doctor in a lab coat with a handful of pills

Anything that interferes with the crucial neurotransmitter acetylcholine can be bad for the brain. A great many medications have what has been called “anticholinergic” activity. Research has verified that anticholinergic drugs may have a serious impact on the brain.

Anticholinergic (AC) Drug Complications:

Older people in particular may be taking a number of anticholinergic (AC) drugs that together have a negative effect on cognitive function. A study in Geriatrics and Gerontology International (April 17, Suppl. 1, 2017) noted that:

“The use of anticholinergic drugs has been strongly associated with adverse health outcomes, including cognitive impairment, dementia, falls, functional decline, hospitalization and mortality, especially in older adults.”

The authors studied older veterans in Taiwan. Their conclusions:

“The results of the present study showed that approximately half of the residents living in veterans’ homes had exposure to anticholinergic drugs, and these AC(+) residents had a significantly higher risk for short-term cognitive decline.”

Although older people are more vulnerable to the complications of anticholinergic drugs, younger people are not necessarily immune. Much depends upon the number of such medications people take. We call this the anticholinergic burden or load.

What Are Anticholinergic Drugs Prescribed For?

This is a key question. That’s because many physicians were taught in medical school that this class of drugs was primarily used for problems of digestive distress like irritable bowel syndrome, diverticulitis and diarrhea. In this case such drugs are often called antispasmodics.

They are also prescribed for overactive bladder and incontinence, motion sickness, dizziness, symptoms of Parkinson’s disease and breathing problems like asthma and COPD (chronic obstructive pulmonary disease).

Many medications prescribed for anxiety, depression, allergies, pain, high blood pressure, mental illness, heart failure and heartburn can also have anticholinergic activity. This comes as a shock to patients and physicians alike. The real problem occurs when people take a handful of pills for a diverse range of health problems and end up with a substantial anticholinergic burden.

What Drugs Have Anticholinergic Action?

It can be challenging to tell whether a medicine has anticholinergic activity. Health professionals may not realize that the medicine they are prescribing could affect the brain. In our opinion medical students are not given enough information on this crucial topic. And prescribers do not have easy access to a list of drugs that affect the action of acetylcholine in 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 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.

Uncovering the Impact of Anticholinergic Drugs:

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 anticholinergic 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.

Here is a link to our interview with Dr. Gray. To stream the audio for free, click on the green arrow inside the black circle above the photo. You can purchase a CD to give to your physician or download the MP3 version.

Show 979: Health News Update on Defending the Brain

Medications Included in Dr. Gray’s Study

We have identified drugs with high, moderate and low anticholinergic (AC) action in brackets. The greater the AC activity the more worrisome the cognitive impact. The rankings are somewhat arbitrary and controversial since some research categorizes these drugs differently. This is our best assessment at this time. It may change as better research is conducted.

  • Amitriptyline (Elavil) [high AC activity]
  • Atropine [high AC activity]
  • Benztropine (Cogentin) [high AC activity]
  • Chlorpheniramine (Actifed, Allergy & Congestion Relief, Chlor-Trimeton, Codeprex, Efidac-24 Chlorpheniramine, etc.) [high AC activity]
  • Chlorpromazine (Thorazine) [high AC activity]
  • Clomipramine (Anafranil) [high AC activity]
  • Clozapine (Clozaril) [high AC activity]
  • Cyclobenzaprine (Amrix, Fexmid, Flexeril) [moderate AC activity]
  • Cyproheptadine (Periactin) [moderate AC activity]
  • Desipramine (Norpramin) [high AC activity]
  • Dexchlorpheniramine (Polaramine) [high AC activity]
  • Dicyclomine (Bentyl) [high AC activity]
  • Diphenhydramine (Advil PM, Aleve PM, Bayer PM, Benadryl, Excedrin PM, Nytol, Simply Sleep, Sominex, Tylenol PM, Unisom, etc.) [high AC activity]
  • Doxepin (Adapin, Silenor, Sinequan) [high AC activity]
  • Fesoterodine (Toviaz) [moderate to high AC activity]
  • Hydroxyzine (Atarax, Vistaril) [high AC activity]
  • Hyoscyamine (Anaspaz, Levbid, Levsin, Levsinex, NuLev) [high AC activity]
  • Imipramine (Tofranil) [high AC activity]
  • Meclizine (Antivert, Bonine) [high AC activity]
  • Mepenzolate (Cantil) [high AC activity]
  • Nortriptyline (Pamelor) [high AC activity]
  • Olanzapine (Zyprexa) [high AC activity]
  • Orphenadrine (Norflex) [high AC activity]
  • Oxybutynin (Ditropan, Oxytrol) [high AC activity]
  • Paroxetine (BrisdellePaxil) [low AC activity]
  • Perphenazine (Trilafon) [high AC activity]
  • Prochlorperazine (Compazine) [moderate AC activity]
  • Promethazine (Phenergan) [high AC activity]
  • Protriptyline (Vivactil) [high AC activity]
  • Pseudoephedrine HCl/Triprolidine HCl (Aprodine) [moderate to high AC activity]
  • Scopolamine (Transderm Scop) [high AC activity]
  • Thioridazine (Mellaril) [high AC activity]
  • Tolterodine (Detrol) [high AC activity]
  • Trifluoperazine (Stelazine) [high AC activity]
  • Trimipramine (Surmontil) [high AC activity]

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) [low AC activity]
  • Amantadine (Symmetrel) [low AC activity]
  • Baclofen [moderate AC activity]
  • Brompheniramine [high AC activity]
  • Carbamazepine (Tegretol) [moderate AC activity]
  • Carbinoxamine (Arbinoxa) [moderate to high AC activity]
  • Carisoprodol (Soma) [moderate AC activity]
  • Cetirizine (Zyrtec) [moderate AC activity]
  • Cimetidine (Tagamet) [moderate AC activity]
  • Clemastine (Tavist) [moderate to high AC activity]
  • Clidinium & chlordiazepoxide (Librax) [low to moderate AC activity]
  • Clorazepate (Tranxene) [low AC activity]
  • Codeine [low AC activity]
  • Colchicine [low AC activity]
  • Darifenacin (Enablex) [moderate  to high AC activity]
  • Digoxin (Lanoxicaps, Lanoxin) [low AC activity]
  • Dimenhydrinate (Dramamine, Gravol, etc) [high AC activity]
  • Diphenoxylate plus atropine (Lomotil) [moderate to high AC activity]
  • Disopyramide (Norpace) [low to moderate AC activity]
  • Flavoxate (Urispas) [moderate AC activity]
  • Fluphenazine (Prolixin) [moderate AC activity]
  • Furosemide (Lasix) [low AC activity]
  • Hydrochlorothiazide (Esidrix, Dyazide, HydroDIURIL, Maxzide & literally scores of other medications for high blood pressure) [low AC activity]
  • Loperamide (Imodium) [moderate AC activity]
  • Loratadine (Alavert, Claritin) [moderate AC activity]
  • Loxapine (Loxitane) [moderate AC activity]
  • Maprotiline [low to moderate AC activity]
  • Meperidine (Demerol) [moderate AC activity]
  • Methocarbamol (Robaxin) [moderate AC activity]
  • Methotrimeprazine (Nozinan) [moderate AC activity]
  • Nifedipine (Adalat, Procardia) [low AC activity]
  • Olanzapine (Zyprexa) [moderate AC activity]
  • Orphenadrine (Norflex) [moderate AC activity]
  • Quetiapine (Seroquel) [moderate AC activity]
  • Procyclidine (Kemadrin) [moderate AC activity]
  • Propantheline (Pro-Banthine) [moderate to high AC activity]
  • Ranitidine (Zantac) [low AC activity]
  • Solifenacin (VESIcare) [low to moderate AC activity; more research necessary]
  • Thiothixene (Navane) [high AC activity]
  • Tizanidine (Zanaflex) [high AC activity]
  • Tramadol (Ultram) [low AC activity]
  • Trihexyphenidyl (Artane) [high AC activity]
  • Trospium (Sanctura, Spasmex) [high AC activity]

The drugs listed above were not included in the study by Dr. Gray and her colleagues. Older people who take several of these medications might accumulate a substantial anticholinergic burden.

In compiling this list we relied on a number of resources. There is not unanimity among investigators. Sadly, there is no perfect list. We did our best to locate likely drug candidates and provide a qualitative assessment of the potency of the effect. Resources we consulted included:

European Journal of Clinical Pharmacology (July, 2013)

BMC Geriatrics (March, 25, 2015)

Journal of Clinical Pharmacology (Dec. 2006)

Magellan Anticholinergic Risk Scale

Pharmacist’s Letter

Side Effects of Anticholinergic Drugs:

Drugs in this category can produce a variety of symptoms including:

  • Dry mouth & nose, difficulty swallowing
  • Decreased sweating
  • Constipation
  • Dizziness, drowsiness, unsteady gait
  • Headache
  • Difficult urination, urinary retention
  • Confusion, disorientation, memory problems
  • Difficulty paying attention, cognitive decline
  • Fatigue, muscle weakness, clumsiness, unsteadiness
  • Dry skin
  • Visual difficulties

List revised 5/4/17 based on information found in part 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.

Stories from Readers:

We have heard from hundreds of visitors to this website regarding anticholinergic complications. It’s one thing to read a list of side effects and quite another to see personal stories. Here are just a handful:

Lucia in Louisiana shares her experience:

“I believe it and have personally witnessed it. I have taken more than one of the medications from the list of anticholinergic drugs at various time. Some were prescribed.

“I have had to get off these drugs due to difficulty processing and recalling information. I have had trouble finding the right words. A long time ago I decided for myself that anticholinergic meds create stupidity in me. I can’t afford to swallow stupidity.”

B. in Gloucester, Virginia states:

“My wife used scopolamine patches for three weeks on a vacation to prevent motion sickness which it did. Unfortunately it also caused memory loss.

“That was over four years ago and memory loss continues to this day. We have met with three neurologists and they have done brain scans but offered no remedies. Prior to the day the scopolamine patch was attached my wife had absolutely no memory problems or symptoms of dementia or Alzheimer’s. Her life style and family history indicated no danger signs. We are still searching in vain for a remedy.”

Eileen in Alberta, Canada is caught between a rock and a very hard place:

“I have been on amitriptyline for my fibromyalgia. I have tried other meds but the Elavil is the only one that worked in shutting my brain.

“I am suffering memory loss. I used to have a photographic memory. Now I can’t remember from second to second. I have also been experiencing dizziness. I have been on this medication for twenty years. I have tried getting off the amitriptyline, but after two weeks I could hardly move. I had severe pain every where.”

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:

Can You Reverse Memory Problems from Anticholinergic Drugs?

Can You reverse Memory Problems from Anticholinergic Drugs?

If you found this article helpful, please vote at the top of this page. Share your own experience below in the comment section.

Revised by Joe Graedon 5/4/17

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  1. Go Astros!

    Antacids such as Gavascon have aluminium, do these all cause Alzheimer’s?

  2. Ed

    My wife had a serious loss of short term memory and cognitive skills after a stint on opioids and lorazepam following surgery. She made a remarkable recovery with Neuro PS and Prevagen. Now she is on Morphine Sulfate oral liquid for leg wound pain and continuation of Neuro PS and Prevagen may have reduced the onset of impairment but has not prevented it. The morphine is low dosage 5 mg 2-4 times a day and I am working that down as I search for her memory and personality.

  3. mani

    Wonderful article, describing the anticholinergics.

  4. Linda
    Atlanta, Ga.

    I am 73 year female and have looked several years for the reason for my symptoms.

    I have just been to a doctor for all of these except the sweating thing. I really have trouble with the short term memory. Dr says I have no sign of dementia and he says I do not have any sign of it. I take otc sleeping pill Aleve ,Ropinirole, Fluoxetine.
    Thank you for letting us know. Will let you know what happens.

  5. Margaret K.

    Thank you for researching this and making the info available.

  6. MARY


  7. PM
    Mount Vernon WA

    I’ve been taking minimum dosage Oxybutynin for several years for stress (not urge) incontinence following bladder surgery, and I believe it works to some extent. My doctor dismissed the possible Alzheimer’s connection, said I’d have to be taking much more. I just wish there was a safer alternative to Oxybutynin; however, I do think my memory isn’t as sharp as it used to be, but maybe that’s just part of being 83.

    There’s no AD in my family, but a cousin who died of it shared the same grandmother, who died at 68 of cancer but still seemed mentally OK. This cousin’s mother also had AD but wasn’t related to me except by marriage.

  8. Chris
    Andrew, IA.

    I have COPD, and pulmonary hypertension and am on 240mg of Lasix each day. also, take zantac for my acid reflux, and Xanax once in a while for anxiety. What am I suppose to do, I retain water if I don’t take Lasix. Is any thing safe to use or are we all out of luck when it comes to any meds. we take? You scare people but don’t give us any alternatives for all the bad ones you mention.

  9. Austin

    Wow!! This is really scary and educational. I have been put on a ton of lung/ asthma / COPD meds over the past 8 months and we still don’t know exactly why I can’t breath. It came on quickly and has gone downhill and I have never smoked a day in my life, I’ only 58. Not one doctor ever mention any of the drugs they have put me on (Spriva, Cyproheptadine, Albuterol & Budesonide for the Nebulizer) would cause any of those problems. I don’t want to use any of these medicines now!

  10. mary

    In addition, isn’t Versed, the drug admisnistered for colonoscopies also an anticholinergic drug? Didn’t see this on either list. I experience more memory problems with each colonoscopy. And colon cancer runs in my family so I have had 4 or 5 already at 68 yrs old. So we get tested for colon cancer only to end up with dementia?

  11. Ramona

    I was laughed at by my Pulmonologist about 6-7 years ago when I discontinued using Spiriva because of horrendous memory problems. I was then prescribed Combivent which had the same effect after just several weeks of use. Was criticized by Dr saying that I didn’t give it long enough time. Discontinued Combivent and prescribed Tudorza. Was told it was new and is metabolized differently and wouldn’t have the same effect. WRONG!!

    Then to be sneaky was prescribed a nebulized albuterol with ipratropium bromide and told it was just albuterol. Luckily I had an allergic reaction to this stuff before suffering any more memory loss and confusion. Not one of those pulmonologists would help figure out why this was happening.

    I had to research this and discover that anticholinergics interfere with acetylcholine, the brain, and memory. My memory recovered after discontinuing use but each time it took longer and longer. I ate a ton of eggs trying to replenish the choline. Not sure if it really did anything but finally got back to normal.

    I told pulmonologists that I would not take another anticholinergic because of severe quality of life issues. Had I continued on those meds I would have needed help on a daily basis – assisted living. They acted like I was just a complainer looking for attention. They finally found another medicine that worked just fine….tried and true Theophylline! Drs need to listen and learn from their patients. The problems from anticholinergics are very real.

  12. Gloria

    I was disappointed with the guide about anticholinergic medications and older people. I already had that information free from other sources. Moreover, it was old information (2002) and did not cover the many new prescription drugs since then.

  13. Gail

    I don’t see my sleep aid; Doxylamine Succinate (Kirkland Sleep Aid), on the list. I have probably been taking it for at least 10 years every night. I’m 65 years old, and as far as I know, I still have my brains intact.

    I’ve been trying to do without it, but I hardly sleep at all when I don’t take it. I’m currently taking Kava Kava, Tryptophan, and Melatonin all at once as a substitute, but that combination only gives me 2 -4 hours of sleep a night.

    • Imodale B
      New York

      I’m with you on the doxylamine. I’m a 66 year old woman who has been taking about 6.5mg every night since about a year ago. Nothing else works as well for me, and have tried everything except for prescription sleeping pills which I refuse to take for as long as I can take doxylamine. I think the jury is still out on this one since I don’t see it on any official list of antihistamines with a link to dementia. Therefore, will continue taking to ensure a good night’s sleep.

  14. Sue G

    I (71 yr old) have been taking 4 mg 3 times a day of Cyproheptadine (Periactin) since 4/16 which is an antihistamine (sedative) and this has the anticholinergic properties that cause cumulative effects over time leading to Dementia and or Alzheimer’s disease. I’m currently in the process of eliminating this and am not sure what the Doctor will substitute because my blood condition causes terrible pruritus due to the histamines, an intense itchiness and rashes you would not believe. Older people, especially, should be concerned & , if taking other OTC drugs with this they should check all meds to see which ones produce the anticholinergic effects. The other one I have been taking is Ranitidine (OTC Zantac). I was shocked when I read the warnings because the doctor didn’t reveal these facts. The build up over years can be dramatic and lead to something we all want to avoid as we’ve all watched relatives and friends & their families succumb to the horrible effects of cognitive disabilities. I really appreciate the list also.

    • Laurie

      I take that same sleep med along with melatonin every night. I could have sworn it was on a previous list! I take Zyrtec as well, and I think it’s time to wean off of it! I’m such a bad sleeper and was even as a kid!

  15. Donna

    I’ve been taking Tylenol PM tablets everyday for about 22 years. I took them for migraine headaches. I’m also going through menopause for 4 years now since I stopped having a period. I haven’t had a migraine so I stopped taking Tylenol PM. But now I take store brand sleep tablets for insomnia which has been on going for about 4 years now. Sometimes I have to take 3 at a time just to fall asleep if I fall asleep at all. But I cannot stay asleep. Are these pills bad for me?

    • Terry Graedon

      OTC sleep aids are usually antihistamines that make people feel drowsy. These anticholinergic medicines can cause confusion and forgetfulness as well as drowsiness, so if you are indeed taking them at higher than recommended doses every night, they could be harmful.

    • Anna

      In reply to Donna in Virginia, you might look into 5-HTP for sleep. It’s OTC. 5-HTP is a precursor to serotonin and melatonin. It’s been a Godsend for me, after a decade of insomnia. It’s definitely best to to ease into it at the lowest dose possible. (Thorne Research has 50mg caps, which also include the B6 cofactor in the bioavailable form of P5P.)

      My dosage varies; I take more when PMSing. I feel the soporific effects within 30 minutes. If I take too much, I’ll sleep too long and too soundly (right through my alarm) and will also feel kind of down the following day (likely because of too much serotonin/melatonin relative to other neurotransmitters).

      You could also look at tryptophan, which is an amino acid and precursor to 5-HTP. Supplementing with tryptophan works for some people; it didn’t work for me–neither did supplementing with melatonin. Hope this info on 5-HTP helps someone. Sleep deprivation is horrible.

  16. Dianne
    Washington State

    Am I missing something?!? No where does it say what this category of drugs are prescribed for. For what ailments/conditions are these drugs prescribed?

  17. NB

    Even taking “natural” remedies can be a problem. One day, while very depressed, I wondered why. The new natural formula had all the herbs and etc that was supposed to bring back my old pep. I suddenly realized that the new pills I had added may not be the best for me. Reading the labels, it was apparent some duplications were made. I quit the newer pills and paid more attention to what I was eating and getting more exercise.

  18. Kenneth

    I think a big one might be missing from your list. It’s one that doesn’t like negative attention. Lyrica /Pregablin and Gabapentin cause dry mouth & eyes to the point of people losing teeth, brittle teeth, blurry and or double vision. I don’t know what qualifies as being anticholernergic but the reports of this side effect are many.
    To include extreme brain fog that becomes a danger.

  19. mike

    I experiences these effects with taking Zyrtec and Claritin. I switched to Allegra (buy at Costco for the cheapest price) and experiences no side effects. Also, it doesn’t say on the bottle but it won’t work if you don’t take on an empty stomach and wait 20 minutes before eating after taking it.

  20. Rita

    My doctor & pharmacist don’t know a thing about this. Do you have an app that I could put the prescription or the supplement in & find out if it has antichlorengic medication s in them? I am having a great deal of problems with this & I hope you can help me.

  21. Elaine

    Will 50 mg Trazodone cause dementia. I use it for insomnia.

  22. Gloria

    Which kegel device is FDA approved and is effective for mature women?

  23. Marilyn

    I have been taking 300 mg of trazodone every night for the last 15 years to help me sleep. I have a lot of trouble with word retrieval. Is trazodone an anti-cholinergic drug ?

  24. Ruth
    Elkins, West Virginia

    I ended up in the hospital ‘off my gourd’. I didn’t even know what had happened until later in the week. I am on several anticholinergic medications such as Elavil, gabapentin, Benadryl, Vistaril, Phenergan, Claritin, Zantac, Tizanidine.

    I appreciate this list and will be showing it to my PCP.

  25. sam


  26. Judy

    I have taken a half unisom tablet for years and never had any of the side effects connected with the anticholineric chemical in it. I am 73.

  27. Mary

    I have taken claritin-d daily for the last ten years. Attributed mental fog and memory issues to chronic lack of sleep. Have stopped as of two days ago and have no plans to ever take it again. Thank you for this information!
    I also take generic ritalin (10 mg twice daily) to help me focus in a chaotic work environment. Not worried about addiction because I have no interest in taking it on days I am not working but is this an anticholinergic?
    Thank you!

    • Anna

      Mary in NC, it’s possible that you’re fine taking Claritin-D. I take Benadryl precisely for the anti-cholinergic effects. (My brain/body makes too much choline, likely secondary to BHMT gene mutations/polymorphisms.)

      Re: chronic lack of sleep, look into 5-HTP, if you haven’t already. (I wrote more about it in a reply above.)

      In short, anticholinergic is good for some of us! Benadryl helps me think, focus, and get stuff done; otherwise, I feel like a zombie.

  28. PAM
    sacramento, ca

    My 88y/o mother has ALZ. since 2000 still living due to being in good health. She drank 3Tbl of Mylanta daily and was found to have Aluminum in a 3D brain scan. she also drank from a aluminum can six times per day from diet pepsi to Miller lite beer.

  29. Jay
    Houston, TX

    Dr. Gray actually recommends using Claritin and Zyrtec as a substitute for anticholinergic drugs.
    “Gray offered similar advice. “If providers need to prescribe a medication with anticholinergic effects because it is the best therapy for their patient, they should use the lowest effective dose, monitor the therapy regularly to ensure it’s working, and stop the therapy if it’s ineffective,” she suggested. She said that substitutes are available for some anticholinergic drugs, including a selective serotonin re-uptake inhibitor (SSRI) antidepressant like citalopram (Celexa) or fluoxitene (Prozac) for depression, or a second-generation antihistamine such as loratadine (Claritin), fexofenadine (Allegra), or cetirizine (Zyrtec) for allergy relief.”

What Do You Think?

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