Recent research has verified that anticholinergic drugs may have a serious impact on the brain. Older people in particular may be taking a number of anticholinergic drugs that together have a negative effect on cognitive function. But it can be hard to tell whether a medicine has anticholinergic activity. Health professionals may not realize that the medicine they are prescribing could affect the brain. Here is one reader’s question about an interview we did on the radio with a key investigator.
Q. I listened to your recent interview on the radio with Dr. Shelly Gray about drugs that might increase your risk of developing Alzheimer’s disease. I am not sure of the spelling, but I believe you called them anti-colonergic, or something like that.
I have been taking sleeping pills for several years and worry about forgetfulness. I have a terrible time remembering people’s names and faces.
Please share the list of drugs that could affect memory. I do not want to hasten dementia. I have seen what this condition can do and it is a terrible thing for family and friends to deal with.
A. The actual category of medications you are referring to is spelled anticholinergic. Anticholinergic drugs interfere with the action of the neurochemical acetylcholine. This article explains how anticholinergic drugs could affect your brain. Some people may be more susceptible to anticholinergic effects than others. Some medications have stronger anticholinergic activity than others. What we worry about more than anything is the total anticholinergic “burden” that may be created by a combination of different drugs.
A study in the journal JAMA Neurology (June 1, 2016) noted that when patients use medications with medium or high ancitholinergic activity there was an association with:
“poorer cognition (particularly in immediate memory recall and executive function), reduced glucose metabolism [in the brain], whole-brain and temporal lobe atrophy, and clinical decline. The effect appeared additive because an increased burden of AC [anticholinergic] medications was associated with poorer executive function and increased brain atrophy…These results suggest that medications with AC properties may be detrimental to brain structure and function, as well as cognition.”
No one should ever stop such a medication without consulting with the prescriber. If you are taking one or more of these drugs, however, be sure to discuss with your physician whether there may be alternative treatments that do not put you at increased risk for dementia.
Medications Included in Dr. Gray’s Study
- Amitriptyline (Elavil)
- Benztropine (Cogentin)
- Chlorpheniramine (Actifed, Allergy & Congestion Relief, Chlor-Trimeton, Codeprex, Efidac-24 Chlorpheniramine, etc.)
- Chlorpromazine (Thorazine)
- Clomipramine (Anafranil)
- Clozapine (Clozaril)
- Cyclobenzaprine (Amrix, Fexmid, Flexeril)
- Cyproheptadine (Periactin)
- Desipramine (Norpramin)
- Dicyclomine (Bentyl)
- Diphenhydramine (Advil PM, Aleve PM, Bayer PM, Benadryl, Excedrin PM, Nytol, Simply Sleep, Sominex, Tylenol PM, Unisom, etc.)
- Doxepin (Adapin, Silenor, Sinequan)
- Fesoterodine (Toviaz)
- Hydroxyzine (Atarax, Vistaril)
- Hyoscyamine (Anaspaz, Levbid, Levsin, Levsinex, NuLev)
- Imipramine (Tofranil)
- Meclizine (Antivert, Bonine)
- Nortriptyline (Pamelor)
- Olanzapine (Zyprexa)
- Orphenadrine (Norflex)
- Oxybutynin (Ditropan, Oxytrol)
- Paroxetine (Brisdelle, Paxil)
- Perphenazine (Trilafon)
- Prochlorperazine (Compazine)
- Promethazine (Phenergan)
- Protriptyline (Vivactil)
- Pseudoephedrine HCl/Triprolidine HCl (Aprodine)
- Scopolamine (Transderm Scop)
- Thioridazine (Mellaril)
- Tolterodine (Detrol)
- Trifluoperazine (Stelazine)
- Trimipramine (Surmontil)
Dr. Shelly Gray’s article, “Cumulative Use of Strong Anticholinergics and Incident Dementia,” was published Jan. 26, 2015, in JAMA Internal Medicine. Here’s a link to the abstract.
Other Drugs that May Have Some Anticholinergic Activity
- Alprazolam (Xanax)
- Amantadine (Symmetrel)
- Carbamazepine (Tegretol)
- Carisoprodol (Soma)
- Cetirizine (Zyrtec)
- Cimetidine (Tagamet)
- Clorazepate (Tranxene)
- Darifenacin (Enablex)
- Digoxin (Lanoxicaps, Lanoxin)
- Dimenhydrinate (Dramamine, Gravol, etc)
- Diphenoxylate plus atropine (Lomotil)
- Fluphenazine (Prolixin)
- Furosemide (Lasix)
- Hydrochlorothiazide (Esidrix, Dyazide, HydroDIURIL, Maxzide & literally scores of other medications for high blood pressure)
- Loperamide (Imodium)
- Loratadine (Alavert, Claritin)
- Methocarbamol (Robaxin)
- Nifedipine (Adalat, Procardia)
- Quetiapine (Seroquel)
- Ranitidine (Zantac)
- Solifenacin (VESIcare)
- Thiothixene (Navane)
- Tizanidine (Zanaflex)
- Trospium (Sanctura, Spasmex)
These drugs have less pronounced anticholinergic activity and were not included in the study by Dr. Gray and her colleagues. Older people who take several of these medications might still notice some undesirable effects, however.
Side Effects of Anticholinergic Drugs
Drugs in this category can produce a variety of symptoms including:
- Dry mouth & nose
- Decreased sweating
- Dizziness, drowsiness, unsteady gait
- Difficult urination
- Confusion, disorientation, memory problems
- Visual difficulties
List revised 5/3/16 based on information found in the publication, “Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults,” (JAMA Neurology, online, April 18, 2016).
Remember, never stop taking any medication without medical supervision. Some of the drugs on this list can trigger serious withdrawal symptoms if stopped suddenly. We offer this list to enhance communication between patients and healthcare providers.
Are The Anticholinergic Effects Reversible?
We received this excellent question from a reader of our newspaper column. We think you will find it of interest:
Revised by Joe Graedon 3/20/17