Be especially cautious with anticholinergics if you are concerned about your memory, diagnosed with mild cognitive impairment or dementia, or want to reduce the risk of Alzheimer’s.
—Melissa Batchelor, PhD, RN, FNP, FGSA, FAAN
Anticholinergics are medications that block acetylcholine, a crucial neurotransmitter in the body. This blocking leads to lower brain function and can cause drowsiness. While some people take these drugs for their sedative effects, these drugs can be problematic for someone who has a vulnerable brain – meaning a person already experiencing memory problems.
Research links anticholinergic drugs to an increased risk of Alzheimer’s disease and hospitalizations in older adults. The American Geriatrics Society warns against these drugs, listing them on the Beers List updated in May of 2023 of medications older adults should avoid or use cautiously.
Common Anticholinergic Medications to Avoid
Anticholinergics are present in allergy medicines, muscle relaxants, painkillers, and many over-the-counter (OTC) medications.
Here are seven types of anticholinergic medications that older adults should be cautious about:
Sedating antihistamines: e.g., diphenhydramine (Benadryl) is a prime example as a medication that is available over-the-counter but has strong anticholinergic activity. Non-sedating antihistamines, such as loratadine (brand name Claritin) are less anticholinergic and are safer for the brain.
PM versions of OTC pain medications: Most OTC pain medications, such as acetaminophen and ibuprofen (brand names Tylenol and Motrin, respectively) come in a “PM” or night-time formulation, which means a mild sedative — usually an antihistamine — has been mixed in. The same is true for night-time cold and cough medications such as Nyquil.
Medications for overactive bladder: These include bladder relaxants such as oxybutynin and tolterodine (brand names Ditropan and Detrol, respectively).
Medications for vertigo or motion sickness: Meclizine (brand name Antivert) is often prescribed to treat benign positional vertigo. It’s also used to treat motion sickness.
Medications for itching: These include the strong antihistamines hydroxyzine (brand name Vistaril) and diphenhydramine (brand name Benadryl), which are often prescribed for itching or hives.
Medications for nerve pain: An older class of antidepressant known as “tricyclics” isn’t used for depression that much any longer, but these drugs are occasionally still used to treat pain from neuropathy. Commonly-used tricyclics include amitriptyline and nortriptyline.
Muscle relaxants: These include drugs such as cyclobenzaprine (brand name Flexeril) and they are often prescribed for back or neck pain.
Also Paxil (paroxetine) is an SSRI-type anti-depression/anxiety drug that is anticholinergic which is why this drug is almost never prescribed for older adults by a provider with expertise in geriatrics. However, other SSRIs, including Lexapro (Escitalopram), Celexa (Citalopram), and Zoloft (Sertraline) are not anticholinergic, which is why SSRIs aren’t on the list above.
Find out if you are on an anticholinergic medication by consulting a list or using an “anticholinergic burden scale” calculator. If you discover that you or a relative is taking such medications, consult a doctor or pharmacist to discuss potential adjustments, safer alternatives, or non-drug treatments.
Read more about the BEERS LIST here:
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