older woman hand to head looks confused

Q. Do you have a list of the drugs that should not be prescribed to elderly people? If you don’t, do you know where I could get such a list?

My doctor was not very well informed nor was he interested in helping me find out which drugs are dangerous for people over 60.

A. If you are over 60 and your doctor does not know which drugs are risky, you might need to find a physician more knowledgeable about the special needs of older people. Your current doctor could accidentally prescribe a medication that might lead to joint pain or make you dizzy or forgetful. A surprising number of commonly prescribed drugs can leave older people confused or with “brain fog.”

How Can You Tell If Your Medicine Is Anticholinergic?

A key brain chemical is acetylcholine. It is essential for normal memory function. When you interfere with this neurotransmitter you scramble synapses and affect cognitive function.

Doctors prescribed a powerful anticholinergic drug called scopolamine in the early 20th century to women during labor and delivery to induce amnesia for the event. The physicians who came up with this approached described the effect as “clouded consciousness with complete forgetfulness.” They thought this was a good thing.

Many modern medicines have anticholinergic activity. OTC antihistamines, especially diphenhydramine (found in Advil PM, Aleve PM, Benadryl, Tylenol PM, Unisom, etc), can be problematic. Drugs for overactive bladder (OAB) like oxybutynin (Ditropan, Oxytrol) and tolterodine (Detrol) are also anticholinergic.

For a partial list of anticholinergic drugs included in a study by Dr. Shelly Gray, here is a link. Shelly Gray, PharmD, MS, is Professor and Vice Chair of the Department of Pharmacy in the School of Pharmacy at the University of Washington. She is also director of the Geriatric Pharmacy Program. Dr. Gray found that:

“Higher cumulative anticholinergic use is associated with an increased risk for dementia.”

You can listen to our radio interview with Dr. Gray about her research here. The interview with Dr. Gray begins about 6 minutes and 30 seconds into the show. We think you will find her research quite convincing. The streaming audio at the top of the page is free. The mp3 download is $2.99.

Tales of Brain Fog

JoAnn reported:

“I took Ditropan several years ago. The mental fuzziness was awful. A friend was also taking it, but didn’t connect the symptoms with the medication — she attributed them to aging, which made her feel depressed. I wish there was a good treatment for incontinence, but virtually all the applicable medications have this same side effect.”

Abigail shared her experiences on anticholinergic anti-diarrhea drugs:

“I experience noticeable memory problems and mental confusion with Diphenoxylate plus atropine (Lomotil). Loperamide (Imodium) is one of the products that contains an anticholinergic. Imodium was usually effective but caused me to suffer mental confusion and memory problems. People’s Pharmacy wrote about anticholinergics, but I had no idea I was ingesting them until I looked up Imodium and the Rx Lomotil online.

“Please keep reporting on the cognitive effects of taking anticholinergics. The peace of mind they give me comes at a high price – suffering with several types of mental impairment. Feeling ‘loopy’ is the most benign of these. Mental confusion, poor word and name recall, inability to plan effectively or to make a list, and disorientation in time and space are just a few.

“If I go anywhere without a list, I may not remember all the reasons I am there. I try to space out the days I need to take anticholinergic preparations to give my brain time to recover its normal functioning. The symptoms are very much like those of mild traumatic brain injury (MTBI).”

You will find a list of Medications with Anticholinergic Activity plus the Beers List of Drugs Older People Should Generally Avoid in our book, Top Screwups. There is also an in-depth discussion of the impact of statins on memory and other stories of brain fog.

Here is a link to the book as well as a link to our Guide to Drugs and Older People.

Share your own experience with medications that have caused you brain fog below in the comment section and please vote on this article at the top of the page.

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  1. Peggy
    Washington
    Reply

    I agree, Aspirin is the best. Pain due to hip problems was stopped with Bayer Aspirin, 2-3 times a day plus bed rest. New hip yesterday and am on pain pills. Can’t wait to get off and onto Aspirin as needed.

  2. Nick
    Glyndon, MD
    Reply

    Wow! Thanks so much. Because of a fall I’d taken, I took Aleve P.M. for 5 straight nights. Talk about brain fog! Couldn’t remember people’s names at work, couldn’t finish Sudoku puzzles, lots of other glitches. I didn’t take the Aleve last night (because of the article) and I’m 100 percent better. Not sure what I’ll blame next time I’m out of it, though.

  3. Cindy Black
    Seattle, WA
    Reply

    I was sure I’d heard somewhere that Benadryl was not a good thing to be taking, but for the life of me I couldn’t remember WHY. Diphenhydramine does do a good job of promoting sleep, so in a pinch I’ve occasionally taken a Benadryl despite my better judgement. I’m SO GLAD it’s been so infrequent, and now I’ll never take another! THANKS; this whole article was very informative.

  4. Mary
    Reply

    That list includes natural desiccated thyroid (NDT) from pigs. I am not sure how accurate the list actually is. Are statin drugs on it for one?

    Also, I have seen that Armour Thyroid had greatly increased the price of that drug that many prefer to Synthroid.

  5. Vicki
    Atlanta
    Reply

    Yes, yes, yes!!! Thank you for this informative article! The very first thing my mother’s geriatric psychiatrist advised was STOP taking Benadryl for her insomnia. My mother-in-law’s advised the same. So I was shocked when earlier this year a fellow church member, probably about the age of 70, told me her doctor advised her to take Benadryl for sleeplessness! I strongly encouraged her to stop it and shared my mother’s story. Mom, now 83, has suffered from an anxiety disorder her entire life. In her mid-fifties she finally sought psychiatric care that saved her. But she still took Benadryl for probably 20 years. She stopped Benadryl at age 77 when she began seeing a geriatric psychiatrist. She began the drugs prescribed to treat memory loss and dementia at the age of 78 and continued to drive and live independently. At the age of 81 she had eye surgery to correct a detached retina and the anesthesia PROGRESSED her dementia. Due to vision changes and progressed dementia, she had to stop driving and now lives in a wonderful assisted living facility. While her eye surgery was not elective and could not be avoided, I am certain the anesthesia dramatically changed her. When I had surgery to repair a broken wrist at the age of 56, I shared my fear to the anesthesiologist and he assured me he would administer as little general anesthesia as possible and instead inserted a nerve block in my shoulder, numbing my arm for a week. Patients and their family members should be informed of the consequences of anesthesia on the elderly. Mom should have been hospitalized after eye surgery. She could hardly walk or talk and has no recollection of the week after her surgery. Mom is in overall good physical health with normal blood pressure, no lung or heart issues, etc…I would love to see an article from The People’s Pharmacy on anesthesia in the elderly. Thank you for your website and articles. God bless you as you “care” for your readers. Vicki Davis, Atlanta, GA

  6. nell morgan
    United States
    Reply

    For various reasons I tried Aleve. Each time I used it depression set in. Tylenol is good sometimes at bedtime but not daytime. It is back to the good old aspirin. However, best taken with food.

    • Bev
      Bend,Oregon
      Reply

      Aspirin is the best. For so many things.

  7. Rick
    Raleigh
    Reply

    The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, is a guideline for healthcare professionals to help improve the safety of prescribing medications for older adults.

  8. Judy
    Charlotte
    Reply

    Dr. Gray’s list shows Actifed containing chlorpheniramine. That is incorrect. Actifed contains triprolidine HCl as the antihistamine. Is there any difference?

    • The People's Pharmacy
      Reply

      Chlorpheniramine and triprolidine are both antihistamines that have anticholinergic activity.

  9. L MacPherson
    Canada
    Reply

    Go to Google and ask ANY question.

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