Let’s get right to it: Certain medications like Benadryl, Advil PM, and Zyrtec belong to a class of medications called “anticholinergic drugs.” Recent studies have shown that anticholinergic drugs are linked to dementia.
This is especially concerning, given how popular and easy to access these drugs are, especially among the older generation who may be more susceptible to their effects. Up to 10% of adults over 50 regularly use medication with anticholinergic activity. Many of them use more than one.
But we’re getting ahead of ourselves. Here’s what you need to know:
What are anticholinergic drugs?
Your brain is constantly communicating with the body and with itself using chemical messages. One of these chemicals is acetylcholine. Acetylcholine is involved in important tasks like learning and memory, as well as stimulating muscle contractions in the body.
However, a certain class of drugs called “anticholinergic drugs” blocks acetylcholine from functioning normally. This is a helpful effect in many cases; anticholinergic drugs can help with allergies, control overactive bladders, relieve symptoms of Parkinson’s disease, and even help with depression. But these drugs have a dark side. Recent studies have shown a strong correlation between anticholinergic drugs and dementia.
What are anticholinergic drugs, exactly? Here are some examples you might recognize:
- Diphenhydramine: Advil PM, Aleve PM, Benadryl, Excedrin PM, Tylenol PM.
- Dimenhydrinate: Dramamine.
- Diazepam: Valium.
- Chlorpheniramine: Actifed, Chlor-Trimeton, Codeprex, Efidac-24.
- Doxepin: Adapin, Silenor, Sinequan.
- Alprazolam: Xanax.
- Amantadine: Symmetrel.
- Cetirizine: Zyrtec.
- Loperamide: Imodium.
Anticholinergics aren’t messing around
A 2013 study published by the Alzheimer’s Association looked at 3,690 older adults and found that “exposure to medications with severe AC cognitive burden may be a risk factor for developing MCI [mild cognitive impairment].”
A team led by a pharmacist from the University of Washington’s School of Pharmacy published a study in 2015 stating that “higher cumulative anticholinergic use is associated with an increased risk for dementia.”
Most recently, a JAMA Neurology study published in April 2016 tracked almost 3,500 individuals over the age of 65. They found that “The use of AC [anticholinergic] medication was associated with increased brain atrophy and dysfunction and clinical decline.” Those who had used anticholinergic drugs were more likely to have developed dementia than the other study participants, and the risk went up as the individual used it more.
There is growing evidence that shows anticholinergic drugs are a poor choice for anyone who wants to keep a clear head as they age. This is hardly surprising, given the anticholinergic side effects of hallucinations, memory impairment, and confusion. The body also produces less acetylcholine as it ages, which means anticholinergic drugs can be especially damaging for seniors.
With that said, it’s important to note that from a statistical standpoint, there is no cause-and-effect relationship between anticholinergic drugs and dementia. It’s as your science teacher might have said: “Correlation does not equal causation.” By this, we mean that it’s true that the studies show that those who took high doses of anticholinergic drugs also had a high chance of dementia. But this does not necessarily mean that the dementia is caused by the drugs.
What to do if you’re currently taking anticholinergic drugs
Although more research is necessary to determine how dangerous anticholinergic drugs actually are, there are steps you can take in the meantime to stay safe. If you are currently taking an anticholinergic drug, here’s what to do:
Find out the drug’s ranking
The Anticholinergic Cognitive Burden Scale was developed by Malaz Boustani, an Indiana University School of Medicine geriatrician. It ranks anticholinergic drugs on a scale of 1-3. Drugs in the “1” category are linked to a risk of dementia, but not as strongly as category “3” drugs.
Talk to your doctor
If you’re using one of these drugs for a short-term problem, it’s probably not a big deal. Again, as the 2016 study showed, the risk of dementia goes up with the amount of the drug used. If you’re using only a small amount, don’t let it stress you out.
If you are using an anticholinergic drug as a long-term solution, however, you might want to talk to your doctor about realistic alternatives. “There are so many alternatives to these drugs,” says geriatrician and Harvard assistant professor Dr. Sarah Berry. “For example, selective serotonin re-uptake inhibitors (SSRIs) like citalopram (Celexa) or fluoxetine (Prozac) are good alternatives to tricyclic antidepressants. Newer antihistamines such as loratadine (Claritin) can replace diphenhydramine or chlorpheniramine (Chlor-Trimeton). Botox injections and cognitive behavioral training can alleviate urge incontinence.”
Now, the reality is that sometimes, an anticholinergic drug is the best option for the situation. If this is the case, talk to your doctor about dosage. “They should use the lowest effective dose, monitor the therapy regularly to ensure it’s working, and stop the therapy if it’s ineffective,” writes Dr. Shelley Gray et. al. in the 2015 JAMA study.
Finally, if you are taking any drug, especially if it’s a prescription drug, don’t stop taking it without first discussing it with your doctor. Many medications can hurt your body if you don’t wean yourself off of them correctly. Always defer to your doctor’s orders.
We pay attention
At The Recovery Village, we keep tabs on the latest developments in medicine to stay informed and keep you safe. We provide a multidisciplinary treatment approach and ensure that every patient gets the personalized treatment they need to recovery. Want to learn more? Give us a call at 844-868-7953 to talk to one our compassionate representatives.
Savva, George. “Investigating the links between anticholinergic drugs and benzodiazepines and risk of dementia.” Alzheimer’s Society. Alzheimer’s Society. Web. 8 Aug 2016. <https://www.alzheimers.org.uk/info/20053/research_projects/657/investigating_the_links_between_anticholinergic_drugs_and_benzodiazepines_and_risk_of_dementia>.
Cai, Xueya, Noll Campbell, Babar Khan, Christopher Callahan, Malaz Boustani. “Long-term anticholinergic use and the aging brain.” Alzheimer’s & Dementia. Alzheimer’s & Dementia, 2013. Web. 8 Aug 2016. <http://www.alzheimersanddementia.com/article/S1552-5260(12)00081-7/pdf>.
Gray, Shelly L., Melissa L. Anderson, Sascha Dublin, Joseph T. Hanlon, Rebecca Hubbard, Rod Walker, Onchee Yu, Paul K. Crane, Eric B. Larson. “Cumulative Use of Strong Anticholinergics and Incident Dementia.” JAMA Internal Medicine. The JAMA Network, Mar 2015. Web. 8 Aug 2016. <http://archinte.jamanetwork.com/article.aspx?articleid=2091745>.
Risacher, Shannon L., Brenna C. McDonald, Eileen F. Tallman, John D. West, Martin R. Farlow, Fredrick W. Unverzagt, Sujuan Gao, Malaz Boustani, Paul K. Crane, Ronald C. Petersen, Clifford R. Jack, William J. Jagust, Paul S. Aisen, Michael W. Weiner, Andrew J. Saykin. “Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults.” Alzheimer’s Disease Neuroimaging Initiative. The JAMA Network, 1 Apr 2016. Web. 8 Aug 2016. <http://i2.cdn.turner.com/cnn/2016/images/04/18/risacheretal_jamaneurology_final_inpress_041116.pdf>.
Cafasso, Jacquelyn. “Anticholinergics.” AARP. AARP, 4 Jun 2013. Web. 8 Aug 2016. <http://healthtools.aarp.org/health/anticholinergics>.
“Anticholinergic Cognitive Burden Scale.” Aging Brain Care. Aging Brain Care, 2012. Web. 8 Aug 2016. <http://www.agingbraincare.org/uploads/products/ACB_scale_-_legal_size.pdf>.
Merz, Beverly. “Common anticholinergic drugs like Benadryl linked to increased dementia risk.” Harvard Health Publications. Harvard University, 28 Jan 2015. Web. 8 Aug 2016. <http://www.health.harvard.edu/blog/common-anticholinergic-drugs-like-benadryl-linked-increased-dementia-risk-201501287667>.