Antihistamines And Dementia: Drawing Proper Conclusions From What We Hear And Read
I did not expect that I would be writing about this, but some patients have asked me this allergy season whether antihistamines are safe to use because they either heard or read that antihistamines could cause dementia. As antihistamines have been a mainstay of treating nasal/sinus allergy symptoms for many decades, avoiding them would eliminate a treatment option that has been considered reasonably safe.
What exactly have been the studies that have led to the impression that antihistamines cause dementia? There seem to be three studies since 2015 that the mainstream media have publicized widely. All three studied classes of medication that have a certain physiologic effect called anticholinergic. Among these medications included antihistamines that diffuse to a high degree through what is called the blood-brain barrier. These antihistamines are referred to as 1st generation antihistamines. These were first available before the 1990s and include Benadryl, Tylenol PM, Advil PM, Dimetapp and Dramamine.
The above 1970s cultural reference is meant to highlight not just the natural human fear that what we do may be in vain but also the consequences of looking too far ahead. It is logical and sensible to be concerned about side effects. Science helps us to understand, though, the risk of having a side effect and who is more likely to have it.
What To Do If You Or Your Relative Is On These Medications
So what should you do if you discover that your older relative or you yourself are taking some of these medications?
If its an over-the-counter anticholinergic, you can just stop it. Allergies can be treated with non-sedating antihistamines like loratadine , or you can ask the doctor about a nasal steroid spray. PM painkillers can be replaced by the non-PM version, and remember that the safest OTC analgesic for older adults is acetaminophen .
If you are taking an over-the-counter sleep aid, it contains a sedating antihistamine and those are strongly anticholinergic. You can just stop an OTC sleep aid, but in the short term, insomnia often gets worse. So youll need to address the insomnia with non-drug techniques.
You should also discuss any insomnia or sleep problems with your doctors its important to rule out pain and serious medical problems as a cause of insomnia but be careful: many of them will prescribe a sleeping pill, because they havent trained in geriatrics and they under-estimate the risks of these drugs.
If one or more of the medications above has been prescribed, dont stop without first consulting with a health professional. Youll want to make an appointment soon, to review the reasons that the medication was prescribed, alternative options for treating the problem, and then work out a plan to reduce or eliminate the drug.
Now go check out those medication bottles, and let me know what you find!
What The Study Found Regarding Benadryl And Dementia
A team led by Shelley Gray, a pharmacist at the University of Washingtons School of Pharmacy, tracked nearly 3,500 men and women ages 65 and older who took part in Adult Changes in Thought , a long-term study conducted by the University of Washington and Group Health, a Seattle healthcare system. They used Group Healths pharmacy records to determine all the drugs, both prescription and over-the-counter, that each participant took the 10 years before starting the study. Participants health was tracked for an average of seven years. During that time, 800 of the volunteers developed dementia. When the researchers examined the use of anticholinergic drugs, they found that people who used these drugs were more likely to have developed dementia as those who didnt use them. Moreover, dementia risk increased along with the cumulative dose. Taking an anticholinergic for the equivalent of three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less.
The University of Washington study is the first to include nonprescription drugs. It is also the first to eliminate the possibility that people were taking a tricyclic antidepressant to alleviate early symptoms of undiagnosed dementia the risk associated with bladder medications was just as high.
Recommended Reading: Are Brain Freezes Bad For You
Sleeping Pills And Memory Loss
Elderly people have more trouble sleeping than younger folks. Some causes include waking to urinate, pain due to arthritis or other inflammations and lack of exercise. Sleeping pills can help, but they have a dark side. They can cause memory loss.
Daniel Kripke, M.D. Professor of Psychiatry at UCSD School of
Medicine talks about how the new class of “improved” sleeping
pills can be harmful to older adults.
Why These Drugs Have A Stronger Effect In Older People
As we age, our ability to process medication changes. The kidneys and liver clear drugs more slowly, so drug levels in the blood remain higher for a longer time. People also gain fat and lose muscle mass over time. Both these changes affect the way drugs are distributed to and broken down in body tissues. And because these drugs are stored in body fat, they can continue to produce effects days after people stop taking them, especially in people with a higher proportion of body fat. In addition, older people tend to take more prescription and over-the-counter medications, each of which has the potential to suppress or enhance the effects of the others.
You May Like: Does Sneezing Kill Brain Cells
Whats The Bottom Line
Its possible, but not proven, that some anticholinergic drugs increase the risk of dementia. If you need long-term treatment for one of the relevant medical conditions, talk to your doctor about other medication options that are not in the anticholinergic class, such as antidepressants like Celexa and Prozac. In many cases, there may be choices.
Beware: These 10 Medications Can Cause Memory Loss
Forgetfulness and mental confusion are often associated with aging, but the fact is, scientists have found that memory loss is not an inevitable part of aging. There are many factors that play a role in memory impairment, including alcohol and drug abuse, heavy smoking, head injuries, stroke, sleep deprivation, severe stress and illnesses such as Alzheimers disease and depression. Some of these are commonly known to affect memory, but there is one huge factor causing memory loss that is often overlooked. Many commonly prescribed drugs can interfere with memory. If youre currently taking medication and are having trouble remembering things, one of these may be the culprit.
Read Also: What Does The Front Of The Brain Control
Other Drugs That Can Cause Memory Loss
Research demonstrates that other drugs can cause memory loss as well. As stated by Dr. Armon B. Neel, Jr., a board-certified pharmacist for AARP TK, other medications that affect memory include: Anti-anxiety drugs, cholesterol-lowering drugs, narcotic painkillers, hypertension drugs, certain sleeping aids, and certain antihistamines.
Drugs that treat mental health issues, such as narcotic painkillers, anti-anxiety medications , and sleeping aids , tend to affect different brain pathways and block neurotransmitters related to memory.
Drugs that treat high cholesterol and hypertension do the same. Specifically, statins may lower the brains levels of cholesterol, which is essential in forming connections between nerve cells. Beta-blockers interfere with norepinephrine and epinephrine, two key neurotransmitters and hormones that regulate the strength of memory.
If you are on a prescription medication that could be contributing to memory loss, talk to your doctor. Ask your doctor why that specific medication was prescribed and whether alternative options can treat your problem. If you are using an over-the-counter medication that is linked to memory loss, you may be able to wean yourself off it on your own. Just remember it may be worth your while to speak to a healthcare professional regardless to ensure that you are doing things properly. Switching up your medications could improve your quality of life by boosting your mental sharpness.
How Do You Know Which Medication Is Right For You
Figuring out the right allergy medication for you depends on your symptoms, your preferences, and a careful weighing of the side effects that drug might produce. So, if youre not sure whats right for youparticularly if youve tried a few over-the-counter options without successits worth talking to an allergist about what might work. In addition to the OTC options, there are prescription allergy medications they can prescribe as well as eye drops and nasal sprays that may be better for your particular set of symptoms.
When choosing an antihistamineor trying to figure out where a new symptom came frombe aware that the medication can come with side effects, including some that may be a little surprising. Here are some of the most common antihistamine side effects that you should know about.
Don’t Miss: Boxers With Brain Damage Famous
What Are The Side Effects Of Antihistamines
Antihistamines are usually the first type of medication individuals try when they’re treating allergies, as these medications are easier to access and take than more involved treatments like allergy shots and steroids. Antihistamines tend to be effective for mild to moderate allergies. When an individual inhales or touches their allergy trigger, the immune system responds by creating histamines. These chemicals lead to swelling in the nose, runny eyes and nose, and itchiness in the eyes, nose, and mouth. Some individuals also experience an itchy skin rash called hives. By blocking or reducing histamines, antihistamines help stop the symptoms of allergies.
However, it’s important to understand the potential risks of antihistamines and how to use them responsibly.
Advice For Older Adults
Seniors concerned about taking anticholinergic drugs need to approach their primary care physician and talk about the risks versus the benefits of taking these medications, said Shellina Scheiner, an assistant professor and clinical geriatric pharmacist at the University of Minnesota.
Dont try stopping cold turkey or on your own.
People can become dependent on these drugs and experience withdrawal side effects such as agitation, dizziness, confusion and jitteriness, Ailabouni said. This can be managed, but you need to work with a medical provider.
Also, dont make the assumption that if drug is available over the counter that its automatically safe for your brain, Boustani said. In general, he advises older adults to ask physicians about how all the medications theyre taking could affect their brain.
Finally, doctors should not give anticholinergic medications to people with any type of dementia, DeKosky said. This will not only interfere with their memory but is likely to make them confused and interfere with their functioning.
This column is produced by Kaiser Health News, an independent news service that is not affiliated with Kaiser Permanente.
Correction: In earlier editions, the brand name for imipramine, Tofranil, was misspelled.
Q Is There Any Evidence That Anticholinergic Drugs Increase Your Risk For Dementia
A. There is evidence that certain medications both prescription and over-the-counter are associated with an increased risk of dementia. The latest study to confirm this connection came out in June 2019 in the Journal of the American Medical Association . This large, robust study showed a definite link between anticholinergic medications and patients who have dementia, but it didnt prove that there was a direct cause.
Given the known increased risk of dementia with certainmedications, we try to get patients off of these medications, if possible. Wehave seen patients cognition improve as a result.
Study Design And Treatments
The study was conducted according to a 3 × 2, double blind, cross over design. The two factors were Treatment and Time of testing . Treatments were single oral doses of cetirizine 10 mg, cetirizine 20 mg and placebo. Subjects were tested twice on each testday, at 1 and 3 h after drug administration. All test days were separated by a washout period of 1 week. The order of treatments was counterbalanced using six independent 3 × 3 Latin squares.
Also Check: How Do Puzzles Help The Brain
Common Meds And Dementia: How Strong Is The Link
May 9, 2016 — Could your chances of getting dementia depend on whatâs in your medicine cabinet?
A new study found that medicines taken by millions for depression, asthma, allergies, and other conditions may raise that risk.
The drugs involved in the study are known as anticholinergics. They work by blocking a brain chemical called acetylcholine, which is crucial for memory. Although this isnât the first time researchers have looked at this link, the new study looked at about 100 over-the-counter and prescription drugs that work in this way, ranging from the antidepressant Paxil to the allergy drug Benadryl to the motion sickness remedy Dramamine .
The experts found a strong link between the drugs and dementia, but they didn’t prove the meds directly cause it. WebMD asked the lead researcher on the recent study and an expert on Alzheimer’s disease to help people taking the drugs understand what to know and do.
What did this study actually show regarding these drugs and dementia?
The brains of those people taking the medicine did not work as well as the brains of those not taking them. “We saw an increased risk of getting dementia over time,” says researcher Shannon Risacher, PhD, assistant professor of radiology and imaging sciences at the Indiana University School of Medicine.
Study participants took the medicines on average for about 7 years.
Are some of the drugs more likely to increase the risk of dementia than others?
What Does Previous Research Show
Other studies have also suggested that long-term use of some anticholinergic medications might increase the risk that older people will develop dementia.
For example, a 2015 study by researchers at the University of Washington found that people age 65 and older who took these medications for three years or more had a 54 percent greater risk of developing dementia than people who took the medications for three months or less.
A 2014 review found more than 30 studies that suggested confusion and other symptoms of cognitive decline increase with the amount of anticholinergic medication someone takes.
Dr. Malaz Boustani, director of the Regenstrief Center for Health Innovation and Implementation Science at Indiana University, has created a tool called the anticholinergic cognitive burden scale, which ranks drugs by their suspected effects on cognition. Experts suggest avoiding extended use of drugs with a rating of 3 on the scale or combinations of drugs that together rate 3 or higher.
You May Like: How Are Puzzles Good For Your Brain
Antihistamines Part Ii: Long
We were unable to process your request. Please try again later. If you continue to have this issue please contact .
The last Pharmacology Consult column, Antihistamines for the common cold: Wheres the evidence? , reviewed recently published data suggesting that antihistamine product use may be increasing for the treatment of common cold symptoms. Because recent recommendations and regulations have decreased the use of cough/cold products in the pediatric population, pediatric health care providers may be turning to antihistamine-based products instead. Commonly used first-generation antihistamines have strong anticholinergic properties, and recently published data from the adult population have suggested that long-term use of these drugs may increase the risk for developing dementia. As summaries of these publications find their way to the lay media, it is understandable that parents may wonder about the long-term safety of using antihistamines in children. Although the diagnosis of dementia is certainly not associated with the pediatric population, parents may still express concern about the adverse effects and long-term safetyof antihistamines.
Second-generation antihistamines , considered nonsedating because of their relative lack of CNS penetration, are commonly prescribed to children and adults for allergic conditions. Second-generation antihistamines display no significant anticholinergic pharmacologic actions.
Anticholinergic drugs and dementia risk
Common Anticholinergic Drugs Like Benadryl Linked To Increased Dementia Risk
- By Beverly Merz, Executive Editor, Harvard Women’s Health Watch
One long-ago summer, I joined the legion of teens helping harvest our valleys peach crop in western Colorado. My job was to select the best peaches from a bin, wrap each one in tissue, and pack it into a shipping crate. The peach fuzz that coated every surface of the packing shed made my nose stream and my eyelids swell. When I came home after my first day on the job, my mother was so alarmed she called the family doctor. Soon the druggist was at the door with a vial of Benadryl tablets. The next morning I was back to normal and back on the job. Weeks later, when I collected my pay , I thanked Benadryl.
Today, Im thankful my need for that drug lasted only a few weeks. In a report published in JAMA Internal Medicine, researchers offers compelling evidence of a link between long-term use of anticholinergic medications like Benadryl and dementia.
Anticholinergic drugs block the action of acetylcholine. This substance transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates muscle contractions. Anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and drugs to relieve the symptoms of Parkinsons disease.
You May Like: Midbrain Hemorrhage
When Should I Be Concerned
Consulting a medical professional becomes critical when memory lapses are affecting your ability to live your life or if youre noticing significant forgetfulness in a loved one. Initial screenings can rule out certain illnesses or identify unexpected factors that may be contributing to your forgetfulness, while neuropsychological testing can bring you closer to an answer.
If You Take One Of These Drugs
It’s always good to review the potential benefits and harms of these medications with your doctor. If a drug appears problematic, the two of you can explore alternatives by considering the reason it was prescribed and seeing if there is a different type of drug that can be used as a replacement.
Don’t stop taking the drugs on your own. It isn’t safe to quit most benzodiazepines and anticholinergic drugs “cold turkey.” Work with your clinician to develop a plan for tapering off them.
Also Check: Cebria Vs Prevagen