The People's Perspective on Medicine

Are Anticholinergic Drugs Bad for Your Brain?

Are you taking a drug that could affect your memory and shrink your brain? A new study shows that anticholinergic drugs have a negative impact on the brain.
Brain decline and dementia or aging as memory loss concept for brain cancer decay or an Alzheimer’s disease with the medical icon of a old rusting mechanical gears and cog wheels of metal in the shape of a human head with rust.

Neuroscientists have been warning for years that a class of medications called anticholinergic drugs (AC) could be bad for your brain. That’s because AC drugs interfere with a crucial neurochemical called acetylcholine and alter brain cell function. New research (JAMA Neurology, online, April 18, 2016) confirms that:

“The use of AC medication was associated with increased brain atrophy and dysfunction and clinical decline. Thus, use of AC medication among older adults should likely be discouraged if alternative therapies are available.”

What the New Research Uncovered about Anticholinergic Drugs:

The investigators studied 451 older people who were considered “cognitively normal” at the start of the research. The scientists tested people for their memory and mental functioning over the course of the trial. Some were given sophisticated PET scans to assess glucose uptake, a measure of neuronal activity. Others got scans utilizing MRI technology to determine the size and shape of their brains.

The goal of the research was to see whether medications with anticholinergic activity affected brain physiology and mental capability–things like memory, problem solving, planning ability and basic thinking.

The bottom line from this research appears to be that AC medications are bad for your brain! Not only did the drugs affect cognitive ability, they also reduced glucose metabolism in the hippocampus, an area of the brain critical for normal memory consolidation. There was also a relationship between the use of AC medicine and brain structure. The greater the anticholinergic “burden” the more brain deterioration was observed.

In Their Own Words:

Please do not take our word for this research. Here is what the investigators found:

“Use of medications with medium or high AC effects in the ADNI cohort was associated with poorer cognition (particularly in immediate memory recall and executive function), reduced glucose metabolism, whole-brain and temporal lobe atrophy, and clinical decline. The effect appeared additive because an increased burden of AC medications was associated with poorer executive function and increased brain atrophy. Similar effects were seen in an independent cohort of older adults. These results suggest that medications with AC properties may be detrimental to brain structure and function, as well as cognition.”

In other words, drugs with anticholinergic activity are bad for your brain. The more medicines you take with AC action, the worse the impact.

We’ve Been Warning About Anticholinergic Drugs for Years!

This recent research is new, but the general picture is not. Doctors have known that anticholinergic drugs could alter brain function for more than 100 years. At the beginning of the 20th century, German obstetricians began giving women in labor a powerful AC drug called scopolamine together with morphine.

They called this “twilight sleep.” They found that women would not remember the pain or anything else about the delivery process. These physicians described it as “clouded consciousness with complete forgetfulness.”

That should have been a tip off that AC drugs were scrambling neurons. Health professionals assumed it was a short-term effect and pretty much ignored the long-term consequences of administering AC medicine to millions of patients.

Do Doctors Know About Anticholinergic Drugs?

Physicians get surprisingly little training about AC drugs. They learn about medications such as atropine, hyoscyamine and scopolamine, which have been used to treat diarrhea and what was once called spastic colon and is now frequently referred to as IBS (irritable bowel syndrome).

Perhaps you have heard of Lomotil (a combination of atropine and diphenoxylate). It has been prescribed for decades to combat diarrhea. And scopolamine (Transderm Scop) has been a mainstay in the treatment of motion sickness.

What many health professionals do not realize, however, is that there are dozens of other drugs with AC activity. Over-the-counter antihistamines such as brompheniramine and diphenhydramine are considered anticholinergic medications. If you don’t recognize the name diphenhydramine, consider all the nighttime pain relievers. What turns Advil, Aleve, Bayer, Excedrin and Tylenol into “PM” drugs is diphenhydramine.

The motion sickness medicine Dramamine is also a potent AC drug containing the ingredient dimenhydrinate (which is in part diphenhydramine). Oh, by the way, the popular allergy medicine Benadryl is also diphenhydramine.

Ask your doctor about the antidepressant paroxetine (Paxil), the vertigo drug meclizine (Antivert) or the medicine for overactive bladder symptoms oxybutynin (Ditropan). These are all AC drugs.

The Anticholinergic “Burden”

The point is that there are dozens and dozens of drugs with AC activity. While taking one such med for a few weeks or months probably won’t be terribly bad for your brain, we do worry about what the researchers call the total anticholinergic burden. Someone who is taking a nighttime PM pain reliever together with a medicine for overactive bladder plus a certain type of blood pressure pill might be getting a large dose of anticholinergic activity. That could be quite bad for the brain over the long haul. Many people may not realize that their brain fog could be due to the medications they are taking.

If you would like to know whether your medications might have anticholinergic activity, you may want to consult this list we compiled for you. You may also wish to read stories from readers who have experienced mental side effects from anticholinergic drugs.

You may also want to read our book, Top Screwups Doctors Make and How to Avoid Them. In our chapter on older people we discuss the problem of anticholinergic drugs in far greater detail.

Please share this special People’s Pharmacy Alert with friends and family. Never stop a medication suddenly and be sure to check with your doctor before discontinuing any prescription drug. Please vote on this article at the top of the page and leave your story in the comment section below.

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    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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    I seem to understand that this is an issue for older adults. But is it a concern for those in their 20’s of 30’s, who use Dramamine, Nytol, or PM meds?

    Functional MRI’s and others of the latest toys are fun – but old fashioned sleep studies can show why memory and brain function are declining when sleep cycles are ruined by drugs including AC types.

    Psychiatrists had odd ideas about sleep studies and sleep cycles – when their patients on 300 mg of Elavil had been REM sleep deprived for years and not doing well functionally – discontinuing the drugs led to weeks and months of excessive REM sleep rebound which was also hard on most patients. If a patient takes any drug which is active during the hours of sleep and is having any brain function complaint, a sleep study interpreted by a motivated physician can give a good idea if the drugs are part of the problem. Hypertension drugs are frequently overlooked as sources of brain dysfunction, ACE drugs have AntiCholinergic effects and Beta-blockers frequently affect brain function in good or bad ways.

    In another comment there is a question about Neurontin. Neurontin affects sleep cycles in some patients adversely and in others controls pain well enough that sleep is improved but the tolerability of the drug will change with time, dose, age, illness and drug interaction.

    I have suffered from extreme motion sickness all of my life. My inability to remember much of anything from childhood family vacations is a family joke, but is probably due to Dramamine usage. Scopalamine patch wipes me out, as do normal doses of antihistamines – a one-half children’s dose will hold me for 24 hours. There is probably genetic variation in drug metabolism, but I would be cautious. I don’t know if there’s any truth to the old wives’ tale about sneezing destroying brain cells, but taking an anticholinergic antihistamine to prevent the sneezes might be even worse. :-)

    I have been on Gabapentin/Neurontin for over a year for nerve pain – does this drug fall into the anticholinergic category? I am very concerned as I am noticing symptoms I never had before taking this drug.

    Are there things we can do to heal from the effects of these anticholinergics?

    Are there “antidotes” to the anticholinergics?

    I have taken Benadryl,Paxil and Oxybutinin (maybe others?) FOR YEARS. What can I do to UNDO their effects? I have felt as though my memory is half gone for quite a while. I am 83 and made good use of a very good brain and a high I.Q. This information has been demoralizing and I hope you have some suggestions for reversing my mental “direction” Thank you .

    I think I am doomed! At 78 with mild (not in my opinion) cognitive impairment, I am frightened by the thought of dementia. Aside from diabetes, I take, or have taken many AC medications. Anti-vert when I was still in my teens, so an early start. Diuretics since 1960 for what they called idiopathic edema (not so, an allergic reaction to a medication) and now call lymphedema. Lyrica for diabetic and fibro neuropathy. BTW, the diabetes was caused by a doctor and his anti menopause injections. It is well controlled; but that does not mean to non diabetic levels. Our whole country carries blood sugars that are too high.

    To defend my poor brain, I take choline in several different forms. The decline has slowed, but not stopped. If I were able to walk, I might be able to reverse it. Alas, too frail, won’t even go into that.

    Allopathic medicine and the industrial food machine have made many of us sick, young and old. The organic foods community is fighting back; hopefully it is not too little, too late. I shop my farmers’ market when it is available. Cook more from scratch than I did 20 years ago. Many farmers there grow organically, but cannot afford to become certified. Unfortunately, the toxic load in my body is just too great for me to get rid of it. It is the old saying about too late smart.

    So I advise all you younger people out there: eat well and properly, exercise by doing things like walking, keep your weight down and use your brains. Read, don’t watch TV and if you are chained to a desk, make sure you get up and move your body at least once every half hour.

    My husband has a painful knee and one alternative is replacement. The other, which his doctor suggested he try first, is Aleve; he was told to take two, twice daily–a total of four.
    Is there an alternative to Aleve?

    Aleve is ok to take if you are worried about anticholinergic effects, it is Aleve PM that is what you would be concerned with, because it contains diphenhydramine, which is your anticholinergic drug.

    People’s Pharmacy listed a handful of AC drugs. Is there a more complete list?

    Do you have a list of all the other blood pressure drugs that have an anticholinergic effect?

    Hay thanks ,for sharing this information about the side effect of some drugs I did not that lisinipril make forgetfulness or short memory, but some times is the problems they treated if not other alternatives what is the other way , we cant findhelph

    Thanks

    Your information and assessments are interesting and certainly provide a perspective not otherwise available. As for your book on “screw ups, ” I try diligently to be positive and avoid negativity. So, what kind of reaction or predisposition would be expected from “Top Screw Ups Doctors Make……?” Why “screw up” your attempt to help people with a negative and unvetted title.

    This is important information, decisions to be made. It also makes me wonder whether the bevy of natural substances (like ginger for motion sickness, but as you know, there are many many others) also have an anti-cholinergic effect.

    I have had so many CT scans X-rays I must glow in the dark and these scans have been a joke
    I’ve been told I’ve had kidney cancer when it turned out to be a deformed kidney & 8mm kidney stone
    I had an IVF filter implanted for pulmonary embolism when it was a mistake
    I was told I had Lyme disease and began treatment
    These are just 3 screw ups and one CT scan was on the wrong side of my body
    I could list all the other mistakes but it gets me upset
    Last year I went to ER after a fall on ice. They said I had a fracture which I did. But I also had a dislocated shoulder and torn rotator cuff that they did. Not know
    Doctors drive me crazy
    Beware

    I have had COPD for ten years and have been on various inhalers that I take twice a day. I started with Spireva, which caused unusual weight gain and disrupted digestion so badly that I needed a drug to get me working again. It seems that Spireva is an AC, and I became aware of the problems with AC’s at that time. I have avoided all other AC’s in COPD meds. These include, but not limited to, Ellipta, Combivent, Atrovent, and probably others. I think some of these are also prescribed for asthma. So imagine how many people are inhaling these on a daily basis. Please check the fine print on all meds.

    I have been over medicating for years with the high blood pressure dialzepham. My rapid heart rate had caused me to practically stop doing anything. Drs. Kept giving me different medications which never worked. One caused a terrible rash on my arms which l finally used capsacin cream to get rid of it. When it went away my arm had shrunk. Now one arm is smaller. I stopped taking dialzepham and my rapid heart rate slowed down. Now, l only take Atenenol for blood pressure and it is working much better. I read that beets help and wonder if beet root would work. I have been taking OTC sleep drugs for over 25 yrs so not sure what to do. Take a prescription medication?

    Calcium betta blockers caused my higher than normal heart rate over 100 BPM then they put me on metropanol heart rate lowered to 45 BPM so low it was hard to find a pulse. I binned the PB pills and now I meditate and moderately exercise and have never felt better!

    Thank you so much for this information. I really try to not take very many medications unless deemed absolutely necessary but having taken HCTZ for many years now, I am emailing my primary to stop prescribing as I do have numerous symptoms associated with that drug.

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