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
“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.