The class of medications with anti-cholinergic side effects includes drugs commonly used for allergic and intestinal problems, overactive bladder, depression and Parkinson’s disease. Some are used to help people fall asleep. Some examples:
Allergy or Sleep Aids: diphenhydramine (like Benedryl or Sominex), chlorpheniramine (like ChlorTrimeton)
Bladder: oxybutynin and tolterodine
Depression: doxepin, amitriptyline, paroxetine (Paxil)
They have well-known side effects of mental confusion or slowness, but it was always thought that these side effects were temporary, and that the person’s mind would return to normal after stopping the drugs.
But three recent research studies, from Germany, France, and now most recently from the USA, suggest these the mental side effects could be permanent, especially if the medications are taken frequently for several years and/or in higher doses.
All of these drugs decrease the activity of the nerve transmitter acetylcholine. Common and irritating side effects of these drugs include dry mouth, dry eyes, constipation, urinary retention, and drowsiness. Normally, as we age, our brain’s supply of acetylcholine decreases, and patients with dementia, including Alzheimer’s Disease, typically have low acetylcholine activity.
The recent USA study published in JAMA Internal Medicine, was particularly well-designed, and followed over 3000 men and women over age 65 who started the study, in the mid-1990s, with no evidence of dementia. They were given mental and physical tests every 2 years up until 2012.
The researchers found that over that time, that 23% developed some form of dementia, most commonly Alzheimer’s Disease. They looked at each person’s total anticholinergic drug use over the years, taken during the years of the study, and noted that the people that took these drugs for over three years, and/ or at high doses, had a 20 to 55% higher risk of developing dementia as persons who didn’t take these medications or only took them for short periods of time.
The more the person took these medications, the higher the risk. The researchers emphasize that this does not prove that the medications caused the dementia, but it’s likely that it was a significant factor.
What to do if you take these medications
First, if you have any question if a medicine you take is an anti-cholinergic, ask your pharmacist or your doctor. If you are taking one of these drugs, there is a good chance you could switch to a more modern medication that would work for you without the anticholingeric side effect.
For example, if you take Benedryl for ChlorTrimeton for allergies, you could switch to a newer antihistamine such as Claritan (loratadine), which is not an anti-cholinergic (and likewise does not make you drowsy). If you are taking an the older tricyclic type of antidepressant such as amitriptyline or doxepin, your doctor consider you switch to a newer SSRI type of antidepressant such as citalopram or fluoxetine. Bladder problems can often be treated with botox injections or sometimes with behavioral therapy.
If you absolutely must take an anticholinergic drug, this research shows it’s best to take the lowest dose that is effective for you, and for the shortest time possible. Any questions, ask your doctor or pharmacist.
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