awakening me. The only thing that seems to help me get back to sleep is 25 mg of acetaminaphen PM. Yes, another anticholinergic, the very thing I’m trying to avoid (although I worry that the the damage is already baked in). I feel like I’m caught between a rock and a hard place, because I need my sleep. Any suggestions?

    Reply
    • Nicole Didyk, MD says

      March 11, 2020 at 5:05 PM

      Hi Dale. Dr Kernisan has a great article about sleep which you can read here. It is natural for older adults to need less sleep, in general, than younger adults.

      Another helpful site about sleep is mysleepwell.ca, which has a lot of information about Cognitive Behavioural Therapy for Insomnia, which can be very effective, without medication.

      If a person is being woken up by pain, then it’s probably more of a pain problem than a sleep problem, and talking to your MD about pain management might be more effective than trying to find the ideal sleeping pill. Good luck.

      Reply

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