The People's Perspective on Medicine

Are Your Drugs Raising Your Risk for Dementia?

Many popular prescription and over-the-counter medicines have anticholinergic activity and can increase the possibility of developing dementia.

Here we go again, with headlines that sound like they could be hype:

“Hay-fever drugs linked to Alzheimer’s” (Irish Independent)

“Over-the-counter pills could raise risk of Alzheimer’s: study” (New York Post)

“Common allergy, depression meds may increase odds of dementia” (CBS NEWS)

“Dementia ‘linked’ to common over-the-counter drugs” (BBC News Health)

These headlines are scary. Should you be concerned? In a word, yes!

Researchers studied participants in the Adult Changes in Thought (ACT) study conducted in the Seattle area (JAMA Internal Medicine, online, Jan. 26, 2015). These were older people enrolled in an integrated health care delivery system called Group Health. Over 3,000 individuals were included in the research, and none had dementia when they entered the study starting in 1994.

Scientists tracked their drug use and cognitive function over the next two decades. The higher the dose of anticholinergic drugs and the longer such medications were taken, the greater the risk of dementia. In this study the most common anticholinergic drugs were antihistamines found in over-the-counter allergy drugs and nighttime pain relievers, antidepressants that are also prescribed for nerve pain and medications prescribed to treat incontinence or symptoms of overactive bladder. The authors conclude:

“Higher cumulative anticholinergic use is associated with an increased risk for dementia. Efforts to increase awareness among health care professionals and older adults about this potential medication-related risk are important to minimize anticholinergic use over time.”

The Evidence Keeps Accumulating:

In the BMJ (formerly the British Medical Journal) an article was published on April 25, 2018 reinforcing the relationship between anticholinergic drugs and dementia. The authors concluded:

“Many people use anticholinergic drugs at some point in their lives, and many are prescribed to manage chronic conditions leading to potentially long exposures. There are robust associations between levels of anticholinergic antidepressants, antiparkinsons, and urologicals and the risk of a diagnosis of dementia up to 20 years after exposure.”

What Are Anticholinergic Medications?

We have been writing about this category of drugs for a very long time because of a clearly established link to cognitive impairment. These medicines are known as anticholinergics because they interfere with the ability of a crucial brain chemical called acetylcholine (Ach) to attach to nerve cells. ACh is essential for muscle contraction. Without adequate amounts of this neurotransmitter you could not breathe, blink your eyes or tie your shoelaces. Body movement can only happen when ACh triggers a muscular contraction.

Acetylcholine is also critical for proper brain function. Without ACh doing its job transmitting messages between brain cells, you would become forgetful and confused.

Twilight Sleep for “Painless Childbirth”

One of the most potent anticholinergic medications, scopolamine, was used for decades with a narcotic like morphine to induce “twilight sleep.” Starting about a century ago, women were given this combo during labor and delivery so they wouldn’t remember the pain or anything else about the experience. The German researchers who developed this approach in the early 20th century said that it produced:

“clouded consciousness with complete forgetfulness.”

Modern-Day Anticholinergics

Most physicians are offered a few hours of training about anticholinergic drugs (at best). They are taught about belladonna, aka deadly nightshade. (The drugs atropine, hyoscyamine and scopolamine were derived from the plant Atropa belladonna.) Such medications have been used to treat diarrhea and what was once called “spastic colon.” The combination of atropine and diphenoxylate (Lomotil) remains popular for diarrhea.

Scopolamine (Transderm Scop) is still prescribed for motion sickness, and ophthalmologists and optometrists may use atropine drops to dilate the pupils during an eye exam. Doctors also employ other anticholinergic drugs such as ipratropium (Atrovent) and tiotropium (Spiriva) for asthma. Anticholinergics such as fesoterodine (Toviaz), oxybutynin (Ditropan) and tolteradine (Detrol) are frequently utilized to control the symptoms of overactive bladder.

Popular Antihistamines & Sleep Aids

What most modern-day physicians have not learned, however, is that many other drugs also have anticholinergic activity. As mentioned in the ACT study, first-generation antihistamines were linked to dementia. We are talking about drugs like chlorpheniramine and diphenhydramine (DPH).

You may be surprised where DPH shows up. It is the primary ingredient in many allergy and hay fever meds including the popular brand name Benadryl. But DPH is also found in a huge number of nighttime pain relievers and sleeping pills. Look at the label of Advil PM, Aleve PM, Bayer PM, Excedrin PM, Nytol, Simply Sleep, Sominex, Tylenol PM or Unisom and you will likely find diphenhydramine as a key ingredient.

We do not worry very much about the occasional use of such drugs. But chronic use, day in and day out for both pain and insomnia, begins to add up to substantial anticholinergic exposure.

Antidepressants

The researchers noted that an older class of antidepressants called “tricyclics” was also linked with dementia. Drugs such as amitriptyline or doxepin are not prescribed as much for depression as they once were. That’s because of newer antidepressants such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac) and sertraline (Zoloft). But some physicians prescribe amitriptyline for nerve pain and doxepin for insomnia. These drugs can produce classic anticholinergic side effects: dry mouth, constipation, blurred vision, rapid heart rate, difficult urination, confusion, cognitive impairment and drowsiness.

Bladder Drugs (Urinary Incontinence)

In the ACT study the most common anticholinergic drug in the class of meds for overactive bladder was oxybutynin (Ditropan). Other medicines in this category include fesoterodine (Toviaz), and tolterodine (Detrol). By the way, an over-the-counter form of oxybutynin is now available for women under the brand name Oxytrol.

Here’s the Real Problem:

What concerns us far more than any individual anticholinergic medication is the combination of several drugs with anticholinergic activity. Physicians may not realize that the anti-anxiety agent alprazolam (Xanax) has anticholinergic activity. So does the ulcer drug cimetidine (Tagamet). The dizziness drug meclizine (Antivert, Bonine) also has this activity.

We could go on and on, but by now you get the picture. There are dozens of medications that have this property. Someone taking Tylenol PM to get to sleep who is also taking amitriptyline to ease nerve pain along with oxybutynin to control an overactive bladder could end up disoriented and forgetful. But don’t take our word for it. Here are stories from visitors to this website:

C.S. writes:

“Many years ago my urologist prescribed Ditropan and I took the drug for about four years. I had an hour’s drive to work each day and I began to realize that many days I could not remember the drive and would arrive at work with my mind in a somewhat “fuzzy” state. I happened to pick up a new prescription for Ditropan at the pharmacy and started reading the side effects of the drug.

“I saw that my symptoms could be connected to the drug. I stopped taking the drug immediately and decided that I would try to control my bladder some other way (exercises, etc). My symptoms went away and I have not had any problems since. I still cope with bladder issues but I would rather be clear-headed.”

Robert adds:

“I was prescribed amitriptyline for headaches and couldn’t stop sleeping! I also felt sluggish mentally and pretty much dead overall. It was an awful feeling.”

This comment comes from Abigail:

“I appreciate your warning about anticholinergics. I only took Lomotil for IBS [irritable bowel syndrome] when I went out for an event, so I thought my episodes of brain confusion were caused by senior moments. After your warning I realized I was taking an anticholinergic. I stopped taking Lomotil and have regained my mental clarity. Thank you!

Who Takes an Anticholinergic Drug?

You might wonder how many older people are on anticholinergic medications. According to the Seattle team of researchers, 8% to 37% are taking such drugs, despite warnings to health professionals that risks might outweigh benefits. In other words, as many as one-third of people over 65 could be taking an anticholinergic drug without even knowing it. The authors of the study point out that this may not be reversible:

“The general view is that anticholinergic-induced cognitive impairment is reversible on discontinuation of medication therapy. However, several investigators have reported that anticholinergics may be associated with an increased risk for sustained cognitive deficits, such as mild cognitive impairment or dementia. One biologically plausible mechanism for these findings is that cumulative use of these agents results in pathologic changes in the brain similar to those observed with Alzheimer disease (AD).”

Most Doctors Don’t know Which Drugs Are Anticholinergic

As mentioned earlier, medical students get an hour or two training about anticholinergic medicines. They learn about atropine, hyoscyamine and scopolamine, classic drugs in this category.

What they don’t always learn is how many other medications also have anticholinergic activity. If you ask your doctor whether cimetidine (Tagamet), Lasix (furosemide) or alprazolam (Xanax) could have anticholinergic action, the chances are pretty good that you would be told no. But the list of such drugs is surprisingly long.

Learn More!

Here is a link to a list that we have prepared. We must emphasize that no one should EVER discontinue any drug without first checking with the prescriber! That said, the Seattle team of researchers suggests that:

“Prescribers should be aware of this potential association [the increased risk for dementia in people with higher-use of anticholinergic drugs] when considering anticholinergics for their older patients and should consider alternatives when possible. For conditions with no therapeutic alternatives, prescribers should use the lowest effective dose and discontinue therapy if ineffective.”

Would you like to know more about how medications can affect brain function? We have much more information in our chapter, “The Screwing of Senior Citizens.” In addition to a list of anticholinergic drugs, there is a long list of medications that older people should generally avoid (The Beers List). This information can be found in our book, Top Screwups Doctors Make and How to Avoid Them.

We would be derelict if we didn’t point out that this is not the first study linking anticholinergic drugs to dementia. In our book we describe the “Three-City Study” from France. These investigators concluded that

“elderly people taking anticholinergic drugs were at increased risk for cognitive decline and dementia. Discontinuing anticholinergic treatments was associated with a decreased risk.”

In addition to the long list of anticholinergic drugs, researchers have also discovered that benzodiazepine drugs frequently used to calm anxiety or aid sleep are also associated with a greater risk of dementia (BMJ, online Sept. 10, 2014). A problem became apparent in older people who had taken such medicines for at least three months, but the longer they had been on the drugs, the higher their risk of an Alzheimer’s disease diagnosis. If you would like to read more about that study, we have written about it.

What About You?

Lest you think this is only an older person’s problem, we hasten to point out that middle-aged and younger people can also experience anticholinergic side effects. Just because you are 57 does not mean you are immune to these complications.

Health professionals need to be far better educated about anticholinergic pharmacology and its consequences on the brain. And patients need to ask their physicians, nurse practitioners and pharmacists whether any of their medicines have anticholinergic activity.

You may find this article from May 14, 2018 of additional interest:

Please share your own story 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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Side affects of drugs and pills have been my concern since the passing of my husband. Research showed that many of the drugs drs prescribed had the same side affects. Those made his life miserable, as he fought what the doctors said was just the affect of old age. Thank you for this article. I can see I need to be more careful even about OTC drugs.

Please follow up with info on anesthesia and dementia for those over 65.

I have searched for an antihistamine without the acetylcholine activity too, but with little success.
And if you mention it to a Dr. or pharmacist, their eyes glaze over, and they tend to change the subject.

I have experienced loss of memory with Eliquis: In 2015 I was prescribed Eliquis, and immediately I started to experience memory loss: I would go into a room and not remember why. After two weeks I stopped taking Eliquis, and the condition stopped. However, after just two weeks on this drug my memory has not been as sharp as it formerly was.
For example: I could remember names: Now I cannot remember names to the extent that I formerly could.

Dr. Perlmutter in a recent interview reported that newly published studies showed a significant increase in the risk of dementia for those taking drugs for acid reflux – PPI’s.
A 44% risk increase

I have been taking Amitriptyline since 1990. I had problems sleeping and severe depression. Over the years I had gained a lot of weight. Two years ago I warned myself off a dosage of 125 mg. I lost 60 pounds, but my problems with sleep and depression came back. I’ve tried two different antidepressants, but none help me sleep. After not sleeping well for a few days I can’t concentrate on anything and I have no energy.

I’m to the point of throwing caution to the wind and taking Amitriptyline to get sleep and have quality of life instead of trying one medication after another, feeling sleep deprived and not enjoying my life.

Someone mentioned a otc medication similar to Amitriptyline. What is it called?

I have a sister-in-law whose children are at their wits end dealing with her mental and physical decline. She lives in a lovely large duplex which she now will have to vacate and go into a nursing home because she is imagining that her dead husband is calling her from the lower level of her home. She was preparing to attend a wedding the other day. The trouble is there was no wedding to attend. She asked her son to give her the phone number of her dead husband, and said that he was cheating on her. She takes MANY medications!

She told me years ago that she would get lost traveling to their acreage outside of Altoona, Iowa. Not ONE of her children have even checked her medications to see if any of them would be causing her bizarre behavior. She has taken an antidepressant for years and has had many falls causing possible concussions. Many of the heart medications and blood pressure meds warn ‘beware of falls’ on their side effects. I am sick at heart to think that if I mention this information I will be totally ignored, and their mother will be in a dreaded nursing home instead of her wonderful comfortable large duplex.

I was put on a high dose (either 200mg or 250mg…can’t quite remember) of the anticholinergic drug clomipramine in 2007 (at age 19) which I took for five years. Some of the side effects I experienced include huge increases in the time I spent sleeping (up to 12 hour per night), putting on 20kg of weight and substantial increases in the amount I was sweating (had to have 2 or 3 showers a day to try combat the effects of this).

More relevant to the article (ie. from a cognitive perspective) I found it incredibly difficult to learn new skills (to the point of dropping out of further education twice within the five years I took the drug) and struggled to learn even basic skills at the (unskilled) job in retail I had at the time. My behaviour in my social life changed as well, initially for the good but ultimately for the worse (possibly due to the combination of the antidepressant with excessive alcohol consumption) which led me to getting into some really dangerous situations, eventually concluding with a temporary brain injury and short hospital stay which made me realise just how out of hand my life had become.

To cut a long story short – this drug is awful. It completely messed me up as a person and swallowed up a decent chunk of my life that I can barely remember (even though it was fairly recently and I’m only 29 now). I was not warned about the how badly it would affect my cognitive abilities (my memory and ability to learn has definitely improved in the five years I’ve been clomipramine free, but I feel aren’t as good as they were prior to taking it) or behaviour (I become completely oblivious to danger and made a number of really stupid decisions which resulted in both embarrassing myself and emotionally hurting people close to me). In fact some of my friends have said it changed my personality and that at times my behaviour was bizarre to witness.

Personally, I’d recommend avoiding this drug (or others with similar side effects) at all costs and asking your doctor for something different if you’re already on it.

I appreciate the information you’ve provided as I’ve been taking Wellbutrin for depression over 8 years. My concern is that you suggest a purposeful intention (by doctors or the pharmacy industry) to give seniors drugs that are known to cause harm via a title like “the screwing of seniors.” Shame on you for that!

There is an over the counter version of Elavil called Elavil OTC Sleep that is reformulated without the anti-cholinergic ingredient amitriptyline that is in the prescription Elavil.

Please see the following link from the FDA: https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2017/ucm562532.htm. (Omit the period at end if cutting and pasting link.) Elavil OTC Sleep is an unapproved drug.

I have never heard of this being OTC. Is there another name?

I have a myriad of health issues along with a strong family history of Lewy Body Dementia. I lost both my paternal grandmother & my father to the disease.

I am 36 years old. My father began having symptoms when he was just 50 years old, & passed away 8 years later. When I was about 25, I began taking a tricyclic antidepressant, clomipramine (Anafranil). It caused me to have horrible cognitive problems along with many other unpleasant side effects. I had difficulty finding words, & would lose my train of thought mid-sentence. I had always been an avid writer, but I found I could no longer write more than one sentence. At the time however, I was very depressed & desperate for relief, so I continued taking it in spite of the side effects, & continued for 5 years.

Somewhere along the way, my difficulty with verbal communication ceased along with most of the other side effects, but to this day, I have not been able to write like I used to. About 2 1/2 years ago, I began taking amitriptyline (Elavil) for Fibromyalgia. It worked to help me sleep & decreased my pain by 80-90%. I didn’t experience any cognitive or memory problems, however it caused excessive daytime sleepiness in addition to the significant fatigue I was already experiencing, so I began taking bupropion (Wellbutrin) to work as a stimulant & ward off the fatigue & daytime sleepiness. It worked like a wonder in this regard, & I also notice significantly improved mental clarity & memory.

A few months ago, I stumbled across an article linking anticholinergic medications, including both clomipramine & amitriptyline with an increased risk of dementia. I’m already scared out of my wits about developing this devastating disease, & with my family history, I was very alarmed when I recognized medications I had been or was currently taking on the list. I began teetering down my dose of amitriptlyine immediately, & when I was able to see my Dr, I started taking gabapentin (Neurontin) in place of amitriptyline. In a previous comment, bupropion (Wellbutrin) was mentioned as having anticholinergic activity which really surprised me given that it is stimulating. Upon further investigation, I found this mentioned other places as well, though it is not on the list linked to this article.

What I’m wondering now is, if I take a medication indicated as having anticholinergic activity, but experience a lack of cognitive, memory, or anticholinergic side effects, is it still increasing my risk? Aditionally, since gabapentin puts me to sleep, does that indicate anticholinergic activity & thus an increased risk also? And, since bupropion & has improved my cognition & memory improvement without any anticholinergic side effects, is it still increasing my risk simply based on the fact that it may have anticholinergic activity?

Incase other people may be wondering the same thing about other medications, let me just ask this: If someone takes a medication with anticholinergic activity long term, but have a complete lack of anticholinergic side effects, is it still cumulatively increasing the risk of dementia? I am very interested in this topic, however when I google specific medications in regards to whether they have anticholinergic activity, I keep coming across the same lists repeatedly without being able to find much information in regards to other medications not listed. I would appreciate any discussion or input =)

Dear Jennifer,
You certainly can still write well!!!
I’m so glad.

An old editor

First, thanks to all who are sharing their experiences here. I’m in my late 50’s and have been having some memory issues for a few years. Over the course of the last year, they have begun making it difficult at times to function.

I’ve taken many anticholinergic drugs for many years – antidepressants, tranquilizers, incontinence drugs, anti-allergy drugs… and there is a strong history of dementia among my mother’s siblings. I am just now learning of the connection between these drugs and cognitive issues, thanks to a doctor who really knows her stuff. I have fears that some of the damage may be irreversible, though I have stopped taking the worst culprits.

Memory/cognitive issues are starting to impact my daily life at this point – completely forgetting how to use equipment/objects that I have used hundreds of times, difficulties with written and oral communication/math/reading that have always come very easily to me. It sucks.

I wonder the same thing. I have been on elavil for 20 years and ativan for 5 and my cognition is getting worse. I’m 43 and everyone I tell says it’s hogwash.

So wondering if you are taking a drug with an anticholinergic, can one replace some of that by taking ACH or Choline? There are supplements with this in it, as well as certain foods high in choline. I take an over-the-counter sleep aid that contains doxalimine succinate and is the only medication including every RX sleep med known to man, and it’s better to sleep than to get 4 hours/night and waking up 6-8 x/night. And yes, I’ve had a sleep study as well as biofeedback, being hypnotized (really desperate obviously), exercise, Melatonin, etc. I take it every night and tried not taking it and was right back where I started with little to no sleep.

I’m 48. I have bad allergies and asthma, and I’m on an antidepressant. I just recently stopped taking benadryl for my allergies, I’m finding they are worse than I recall. I take Celexa for the depression, but we are in the process of weaning the dosage back. I also take Sudafed. I don’t see how I can stop this one though. The pressure in my sinuses can be horrible. I’m also forgetful. I have a full time job and three kids. How much of my memory issues are due to the drugs and how much for being really busy?

Are antibiotics that are prescribed for gum disease anticholinergic? They said some antibiotics are but not sure which are and which would be better to use. Dementia runs in the family and would not like to add to the risk but gum disease is rather serious.

My thoughts about this subject also pertain to the dangers of certain prescription drugs in general.

I have always tried to emphasize to ANYONE taking an RX med; please, please educate yourself about what you are putting in your body. Just because it was given to you by a medical professional, doesn’t mean that you can nagivigate this territory with blind faith.

And also, as “The People’s Pharmacy” tell us time and again; pharmaceutical companies don’t ALWAYS have our best interests in heart. (see generic medication debacle for example)

It is vry frightening that the drug companies have sold us as remedies the very compounds that may lead to our dementia. Tell me that they didn’t know about this!

I wonder if there is any way to reverse the effects of anticholinergics that many of us have taken for years. I would sure appreciate an article or show about putting acetylcholine BACK into our brains. Is it possible? If so, is it risky? If it is ok, then how do we do that?

Thanks!!

I’m a 54 year-old male who was diagnosed with a sleep disorder about 18 years ago. Basically, my mind went in and out of rem 60 times within 4.5 hours of sleep. I was prescribed Amitriptyline which changed my sleep tremendously for the good.

About 5 years ago Bupropion was added to my medication list due to depression. I didn’t make a negative association with my medications until reading on this subject: In the past 3-4 years my eyesight has worsened to the point of getting prescription glasses last year, and my memory is worsening. My memory has been so bad that I got to the point of going to a specialist to test my memory. I was told my memory was, “typical for a man your age”, but I knew better. I am having problems at work; arguments have increased between my wife and I in the last year due to my forgetfulness on simple things like forgetting to put food away or forgetting to simply put a dish in the oven.

My wife just read an article in our newspaper mentioning the Amitriptyline, and although it’s not a sure thing, it certainly makes sense to relate it to my increasing loss of memory of simple things these days. It’s time to look into this deeper. Thanks for the info on this site!!

That sleep disorder is called narcolepsy. Narcolepsy can also cause serious memory problems. Interestingly, people with narcolepsy have about 60% MORE histamine in their brains than people without narcolepsy. Doctors at Stanford now believe that histamine kills the neurons that secrete the chemical hypocretin (aka orexin), which is essential for maintaining proper sleep/wake cycles. Hypocretin neurons are completely, permanently dead in people with narcolepsy.
I am beginning to wonder what role anticholinergics play in the development of narcolepsy…

I was diagnosed with depression as a teenager in the 90s, and was prescribed amitriptyline. I was drowsier than ever, and a “cloud” / “fog” was in my head, and my legs felt heavy and dead until I stopped. Is there any study on anticholinergic drugs in teens and young adults? Thanks.

Also, are SSRIs shown to have any such effect?

I have been taking bupropion for chronic depression for over 20 years. I recently became aware of the increased risk of dementia as a result of taking anticholinergic drugs. (Dr. Shelly Gray’s research published this year in jama internal medicine, and other articles.)

I’ve also recently been prescribed propranolol for essential tremor, and have occasionally taken zolpidem for insomnia. Add to that a number of orthopedic surgeries with accompanying rxs for such drugs as meloxicam and gabapentin. I’m in my early 70s and am noticing memory problems. Can you advise as to whether the above medications have anticholinergic activity? thank you so much.

Zolpidem (Ambien) can contribute to memory problems. There is more information about anticholinergic medications here:
https://www.peoplespharmacy.com/2015/02/01/where-can-i-find-a-list-of-anticholinergic-drugs/

I thought Alzheimers was treated with anticholinergics? This makes no sense to me.

The drugs used to treat Alzheimer’s boost acetylcholine, a neurotransmitter. They are the opposite of anticholinergic drugs that suppress acetylcholine.

Thanks. The snowball of short term memory loss, easily distracted and behavioral changes in my husband have become unacceptable. Been able to trace it back to six months ago when he requested a less expensive alternative to $500/90day Vesicare and got oxybutynin.
Research of several documented studies about oxybutynin transferring to the brain were eye opening. No hesitation to stop taking this, but Most Concerned about physical damage done and how to cope in the future.
(I myself am a victim of my mother’s prenatal use of DES and thalidomide in the early ’60’s and those have been banned. I feel oxybutynin should be banned as well.)

I too would like to know if Fexofenadine is safe and is not an anticholinergic drug. Recently Mucinex came out with an allergy formula, and Allegra has been out for years (not referring to Allegra-D here) – Are these safer alternatives, in your opinion?

Fexofenadine does not have anticholinergic activity.

People with normal GI systems like to throw dietary advice to people with IBS-D, but in actuality most foods that are healthy for you are poison to me. I have altered my diet as much as I can to cope with IBS-D, but I must take my methscopolamine to be able to function in my job. I take the least amount I can get by with. My choices are bringing home a paycheck and possibly getting dementia later, or being in constant pain and not being able to leave the house. Some choices you just can’t win but have to pick the least painful of the two.

I just have a question: what about long-term use of gabapentin, which I take for post-herpetic neuralgia, following a bout of shingles?

Gabapentin is not an anticholinergic and doesn’t interact with most other types of receptors either.

Without some kind of sleep aid such as two Advil PM’s or a Kirkland (Costco) “Unisom-like” product containing doxylamine succinate 25 mg, I haven’t gotten a good night’s sleep in years. I once switched from Advil PM to the “Unisome-like” product thinking it was safer but alas, I now see that they’re both the dreaded anti cholinergics. With such sleep aids, I consistently get at least six to seven hours of uninterrupted sleep. I exercise daily and am in good health. I heard this morning’s program about the dangers of anti cholinergics and would love to hear suggestions for alternatives. Thanks for all you do.

Magnesium supplements; 30 minutes before going to bed helps you relax and sleep peacefully. It is also used for stress and anxiety. There are several types of magnesium. You can take multiple types of magnesium supplements, or just one type. Make sure it is highly absorbable magnesium. Trial and error until you find the one that works best for you. You will be surprised with the results.

Try Qi gong exercises. It really helps me. Also, when you are stressed out in the middle of the day, you can do the exercises You can find books or videos at your local library

Why do you bother putting up links to any old web pages if nobody can read them? I clicked on the link to the posting on anticholinergics and about two minutes into it it was blacked out by an ad for your newsletter. I was then unable to read the rest of the post. I resent the hard sell and I especially resent being restricted from the content I find important. This happens on all older web pages on your site and makes it a much less valuable resource. I have no desire to subscribe to your newsletter. I will be looking elsewhere for the information now.

If you click on the X in the upper right box of the newsletter offer, it goes away and you can finish reading. In theory, it pops up only when you are moving your cursor to leave the page. Sorry for the inconvenience.

I started taking Ipatropium Bromide nasal spray about a year ago…and when I first told the Dr I noticed a “head rush”, he just stared at me and said he has never heard of that. The past several months I have been experiencing “brain fry” every time I focus on something, and now I am sure it is the anti-cholinergic nasal spray that is causing this frustrating dilemma. I am very angry that the Drs aren’t more aware of this stuff!! Laurie

I don’t take any meds except the Spiriva I was put on last year. After taking it for about 3 weeks, I realized I was getting very “foggy brained”. My doctor just looked at me when I mentioned it. I stopped using it daily, as it was prescribed, and it seemed to take several weeks before I felt “normal” again. I’ve noticed this each time I use the Spiriva now, and only use it once every month so. After reading your article, I am so done with this stuff and will be researching what I can take in it’s place. Thank you so much for this article, I now know I’m not crazy when I tell people Spiriva makes my brain fuzzy.

WOW! Thank you so much for this! As usual you get us such important information and am so grateful.
I have similar questions as above:
1-Any info on ADD drugs?
2-Is there any hope of reversal, of regaining cognitive function after stopping these meds?
3- Oh and here is another: Homeopathic substitutes, or any substitutes that would be considered safe?
Thank you for helping keep us safe,
mary

I’m inspired and hopeful people will start and continue to delve into their ‘health & wellbeing issues! After all, we are in charge of us and our loved ones! Why in the World do so many people place all their ‘faith and trust’ in Doctor’s alone? Yes, they have education and training, but, do we all see how quickly things are coming to light, advancing, and, being discovered in the here and now! We must, as responsible adults, research like there’s no tomorrow without it, to be on the cutting edge of our RX and OTC meds. They all take a toll.
This informative newsletter shares with us that so many of our beliefs are due to big Pharmaceutical Co.’s and our almost childlike trust in the ‘medical system’.

That even though I’m having all these terrible symptoms I was told this ‘med’ would work! If in whatever reasonable amount of time, a med, has not stated making, in some telltale way, a marked improvement in your health….people, you need to stop/change it/or Doctor’s! The damage that can be done is irreversible in some cases. Be aware, ‘Research-Research.

You took the words right out of my mouth!!

It’s good to see other people posting this, as sometimes it feels like I am the only one with these thoughts!

Ever since I was given scopolamine during the birth of my first child, I have noticed that, unlike many of my friends, I do not remember events that happened before that time in my life – for example, I remember little about high school or relationships in college. I have long blamed the scopolamine, but this is the first time I have seen anything written about it. Thank you.

I am an RN, currently working in the primary care medical field. My comment may sound cruel and hard- hearted but I see this all the time: people come to the doctor with various ailments and just want a pill to make it go away, it can be for any little thing that annoys them, or barely impacts their quality of life, but they still want a pill when they come to the doctor. People need to be accountable for their own lives, they need to research meds that are offered to them, (often given under pressure to the doctor to prescribe something )and they also need to just plain “suck it up”.

Not every ailment one has needs a medication to treat it, many things could be alleviated with a healthy diet, weight loss, exercise, good mental health practices, etc. (such as “fibromyalgia, insomnia, hyperactivity in kids) We are a society as a whole who wants the quick fix, with none of the work.

People want antibiotics for colds, sinus symptoms of 2 days duration, you name it, they want a pill to make it go away, rather than try a sensible holistic approach. I have seen very young kids getting bad side effects from tamiflu, that they insisted on getting a script for, to lessen the effect of the flu by what-1-2 days? I would never subject my child to such a questionable thing, unless their was a very true medical need to do so. As I said, I don’t want to sound uncaring or unfeeling, but people need to take charge of their lives, stop blindly trusting pharmaceutical companies, blindly trusting all doctors and do some of their own research to help determine their own course of action.

I think perhaps there are some people who visit their doctors wanting quick fixes, but in actuality there’s a FAR larger number of people seeking advice and help to be healthier. I have found over the last year of experiencing multiple health issues, that my doctors/nurse practitioners/anyone I’ve seen have been TERRIBLE at diagnosing, even common problems, and have relied on trying to prescribe me medications to cover up things. I’m so sick of it, and I’ve learned to research after I had awful side effects from a prescribed muscle relaxer. Messing with the CNS is no joke, and I’m stunned that medical professionals prescribe such medicines like candy. I rarely take my prescribed medicines lately, since I’ve been researching them beforehand. Keep in mind, none were to treat life threatening conditions, so I’m not advocating not taking necessary medicines. Anyway, I’m very frustrated with my doctors and the lack of knowledge they seem to have in diagnosing and treating.

You are correct. I got in the habit of taking ambien in the middle of the night to get back to sleep. For whatever reason, I’m having trouble getting the prescription refilled and have been trying to survive on 4 hours of sleep a night, which is about 1.5 hours less than I was getting before the ambien. The body becomes dependent on the pills and takes weeks to get back to its original state once you quit taking them.

. . . the sad truth is, medications are tested for ONLY 2 – 8 WEEKS before being approved and those tests are very very limited (narrow in terms of this effects and conditions they look at) AND the pharmaceutical companies test their own medications . . .

The fox is watching the hen house.

Maybe start to think of yourself and a CONSUMER of medical services rather than a “patient”, the same way you might think of yourself as a consumer of other services like that of a plumber or builder. The reality is, that that is the world we are in.

Also . . .

Short of a complete medical emergency . . .

ALWAYS do your own research–A LOT OF IT–and allow yourself time to do it well. Don’t take for granted that what any doctor or other healthcare provider tells you is correct; the whole story; right for you; right for your life; etc. (One size does not fit all.)

GIVE YOURSELF TIME to truly consider not only the good, but also the bad, the ugly, and the UNKNOWNS of a medication (and any other medical treatment);

BE VERY VIGILANT–avoid the dangerous downward spiral, i.e., problems caused by the medication mistaken for a worsening of the medical condition it is supposed to treat, or for the emergence of another medical condition, leading to yet more medication (or medical procedures) . . . and on and on. YOU CANNOT TAKE FOR GRANTED THAT YOUR DOCTOR WILL AVOID THIS.

RESIST ALL PRESSURE and “tsk-tsk” finger wagging (shaming) from doctors, etc., family members, etc., when taking THE TIME YOU NEED to decide if a medication recommendation or other medical recommendation is Okay for you and your life . . . BECAUSE IT IS YOU AND YOUR LIFE . . . YOU ARE WORTH THE TIME TO DECIDE WELL FOR YOURSELF.

RESIST THE FEAR- PRESSURE SALE . . . It might sound something like this “You have to take this medication or (insert serious and sometimes scary sounding consequence here).

I’ve been taking anti cholinergics for years for various ailments, none of them diazepines. I’ve never noticed any brain/memory fuzziness and the help with IBS, chronic rhinitis or allergies has been helpful. I’m wondering now if I should stop the antihistamines, meclizine and whatever else might have this ingredient. If you need the anti cholinergics for quality of life issues, like dizziness or IBS big time, how do you decide what course to take? I’m in the early senior citizen category and don’t want dementia. Help!! Advice, welcome.

Scary stuff! Before the advent of computers in every home this kind of information would never have come to light for patients and, yes, many doctors. I suffer from diabetic, and other, neuropathy that presents itself as burning. It took a long time before I was diagnosed with diabetes, even longer, and only with the help of my internet group, until I learned good control. I also have fibro.

When I hit my late 50s, the burning became unbearable and I was put on gabapentin. That failed after a few years and I graduated to lyrica, max dose. Occasional alprazolam to help with sleep. About 10 years ago, in my mid to late 60s, I began noticing confusion and mci. Research led me to choline, and I began using it, to mag threonate somewhat recently. But I will go wild with pain without the lyrica. I suspect many of us are in the same kind of trap.

What we need is more research, perhaps thru functional medicine to enhance cognition, in spite of the anti-cholinergics. Or something to replace them without the side effects. I am 77 now, would love to wean myself off lyrica. However, the one time I tried, I could not handle the pain, which, btw, is not touched by pain meds. Science has found ways to extend lives ( I have had four cancers and a huge blood clot in my largest cardiac artery), but at a cost to the quality of those lives.

Thanks for this alert. I have long lectured myself about taking the common over-the-counter antihistamine doxylamine succinate for sleep. I just saw the physician’s assistant on Monday to extend my CPAP machine prescription and raised the issue. “Don’t worry about it,” he said. Well, I’m going to worry about it! Time to get off, once and for all. What is a puzzle to me is that I have researched negative side effects before and haven’t found the anticholinergic connection. Now, a google search brings that up immediately. I repeat (and at least I know I’m repeating): Thanks for this alert! It’s just what I needed to clean up my act.

I googled “Doxylamine Succinate alzheimers” and nothing shows up about the recent study. Is this antihistamine safe?

Until I read this article I thought I was just sensitive to Xanax which I would usually take at bedtime. Now I know why I could not get out of bed on time the next morning and why my brain remained fuzzy for hours after awakening. No more Xanax for me!

Stopping Xanax (benzo) can take over 6 months done properly.
Otherwise withdrawal can be “unbearable”, and can last 2 years. I am learning that the very hard way; I was on Xanax 10 years, then Klonopin 10 years; at low doses, but far too long.
Benzo’s are only for up to 2 months, with long gaps between cycles.

I have the same concern about some statins having the same problem. Any information on this? I have experienced similar experience with Pravastatin and simvastatin. When I looked in to this I found others had the same experience which had actually been referred to as “brain fog.”

This is an experience with aricept (donepizil) I am speaking as a caregiver-the person taking aricept (supposed to slow down dementia-alzheimers) was unable to sleep -at night-became more mentally confused-and was getting very weak-upon discontinuing the aricept-these symptoms disappeared.

My primary doc has prescribed a dose of one 0.5 mg of lorazapam nightly to help me deal with my chronic insomnia for several years. This seems to be a standard practice. Since it helps, and everyone is saying that the lack of sleep is what causes a host of medical problems and an early death, I’m wondering what you think of my continuing this medication at such a low dose? Thanks for your input! I don’t take anything else, except a mild dosage of generic Coreg (3.15 mg 2x daily for borderline high blood pressure (140/85) and I am 68. Best, Chuck

Re-Chuck’s inquiry of 1/28/2015……I am interested in any response to his inquiry….I am on the same exact dose of the same exact med for the same exact thing….and….I am the same exact age…..could have been me writing that…..Thank you for any enlighting information. I am appalled at this new information about the dementia and alzheimer’s…….associated with the usage of the anti anxiety meds etc……I would like to know what do you do for the insomnia problem, if you cannot or should not use those drugs…..
Thanks so much…..
Karen

Does this mean that cetirizine, 2nd generation anti-histamine is probably safe? I take it daily because I’ve developed an allergy to my cat. I want to keep my cat but I’d rather keep my mind!

Thanks for sharing this information. I am wondering if any studies have been done on ADD medications and the risk for dementia/alzheimers? I have a friend taking Vyvanse and am very concerned. Have any studies been done on ADD medications? Their use is very widespread in the U.S.

The anti-cholinergic problem may be real but the associations to date just raise more questions than answers about cause and effect. Anti-cholinergic drugs most likely have a short term reversible effect on brain function. Captopril, other ace- inhibitors are one class of drug given by docs for long periods which may cause problems this way leading to poor function. Dosing of the drugs with anti-cholinergic side effects is worth more consideration.

This is more of a question. Would Allegra 180mg be considered in this group of medications.

You did not mention the antihistamine Tripolidine HCl. This is found in Actifed. Is this included in the above group? Thanks.

As an MD and psychiatrist I am always wary driving especially in medical areas because of so many people on regular daily anti cholinergics- likely more commonly the cause of accidents than alcohol

But is there hope? if a patient goes off the drug(s) will they regain cognitive sharpness?

Thank you for this and all you do to enhance our lives.

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