The People's Perspective on Medicine

Where Can I Find A List of Anticholinergic Drugs?

People taking anticholinergic drugs over a long period of time may be at greater risk of developing dementia.
Your prescription drugs

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. 

A study published in JAMA Internal Medicine (June 24, 2019) detected a higher risk of dementia among people taking several anticholinergic drugs. The British investigators found that medications for depression, Parkinson disease, schizophrenia and similar disorders, overactive bladder and epilepsy were especially likely to cause people trouble. Taking more than one of these drugs, or taking a high dose for an extended period, increased the likelihood of cognitive difficulties among these individuals who were 55 years old or older.

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.

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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.

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, 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]
  • Methadone [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]
  • Oxcarbazepine (Trileptal) [moderate AC activity]
  • Quetiapine (Seroquel) [moderate AC activity]
  • Pimozide (Orap) [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) [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

BMC Geriatrics (Oct. 11, 2018)

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 based in part 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). Also “An anticholinergic burden score for German prescriber: Score development,” (BMC Geriatrics, Oct. 11, 2018)

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Injuries Due to Falls:

Another worrisome side effect of multiple anticholinergic drugs is a greater chance of a dangerous fall (Drugs & Aging, March 2019). A study of more than 10,000 older Americans found that those taking two or more medicines with moderate or high anticholinergic activity were twice as likely to injure themselves in a fall.

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 Elavil is the only one that worked.

“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?

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

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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.” .
Drugs and Older People

Download this guide to drugs that are usually inappropriate for older people. Avoiding drug-induced forgetfulness and falls.

Drugs and Older People
  • Coupland CAC et al, "Anticholinergic drug exposure and the risk of dementia: A nested case-control study." JAMA Internal Medicine, June 24, 2019. doi:10.1001/jamainternmed.2019.0677
  • Wu YH et al, "Association between using medications with anticholinergic properties and short-term cognitive decline among older men: A retrospective cohort study in Taiwan." Geriatrics & Gerontology International, April 2017. DOI: 10.1111/ggi.13032
  • Risacher SL et al, "Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults." JAMA Neurology, June 2016. DOI: 10.1001/jamaneurol.2016.0580
  • Kiesel EK et al, "An anticholinergic burden score for German prescribers: Score development." BMC Geriatrics, Oct. 11, 2018. DOI: 10.1186/s12877-018-0929-6
  • Green AR et al, "Drugs contributing to anticholinergic burden and risk of fall or fall-related injury among older adults with mild cognitive impairment, dementia and multiple chronic conditions: A retrospective cohort study." Drugs & Aging, March 2019. DOI: 10.1007/s40266-018-00630-z
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Wow,scary! Many of these have been prescribed for me over the years for various reasons. Many made me feel “weird” so stopped them. Some still taken on occasion. Am 84 years old with unsteady gait since on BP med Amlodopine which I take nightly. Retired RN.

Slammed with prednizone and other respiratory meds (albuterol, symbacort, etc.) for 3 solid months two years ago during a misdiagnosis incident. Never recovered clarity of mind such as organizational skills, and still in a state of anhedonia.

I was on Tudorza for COPD. That is the most gosh-awful inhaler I have ever used. Went to the pharmacist and asked him what was going on. He told me I was allergic to antichlorgentics. My veins felt like cement was in them. I was out of it, stumbling around, constantly thirsty. I felt like I was going to die. Felt the same way on zyrtec, claritin, and nexium also. The Tudorza was the worst.

Colestipol should be on the list. I began this prescription to be used off-label to help with almost daily diarrhea after gall bladder surgery almost nine years ago. I was told to take two 1,000 mg tabs a day. My NP said that I could vary the dose to fine-tune. Within two doses my diarrhea stopped (after fats or salads or what ever), but I started having memory problems, mostly short-term. The more doses I took, that helped, the worse my memory became. So, I tapered off to one 1,000 mg dose every other day, and sometimes I try to go three or four days between doses. My memory gets better. Increase doses, and my memory gets bad.

I have been on Tizanidine for years, possibly 15+ years for cervical spinal cord injury due to an automobile accident. I take a low dose, 4 mg, one tablet at bedtime, however, when I am having severe muscle spasms (as often as once a month lasting 2-3 days) I will take 1-2 tablets every 4-6 hrs during that time. I have gone through periods over these last years of being prescribed 2 tablets at bedtime and/or 1 tablet every 4-6 hrs routinely when my pain level remains at high over a an extended time (3+ weeks until my pain level lessens.)

I am now concerned seeing this medication on the list at High AC.

Are my concerns valid?

This does not surprise me, as I find a lot of over-the-counter drugs cause reactions. My mother was on Surmontil for over 30 years, and even before she died the hospital staff were amazed at her clear thinking. However, she also took other drugs listed there at times, and it explains to me why sometimes she appeared dazed, and she would get the staggers. She did suffer from dry eyes and mouth, also dry skin and odd attacks of dizziness. I look back and really wonder why her Dr. did not take her off these drugs . Thank you for this article, and I feel these dangerous side effects need to be highlighted more. Doctors also need to be educated and not just put cognitive decline down to old age.

I just turned 60 and used to have an amazing memory, but have noticed a frightening decline in the last few years, having difficulty finding words, and being able to respond clearly and intelligently to questions, something I was always able to do easily. I have been taking Carisoprodol and Diphenhydramine on a daily basis for close to 10 years for neck pain and as a sleep aid. Both of these drugs appear on the anticholinergic list as having a “high AC effect”. I stopped taking both drugs immediately in May 2018 when I stumbled across an article that listed them as causing early dementia. Prior to reading the article, I had been joking with friends about having early Alzheimer’s (I joked, but was becoming increasing concerned about the decline in the way my brain responded), and am frightened that I have caused the condition because of the medications I took. What is even more upsetting is that there does not seem to be any indication that if you stop taking the drugs, the adverse effects reverse. I have not been taking them for 5 months and have seen no improvements in the way my brain now works. Note that I exercise regularly and eat a healthy diet, which may have kept the effects from being worse (at this point) than they could have been. Does anyone know if the decline continues after you stop taking the meds, or if the decline continues to worsen?

Every medication behind the pharmacy counter has its dangers; the limiting factor is how much can the body tolerate, or more precisely, how much is the patient willing to gamble on his health? What is most disturbing is how many over-the-counter drugs are also included.

My 80 yr old sister used xanax for napping and sleeping at night. Neither I nor my nurse niece could talk her out of it. Robbed her of her memory and finally took her life. Xanax is a short-term med and commonly abused by seniors and others.

Where is Ambien (Zolpidem) on the list? I take 5mg to sleep only when traveling. My dr. said to quit, and I know it means I will not sleep while away from home.

I take no meds, but need a safe one for sleeping to enjoy a vacation. I truly need to know, What is safe? I read that naltrexone is , but it takes weeks before being effective, therefore of no help to me.

I take low dose benedryl and zyrtec nightly for angiodema, a severe allergic condition; in addition to melatonin for sleep help. The only sleepless time of the month is the full moon. Guess I’m a “lunatic” for sure. I’ve taken these since year 2000 and still have no memory problems of which I’m aware.

I have restless legs. What can I do other than take the Miapex that I am taking now ?

My Mother was on several of the high-risk drugs listed here for over thirty years, and when she passed on aged 86 her memory was as sharp as ever. So I wonder about this report. I do know that certain drugs do impair the thinking process but is it only down to drugs? I find if I take something that interferes with my thinking ability it kicks in after about three days, yet a lot of the commentators admit to being on these medicines over 20 years. I personally take the lowest dose of any drug for the shortest time possible and look for a more natural remedy for whatever ails me. I also research everything I have to take thoroughly and even try to look up drugs I currently do not need just in case I do so I can ask for the one that has the least side effects.

I find Drs are all too quick to prescribe medicine for ailments rather than looking at the root cause. I once had severe pain radiating from my spine into my arms and legs. My GP took a look and handed over a script for Tramadol. I took two and soon realised these drugs were mind-altering so I went instead to a chiropractor. Four months later I was totally pain-free and my spine realigned. She actually eased my pain the first day, and over the following months straightened my spine and taught me exercises to maintain it.

I’d like to know why Google Chrome no longer shows full lists of all these medications & who the list originates from. I used to be able to find the full lists & what group they were in as to a high chance or medum chance of loss of cognitive function, memory loss, etc. & there were also listed, drugs that were thought to possibly have anticholinergic effects. I can no longer find these lists. I’d like to know why. I printed 2 of the lists when they were in Google Chrome’s vast lot of information & I found that I had taken many of them for extensive periods of time. There were many antidepressants included in these lists. I’d like to be able to print all of these lists as some did not agree with others. This AARP list is not a full list.

I agree with you. There used to be a huge spreadsheet listing all suspected anticholinergic meds and it has been taken down and it angers me.

I, too have been taking Amitripyline 50 mg for at least 20 years before bed to help me sleep. I have Fibromyalgia. I tried to get off of it twice, but ended up with insomnia and felt I was having a nervous breakdown. I do not believe most doctors know how to help lessen the symtoms that result from discontinuing this drug. Doctors tried to lessen dosage to half, which did no good at all. My short term memory is awful and has caused me to lose self-confidence, feeling so different from everyone else. Has anyone been successful getting off this drug? What is the process? What can I do to lessen symptoms of withdrawal, and what drug is safe to take in place of the Amitriptylene? Should I see a neurologist? I would so appreciate any help I can get. Thanks.

Where is Benadryl on your list of anticholinergics?

I am going through the same thing, I’ve been on amitriptyline for ten years or more. My cognition is not that great, and has a negative affect on my life. I am 64 years old. I am wanting to stop taking it, and I am on day two, my nerves are really jangly. I also have fibromyalgia, and have been taking it for pain management. I am going to go see my doctor today. I have been diagnosed with sojgrens, which causes drying, it is systematic in the way that lupus is.

It can affect any part of the body including the brain, joints, eyes, nose, glands. The amitriptyline is probably contributing to it. I am at a loss to know what else to do. I read that it takes at least 4 days for the drug to clear out of your system. They say that you should come of it gradually, but I am only taking the 50 mgs, so I’m trying it cold.

So far, it is only affecting my central nervous system. I am experiencing a bit of anxiety, I am going to try and tolerate it, because it scares me. My mom had Alzheimer’s real bad, she passed away last year. I am afraid that I may end up like her. I am quitting this drug, no matter what.

Have been taking amitriptyline for severe insomnia (and depression) for the past 20 yrs. It was the only thing that worked, and it changed my life. I am 57 now, and my short term memory is declining rapidly. I can’t remember what someone just said to me seconds ago. I heard it and even replied to it when it was first said, but seconds later I have no clue what it was. So like everyone here, I’m stuck trying to decide if I should suffer the severe withdrawal, insomnia and depression that will most likely destroy my life, or choose to stay on them and have my brain become mush.

My Mom is on like 3 of these drugs and I can tell when she has taken them. She cannot process any information or remember what we talked about 5 minutes ago. I highly recommend moving to safer options if you can.

Re the question about aluminum. The last time I researched this, my impression was that the blood-brain barrier gets damaged and dangerous stuff (like aluminum) gets in when it shouldn’t, and then the brain’s “cleansing” system can get overloaded or damaged too, and then the harmful substances don’t get cleared out and cause tangles and do damage, etc. So, even though aluminum may not be the actual CAUSE, it is a known neurotoxin, and there is no reason you should be putting it in your body. Use tums. Or plain old baking soda in water.

For those of you on anticholinergic sleep meds, a possible low-tech, cheap solution is a sleep mask. Once peri-menopause hit I just stopped sleeping! With a small dose of melatonin and my mask, I sleep like a rock now.

What is a sleep mask? You mean one of those sinus or headache type gel masks for sleep.

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

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.

Wonderful article, describing the anticholinergics.

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.

Thank you for researching this and making the info available.


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.

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.

As a person in “the same boat” with you and others on this website, I suggest doing very thorough research on the internet regarding the drugs you are on and your medical conditions and finding and talking with a few good doctors — preferably specialists, and seek a second or third opinion regarding alternative medications — if there are any. Many people (including many of my friends and family members, and lots of TV doctors on PBS, etc.) would urge us to try dietary changes and healthier food and natural remedies, exercise and other healthy life-style changes. I am about to try them b/c I am over 65 years old and all of the info about prescription drugs (and some OTC drugs) is so scary and I am on several. I realize that I am, or will not willing to give up some of them. I think it’s a “balancing test”.

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!

My husband has a history of asthma, but it had been controlled with mild use of meds. Last year his symptoms became much worse and meds were increased for months. After about six months, allergist believed that chest congestion was not really due to asthma. Referred to pulmonologist who believed that it was caused by silent reflux. He had recently stopped taking Nexium and had no reflux symptoms. Gastroenterologist determined by upper endoscopy that he had bad reflux with yeast infection. Treatment for the yeast and return to Nexium helped the respiratory symptoms heal within the predicted three months. Maybe check for silent reflux?

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?

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.

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.

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.

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.

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.

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!

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?

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.

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.

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?

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.

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.

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.

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.

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

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

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 ?

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.

A missing drug is Doxylamine succinate. It is a strong anticholinergic and found in NyQuil


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.

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!

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.

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.

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.”

After this article came out, I began to wonder if the 50mg of liquid Benadryl give during my 6 Mos of chemo(administered prior to each treatment), was actually a larger contributor to ‘chemo-brain’, or brain fog. Was also on ambien because of life-long sleep issues. My dosage was forcefully reduced because I am female. Had tried 5mg dose myself, to wean off, to no avail, so just stopped it altogether.
However, was introduced to pure lavendar essential oil (2-3 drops rubbed onto the soles of my feet, and I sleep about 6 hours a night about 98% of the time!
I still have minimal memories of those 6 Mos of chemo, 6+ years ago, but am considered an anomaly, as I was not expected to survive!

I have been taking doxylamine succinate (Unisom) for years. I take 1/2 of a 25 mg tablet and I sleep well. I am 74 years old and am experiencing “brain fog” more recently. I was assuming it was a part of my aging process. However after listening to your program last week I am beginning to wonder if the sleep-aid is actually causing the problem. If it is, can the damage be reversed? I plan to stop taking them immediately. I have tried natural sleep aids but they don’t seem to work for me. Is there a supplement that I can take that would get my brain working the way it should? I am very worried about this. Thank you.

I have been taking 50mg of Diphenthydramine HCL, same sleeping aid every night for insomnia for years. I also have had a fractured ankle injury that I have been taking one (and only one) oxcycodone every day. I have since developed gastroperasis (sp) delayed emptying of the gastric contents into the small intestines. Evidently, these cause damage to the vagus nerve, which controls EVERYTHING!

Needless to say, I am stopping everything cold turkey. No wonder there is an increase of ALZ, dementia, GERD, immobility. These drugs are killing us.

What is the alternative to meds with Diphenhydramine (DPH)?

Depends on what you are taking it for. It is used commonly for both sleep and allergies. It is also taken occasionally for motion sickness. This is a pretty great resource regardless, I think. It’s not specific to anticholinergics but does include many, since it is an article published in the Journal of the American Geriatric Society that provides a list of alternatives to drugs that should generally be avoided in elderly patients and thus includes many antocholinergic medications. You can access it here for free:

Atarax and benedryl were routinely administered in the chemotherapy I received for breast cancer. After 5 months of chemo, I attributed my loss of mental function to a condition I read about called “chemo brain” — and chalked it up as another price paid in side affects for the benefit of staying alive.

Because these two drugs were dispensed so often and so casually, I have taken them both since chemo, especially benedryl, because I am allergic to certain insect bites, and because it can aid in sleep. The big-gun cancer drugs have caused organ damage, aging organs 20-25 yrs. I’d say. It may be that the anticholinergics are responsible for the most frustrating loss I have experienced! I remember reading about taking choline back in the ’70’s (Durk Pearson, author of Life Extension) and wonder if that is related…..wishful thinking on my part.

I have IBS and cannot eat anything without getting diarrhea. My fam phys. has had me on Bentyl 15 min. before meals for 16 yrs. I have become increasingly concerned, as my Mother had Alzheimer’s. What is safe ???

Ask your doctor about one of the newer drugs for IBS with diarrhea. They are Xifaxan and Viberzi.
They definitely have side effects, and they are pricey, but they might be appropriate. Find out.

Have been taking allergy meds since I was just a child. Am now 78 yrs. On top of that, I have been on many other anticholinergics over the years as well. Now I know why my memory problems are increasing! I truly believe the less drugs the better! Outside of Vitamin B-12 shots once every few months, my grandma did not take any RX Drugs or over the counter meds & she lived to be 97. She also ate plenty of butter, cooked with lard and bacon grease. So There !!!

I am on several medicines that are anticholinergic, Norvasc/Amlodipine Besylate for blood pressure, which seems to have the most effect, with Cogentin. The Constipation required prune juice and fiber like 3 times a day to fix, Cogentin had to go!

I’ve been prescribed Ziprasidone for thinking, it doesn’t work, and low doses of thorazine and benadryl for sleep daily, and ambien in case those don’t work. The only med I take that’s not anticholinergic is lithium, to prevent mania, and it has damaged my kidneys. Ive been telling my doctors for a year that I’ve been having memory problems at times, and it’s like they don’t listen or care, so long as my blood pressure is good, my sleep is o.k., and I’m not crazy. Now that I’ve read this article I’m going to press for changes. Thanks for the information!

I believe it and have personally witnessed it. I have taken more than one meds from this list are various time. Some were prescribed. i have had to get off due to difficulty processing and recalling info and with word finding. A long time ago I decided for myself that anticholingeric meds create stupidity in me. I can’t afford to swallow stupidity.

Is Doxylamine Succinate considered an anticholinergic drug? I don’t see it on the list.

It is. See:

Not every list contains all of the drugs. Doxylamine is considered a strong antocholinergic, though. It is ironically often omitted from the most current lists because it is not used much. Unisom is occasionally doxylamine but more often contains diphenhydramine as its active ingredient (no, this is *not* cool in my opinion, but you can thank the FDA).

Best to you!

So, I’ve taken Benedryl since I was a child and I also take zrytec. I take them for allergies.

What am I to do instead of suffering with the food and other allergies until God heals me? ? ? I’m 63, have good memory and I am doing well. My memory is absolutely just fine.
When I don’t take these I have some serious issues with rash, itching and other problems. They work thank the Lord! Other things have been tried that did not work.

If you have never been tested for celiac disease, you need to. A form of celiac disease, Dermatitis Herpetiformis, shows up as an itchy rash. Those with celiac disease often have allergies and food sensitivities. Make sure you DO NOT start eating gluten-free before getting tested or you will have a false-negative test result. Be aware that some people’s celiac blood panel may be negative, but the biopsy (gold standard of diagnosis) may be positive for celiac.

Alavert (fexofenadine hydrochloride) is a good allergy med. It is not on the list, but it is also a little more expensive.

My wife used scopolamine patch 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 and her life style and family history indicated no danger signs.

We are still searching in vain for a remedy.
B and M

Thank you, Peoples Pharmacy! Just recently I was trying to think of why Diphenhydramine was considered harmful, and mentioned in a comment that it would be great if you would do a piece on diphenhydramine. And now you have! What a shame, because Benadryl does work very well. I had a bottle but only took one rarely and threw them out years ago. I still use an Ambien about once every 3 weeks, but of course that adds to the Alzheimer’s risk too. With Rx meds, one thing has become apparent: there ain’t no free lunch, that’s for sure.

I have been on Amytriptyline for my Fibromyalgia.I have tried other meds. and the Elavil is the only one that worked in shutting my brain.I am suffering memory loss ( used to have photographic memery) but now I can’t remember from second to second.I also been having dizziness.I have been on this medication for twenty years.I have tried getting off the med. but after two weeks I could hardly move and had severe pain every where.Any suggestion(s) would be greatfuly acepted.Thanks for your help and time.
Eileen J.

It might be possible that you actually have drug-induced lupus (super similar symptoms, including fatigue, severe joint pain and muscle aches, confusion, low-grade fever, etc.). I had it and was misdiagnosed with fibromyalgia.

Nice thing about drug-induced lupus is that symptoms generally go away within weeks or months of stopping the drug(s) causing them. I wrote a paper on it that is short but clarifies tests and provides lots of references (see link below). It’s intended for medical providers but might be helpful, since diagnosing isn’t terribly difficult. You can certainly take to your medical provider to see if it might apply to you. If you really do have fibromyalgia, perhaps acupuncture might be helpful. I wish you the best.

I believe gabapentin/Neurontin is a scripted anticholinergic not shomown here. I consider it a wonder drug, and have taken for cervical dystonia for 18 years. Also have used diphenhydramine since forever. I’ve always had a detailed memory that is scary accurate.
Benefits way override any problems.

I take gabapentin , too. It works as a wonder drug for everything from migraines and menopause to seizures and bipolar condition! Wow. But for me this comes at a price and forces me to make a choice. My cognitive skills have deteriorated and I am afraid I will never go to college. I tried to go off it, and had the most horrible withdrawal. I won’t list all of those symptoms, but just know by day 4 my breathing was so shallow and my heart rate was down to 35bpm, they had to put me back on large doses.
My father just died of Alzheimer’s. He was my true love. We miss him so much and watched our father age 50 years in one single decade. He died at 76. If the pattern is anything like it was when my Grandmother died at 93, Dad at 76, I am 46. Anytime, right? I have sle and I am on a quarter of the meds on here just about.
I hope I can still learn the things I love. Even now my thoughts are all over the place.

Joe and Terry, this is unbelievably timed. Have had a terrible unknown reason and unusual allergy. Woke to HUGE swollen, blistered, cracked painful lips inflammation and rash from nose to chin and an inch or more to either side. Tried every cream lotion–nothing helped. After 8 WEEKS decided to try Benedryl. Took Benedryl and used the cream on lips. Benedryl safe right? Told to always have on hand. Last week I began to mess up every commitment, could not function properly or make decisions. It was so terrible, but I thought it was the allergy when it appears now to have been the Benedryl!
Now ‘hayfever’ has taken hold and I was thinking of Zyrtec or Claritin! Even antihistamines, always thought as safe and given to BABIES! How many times ordered by pediatricians—sickness and even airplane rides.
Guess local honey is the only recourse and hope for the best.
Often traveled to 3rd world countries and carried Lomotil–even needing to take at times. Always recommended by doctor and in the last years given an RX.
No memory of what given for childbirth.
I am astounded and so very grateful for the alert and this list.
Now to search site for ‘natural’ allergy relief suggestions. Hope to find many.
thank you!

Allegra (fexofenadine) is an antihistamine that is not anticholinergic according to credible resources (e.g., Ryan M. Carnahan, R.M., Lund, B.C., Perry, P.J., Pollock, B.G., & Culp, K.R. (2006). The Anticholinergic Drug Scale as a Measure of Drug-Related Anticholinergic Burden: Associations With Serum Anticholinergic Activity. Journal Of Clinical Pharmacology, 46(12):1481-1486.) In addition, your physician may elect to prescribe montelukast (aka Singulair) to treat hayfever, hives, etc., if OTC Allegra isn’t sufficient (see right hand info box at:
Best to you!

I have to take phenegran a few times a week I suffer from chronic unexplained nausea. I have been using this medication for about 6-7 years I use it maybe 4 days a week depending. It does take 24-48 hours sometimes for the mediation to wear off you feel like you are in a fog.I can’t use any of the other because of side effects like regalin .I used Zofan which I liked no sleepiness for about a year but it suddenly started to make my pressure go very high after taking it that is when I was switched to Phenegran .I also have Compazine if all else fail I have to go to that that I may use 20 times a year. Also use Pepto ,Tums & Emetrol. All of the natural stuff works maybe 10% of the time ( Ice,Ginger,Cola syrup , etc..)

How about Allegra? Or Flonase or Nasacort? Or Singulair? None of the various anticholinergic drug lists consider those to be problematice. I mean if you can’t find a natural alternative.

Mary, I also had unexplained nausea quite often. Told my chiropractor in LA, he said to exhale and then he pushed his fist down my abdomen from diaphragm area to left side of colon all the way down. Turns out my long, narrow stomach got caught and squeezed by the diaphragm opening and got stuck. I now do it myself… inhale, exhale and push my fist down to the left inside of hip bone. Sometimes I take some cider vinegar in water, works well for me.

Atrovent is on my list.

As always, consult a health care provider! If your Physician or PA prescribes something, ask questions and share your concerns, but take what is prescribed for the condition/situation you have!

This said, if a problem lessons or goes away or you think a medication is no longer working, share THAT information with your provider as well.

For example, I have taken cyclobenzaprine (Flexeril) for years for severe muscle spasms. It is an anticholinergic and I want to minimize my use of that class of drugs. With my doc’s knowledge (although I am, myself, a physician assistant) I am discontinuing – gradually – my use of cyclobenzaprine, and it’s going just fine!

Patients need to be proactive with their health and their concerns, but need to be certain that they keep their health care provider(s) involved!

As always, consult a health care provider! If your Physician or PA prescribes something, ask questions and share your concerns, but take what is prescribed for the condition/situation you have!

This said, is a problem lessons or goes away or you think a medication is no longer working, share THAT information with your provider as well.

For example, I have taken cyclobenzaprine (Flexeril) for years for severe muscle spasms. It is an anticholinergic and I want to minimize my use of that class of drugs. With my doc’s knowledge (although I am, myself, a physician assistant) I am discontinuing – gradually – my use of cyclobenzaprine, and it’s going just fine!

Patients need to be proactive with their health and their concerns, but need to be certain that they keep their health care provider(s) involved!

I can’t directly comment on the specifics of this study but note that many small scale and some larger scale studies bring out associations between drugs or foods or lifestyles with certain health issues but may not show direct cause and effect. In the case of sleeping medications it is best to not take them, however not sleeping also seems to be associated with alzheimers. This points out something to take into consideration when taking medication and avoiding these meds if not really needed but like much of life it is risk versus benefit. When possible to the least risk to obtain the most benefit.

Please add Loperamide (Imodium) and Diphenoxyl Atropine (Lomotil) to your list of anticholinergic drugs. And add to the symptoms poor balance (risk of falling). I have experienced cognitive difficulties from these drugs and, when I take them, I have difficulty walking a straight line and balancing while going up and down steps. The cognitive problems mimic dementia. The balance problems can be dangerous.

I am 77 and beginning to get some short term memory issues and reading comprehension issues. I am very sedentary because of back and knee pain.
I take Flexeril once at night for back and knee pain and it helps me sleep. Is Flexeril possibly causing my memory issues? Is there a better pain med for my back and knee pain and sleep?
I’m also troubled by constipation. I take a laxative, Aloe Vera gel, and prunes before breakfast. Is there something better? I am thinking of asking for prescription Linzess.

Mary’s suggestions on probiotics and flax are great, especially golden flax tastes milder. Coffee grinders are a great appliance to have, I use one just for seeds and nuts to make “flour”. Make pancakes with eggs, coconut oil, flax meal, chia seeds ground, pumpkin seed meal, buckwheat flour, cinnamon, almond milk, gluten free flour from Bob’s Red mill with sorghum and garbanzo meal in it for fiber.

Also, sunflower seeds (unroasted, plain) for crunch and small diced apples or you can use diced prunes. I use the same ingredients with baking powder, and make an apple cake which is faster than making pancakes. Be creative, this works too well sometimes and I use some coconut which binds. Got constipation once eating too many macaroons.

Hi Betty,
Just a thought—Rather than a laxative you might learn about probiotics.
As well incorporate ground flax seed into your diet or take a spoonful of ground flax mixed in some water, then followed by another glass of water. Just be certain to buy whole seeds and grind as you use them, never buy pre-ground. Simple coffee grinder works well. Flax has many additional health benefits as well. Bet there are articles in PP Library for you to check out both these suggestions.
I wish you the best of health

Does Gabapentin fall into this category?

This study was based on ELDERLY (already at risk) African-Americans (a distinct population) and should not be considered a reason for panicking people. I hate that these studies are flung into the population without adequate background, and people panic and stop taking medications they should. They were also based on DAILY Benadryl for a YEAR before significant affect might be noted. To be clear on things too, I am third generation in line for Alzeheimers, my maternal grandmother and mother both had it. My husband’s mother had it. So, I’m very much being careful. Best bet to avoid it: Exercise. Variety of foods in moderation. Drink in moderation. USE your brain in many ways: sing, create things, read, play games, go outside, etc.

Sorry, you are totally mistaken about the study population. The subjects were 65 and over but not disproportionately represent a racial minority of any type. Also, check out the other human epidemiology studies and the numerous animal studies, plus molecular and cellular studies and recent human imaging studies (latter => Risacher, SL, McDonald, BC, Tallman, EF, et al. Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults. JAMA Neurol 2016; doi:10.1001/jamaneurol.2016.0580). The results of these various studies consistently show that reducing acetylcholine transmission results in dementia pathology.

Want to create a rabbit with amyloid plaques as an experimental model for cellular dementia pathology: just reduce acetylcholine receptor activation (see Roher AE, Kuo YM, Potter PE, et al. Cortical cholinergic denervation elicits vascular Aβ deposition. Ann N Y Acad Sci 2000; 903:366-373.) Moreover, there was a clear biological gradient demonstrated by Gray et al. between exposure and disease. This is not hype. This is science. Don’t mislead people when you lack the background.

Can melatonin be considered anticholinergic?

I am 60 years old, over the past 30 years I have only taken Benadryl twice .both times with the same side effect of memory loss. I had to look up phone numbers that I dialed daily . I wasn’t even sure what year that it was. Thankfully it only last for 24 hours. I had the same issue with sleeping pills. My point is, it was with one dose, not taking a daily for a year as the previous comment mentioned .

Sorry, you are totally mistaken about the study population. The subjects were 65 and over but not disproportionately represent a racial minority of any type. Also, check out the other human epidemiology studies and the numerous animal studies. The results consistently show that reducing acetylcholine transmission results in dementia pathology.

Want to create a rabbit with amyloid plaques as an experimental model for cellular dementia pathology: just reduce acetylcholine receptor activation (see Roher AE, Kuo YM, Potter PE, et al. Cortical cholinergic denervation elicits vascular Aβ deposition. Ann N Y Acad Sci 2000; 903:366-373.) Moreover, there was a clear biological gradient demonstrated by Gray et al. between exposure and disease. This is not hype. This is science.
see my draft summary:

WOW. Thank you so much for this information! I’m doing everything I can to avoid developing Alzheimer’s. Parents and grandparents on both sides of my family were victims. Is Metropolol an anticholineric? What are non anticholineric substitutes?

I also take Fexofenadine/Allegra. Is this, too, anticholineric? Are there any 24 hour allergy medications which would be OK? (I’m one of those people allergic to so many plants, animals, etc. the allergist told me allergy shots aren’t an option. I tell people I’m allergic to everything except green beans and rocks!)

Again, thank you. Carlie

Allegra (fexofenadine) is an antihistamine that is not anticholinergic according to credible resources (e.g., Ryan M. Carnahan, R.M., Lund, B.C., Perry, P.J., Pollock, B.G., & Culp, K.R. (2006). The Anticholinergic Drug Scale as a Measure of Drug-Related Anticholinergic Burden: Associations With Serum Anticholinergic Activity. Journal Of Clinical Pharmacology, 46(12):1481-1486.) The latter-referenced resource contains a 0 to 3 scale with over 100 different medications rated in terms of anticholinergic activity. According to it, Allegra/fexofenadine and Toprol/metoprolol are both rated “0” in terms of anticholinergic activity. In addition, your physician may elect to prescribe Singulair/montelukast (another “0” drug to treat hayfever, hives, etc., if OTC Allegra isn’t sufficient on its own (see right hand info box at:

What about claritin and memory loss, as Zyrtec ? Does Zyrtec cause weight gain?

Scary stuff! I regularly take Sudafed and Zyrtec for allergies….guess I’d rather have a stuffed up nose than risk further exposure. Thanks for your articles on this, and the list of medications!

Is the active ingredient, DOXYLAMINE SUCCINATE 25MG, found in Kirkland Sleep Aid (compare to Unisom Sleeptabs) also an offender?

I do not see it on Dr. Gray’s list.

I am also curious if this causes any long term side effects. I take one pill a night to help me sleep.


“Doxylamine succinate is a potent anticholinergic” according to Wikpedia. Almsot certainly it is very much relevant to this article.

Unfortunately it’s the most effective sleep aid I’ve found, I’ve been taking for a couple of years now. I am trying to discontinue continued use. Sleeplessness here we come, again.

Really worried, been opn 25 mg of amitriptyline for 14 years. Is there concrete evidence of these findings?

“Concrete” is not something you can get with things like this. There are concrete results in animals that clearly demonstrate that blocking acetylcholine transmission, as anticholinergic drugs do, results in neurodegeneration similar to what is seen in human Alzheimer’s disease. Moreover, there are several studies like the Gray one they reference on this website that all report the same thing. Finally, there are a couple of other types of studies in humans (post-mortem examinations of anticholinergic-exposed brains and neuroimaging studies of living brains) that also indicate a dose-dependent relationship between long-term use of anticholinergic drugs and dementia.

I summarized these in a paper you can access at the link below. I am not trying to promote my own work; I just compiled other people’s research into a single paper and cited the primary sources. All the references are provided in it, so you can look into the matter for yourself. For what it is worth, animal studies do suggest that discontinuing anticholinergics early enough seems to prevent anticholinergic-associated brain deterioration.

(25 mg amitriptyline and 3 mg/time released melatonin) every 5th day, and 1-2 hr brisk hike that day. 86 and still worried about dementia. what say you?

My husband and I have been taking Kirkland sleep aids (doxylamine) for years, thinking it’s a safe alternative
To Rx sleep aids. How bad is this med? We r off it now and using melatonin and L theanine

Great comments, thank you.

Glad to learn why my meds cause problems with my brain, I took Benedryl >5 years and sometimes added Alprazolam as anti-anxiety remedy 1/8th of a mg. or so.
My question is: What do I take instead of anti-hystamines, to stop the sneezes, stuffed head etc.? When I use spray it starts dripping.
Moving is not an answer as symptoms return after a few years.
Any suggestions?

Read in the Mayo newsletter a few years ago that Nasalcrom (OTC) would help allergy that caused runny noses. My husband suffered with that, but after trying Nasalcrom, the allergy totally disappeared! I didn’t have to iron many handkerchiefs after that, so I was delighted!

Try Nasonex, two squirts in the am. It should take you through the whole day. If not two squirts am and pm . Nasonex is over the counter now.

Very informative…wonder if doctors get this same information and just don’t take the time to read it…just got through going through about 3 months of flu, abscessed tooth and pain associated with lower back, right hip and upper right butt …here are the medicines the doctors put me on….methylpnisolone ,(back and hip pain)naproxen,(back and hip pain) tramadol, (back and hip pain)levofloxacing, (flu) amoxicillin , (abscessed tooth)…mind you this was two different doctors…

Now I was already taking atorvastatin, clopidogrel, ramipril,metoprolo,asperin,vit B-6,vitB-12 ,vit C, folic acid,and COQ10, for heart problems from 2 other doctors ,AND each of these doctors knew the medications I was on….

No sleep, constipated, pain in back and hip ,and butt and finally my barber and my wife’s hair dresser told us about melatonin 3-5 mg that would help with sleep…its a vitamin, so the doctors will not tell you about it…but it works
The flu medication didn’t really help ,took time to get rid of…the back and hip medicine didn’t help, (had to go to a Orthopaedic doctor for help , who didn’t push a pill on me…)but gave me a shot in the hip joint that worked …

My concern is that doctors only want to push a pill on you …its something about being able to write a prescription and never check back to see how
you are doing…when you call the doctor back you only get a third party to tell your concerns to…

My question is melatonin on your list of ANTICHOLINERGIC drugs?

Melatonin is a hormone, the body produces it when it’s dark and it makes you tired.

Is marijuana anticholinergic? It causes all of the same side effects most notably dry mouth, confusion, disorientation, & memory problems. It would make sense to me that long-term use would be linked to dementia.

My husband has been a asthmatic all his life He takes Symbicort, Spiriva, Apo Simvastation and Cartia He also uses Ventolin when required. Are these safe?

I’ve been taking the CVS generic of ZYRTEC for a few years. My Doctor is aware of this. I do not take any other meds, save for my inhaler. I am a healthy, 55 year old female. Who suffers occasional asthma, triggered by some pet dander, dust mites, & extreme weather. I have not experienced any ill effects, as of now. But my Mother, & maternal Grandmother developed dementia. In their 90s after being institutionalized. Prior to the nursing home experience,neither was a pill taker. Claritin does not work for me. What are some natural alternatives, besides ginger?

For allergies, I’ve replaced my morning coffee with a mix of yerba mate and nettles, ginger, dandelion leaf, dong quai, eyebright, gingko, red clover, and peppermint. I’ve taken quercetin, which also seems to help. I’ve also tried saline nasal sprays and those with grapefruit seed extract.

A really good hepa filter in the bedroom also helps. I have a SwissAir IQ. Also, make sure you have reduced dust mite populations. I’ve taken so many of these drugs over the years that I am actually a little worried. I am taking steps to improve my brain health, starting with nutrition. Sometimes cutting out certain foods will help reduce your inflammation load. When I quit drinking coffee, my allergies got significantly better. The AARP sells a book called “Your Brain” that has great advice on boosting cognitive health.

I take a drug on the list, Paroxetine (Paxil), and have for many years so I was concerned to see it on your list. I talked with a doctor and they told me:
Paxil actually works on serotonin receptors, not cholinergic and it is not listed as one of the classes of medications in the study (they studied 1st generation anticholinergics, tricyclic antidepressants (which Paxil is not), and bladder meds).
Can you tell me why Paroxetine is on the list?

We are taught that while not strongly anticholinergic, Paxil is the most anticholinergic of the SSRI antidepressants…and is thus not the first choice for older patients.

I take Allegra Allergy every day. It contains an antihistamine called fexofenadine that is not on the list. Is this also a problem? I use it as a maintenance as I have a continuing problem with sinus.

I have been hoping to find a list like this. Thank you.

Also, men with prostate issues should avoid any OTC’s, and even prescribed drugs containing diphenhydramine. I found out the hard way! Makes urination just about impossible.

very interesting and informative!!

I have been taking 24 hour Sudafed daily for almost 15 years! I don’t see it listed, but I do see Pseudoephedrine listed in another medication that IS listed. Is that the same? an eye doctor told me that it could damage my eyes.

I have found myself fuzzy-headed at times. I’ve even forgotten a few appointments which isn’t like me. I’ve fallen 4 times in the past 4 years, but I’ve always blamed it on cute shoes, terrain, or something I tripped over. Clariden doesn’t help my allergies. Should I stop taking the sudafed? My doctor never mentioned it.

Pseudoephedrine is frequently paired with an antihistamine that has anticholinergic activity.

Hard to find things that help with sleeping and don’t affect Coumadin levels.

I have found great response to Trazadone and it doesn’t affect my INR.

What about lorazepam? I try not to take many prescriptions because I have to use Coumadin but not sleeping comes with its own dangers-lack of alertness, unable to pay attention,etc.

very interesting and helpful

I was surprised that Dr Gray kept referring to “older adults” ~ people of all ages take over the counter meds on this list, and I would think that if there is a relationship between them and dementia, younger adults should also consider not taking them, especially if there is a cumulative effect. I am 53 this year and have had sleep issues for years. I’ve taken over the counter sleep aids on an occasional basis for years too. All patients of all ages should be advised to talk to their doctors about use of anticholinergics. Personally, I am having memory issues, but I think it’s probably more to do with my chronic sleep deficit than the meds, since I do rarely take them.

Why didn’t you just say ALL benzodiazepines – not just xanax?

Not all benzodiazepines have anticholinergic activity, even though we have warned that benzodiazepine use can be bad for cognition:

I agree 100%. I believe most medications has side effects and there are no free lunch. I try avoid taking medication if I can help it with proper eating and using herbal medication.

“I was having panic attacks. Read a little about coconut oil. Tried it and it worked. Amazing to find a natural cure.”

Elinor, are you saying that coconut oil helped with your panic attacks? How much did you use? What other information can you give ? Do you need to use it regularly, etc.

How much and which brand of Coconut oil do you take ? Dosage? for anxiety and panic attacks? Please respond.

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