Tip Sheet: Ten Medications Older Adults Should Avoid Or Use With Caution
Because older adults often have long-term health conditions that require treatment with multiple medications, there is a greater chance of experiencing unwanted drug side effects. Older people can also be more sensitive to certain medications.
To help you make better-informed decisions about your medications, and to lower your chances of overmedication and serious drug reactions, the American Geriatrics Societys Health in Aging Foundation recommends that older people be cautious about using the following types of medications, including some that can be purchased without a prescription .
If you are taking any of these medications, talk to your healthcare provider or pharmacist. Do not stop taking any medication without first talking to your healthcare provider.
Which Medications Are Anticholinergics
You might be surprised to know that anticholinergic medications include seemingly harmless over-the-counter medications like antihistamines and sleep aids .
To help you understand which prescription and over-the-counter drugs have anticholinergic effects, we found a helpful list from ElderConsult Geriatric Medicine of common medical conditions and the anticholinergic medications typically used to treat them.
Medical conditions include a wide variety of common issues like overactive bladder, sleep issues, coughs, colds, allergies, behavior issues, mood disorders, chronic obstructive pulmonary disease , and Parkinsons disease.
This list might not include every single condition or medication, but its a good start to finding out if any of your older adults medications are anticholinergics.
Use this list to have an informed conversation with your older adults doctor about the risks and benefits of taking that medication.
- Constipation / urine retention
These side effects can make existing dementia symptoms worse or make someone without cognitive issues behave as if they have Alzheimers or dementia.
Common Sleep Problems In People With Dementia
Sleep changes are common in older adults with and without dementia. Many seniors experience changes in the quality of their sleep, the number of hours they sleep, and how much time they spend awake at night. In fact, older adults total sleep time decreases by about 30 minutes per decade starting in middle age.
Sleep problems are even more common in people with dementia. The type and severity of sleep disturbances may vary depending on the cause of your loved ones dementia and the stage of their disease. Sleep problems associated with dementia tend to get worse as the disease progresses.
Your loved one with dementia may experience the following sleep problems:
- Difficulty maintaining or falling asleep, which can be caused by insomnia, problems with the sleep cycle, side effects of medication, or other factors.
- Sundown syndrome, which is common in people with Alzheimers and other forms of dementia, can contribute to problems with sleep. Sundown syndrome refers to increased confusion, agitation, anxiety, and aggression in the evening or during the night.
- Problems with movement during sleep, such as restless legs syndrome which is characterized by an uncomfortable urge to move the legs during periods of rest or rapid eye movement sleep behavior disorder, which makes people act out their dreams.
- Breathing disorders during sleep, such as sleep apnea, which affects about 50% of people with Alzheimers.
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Practical Tips On Medications To Manage Difficult Behaviors In Dementia
You may be now wondering just how doctors are supposed to manage medications for difficult dementia behaviors.
Here are the key points that I usually share with families:
- Before resorting to medication: its essential to try to identify what is triggering/worsening the behavior, and its important to try non-drug approaches, including exercise.
- Be sure to consider treating possible pain or constipation, as these are easily overlooked in people with dementia. Geriatricians often try scheduling acetaminophen 2-3 times daily, since people with dementia may not be able to articulate their pain. We also titrate laxatives to aim for a soft bowel movement every 1-2 days.
- No type of medication has been clinically shown to improve behavior for most people with dementia. If you try medication for this purpose, you should be prepared to do some trial-and-error, and its essential to carefully monitor how well the medication is working and what side-effects may be happening.
- Antipsychotics and benzodiazepines work fairly quickly, but most of the time they are working through sedation and chemical restraint. They tend to cloud thinking further. It is important to use the lowest possible dose of these medications.
- Antidepressants take a while to work, but are generally well-tolerated. Geriatricians often try escitalopram or citalopram in people with dementia.
Taking Anticholinergics For More Than 3 Years Linked To Higher Dementia Risk
For their study, Prof. Gray and colleagues tracked nearly 3,500 men and women aged 65 and over with no dementia symptoms at the start of the study. The participants were part of the Adult Changes in Thought study in Group Health, an integrated health care delivery system in Seattle.
To assess how much exposure the participants had to anticholinergic drugs, the researchers used computer records from the pharmacies that dispensed them.
From the pharmacy data they added up all the standard daily doses and worked out the cumulative anticholinergic exposure for each participant over the past 10 years. This was updated as participants were followed up for an average of 7 years.
Over the period of the study, nearly 800 participants developed dementia.
The results showed that the most commonly used medications were tricyclic antidepressants , first-generation antihistamines , and antimuscarinics for bladder control .
The researchers estimated that people taking at least 10 mg per day of doxepin, 4 mg per day of chlorpheniramine, or 5 mg per day of oxybutynin for more than 3 years would be at greater risk for developing dementia.
Prof. Gray also told Medical News Today the dose risks associated with Benadryl: The dose of diphenhydramine that would correspond to the highest risk group is taking the equivalent of 50 mg each day for longer than 3 years or 25 mg per day for longer than 6 years in duration.
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Can They Be Taken Together
A person should not take Advil PM and Tylenol PM together.
Both medications contain diphenhydramine. Both product labels also recommend not taking them with other tranquilizers or sleep aids.
If a person experiences trouble sleeping or continued pain after taking either medication, they should talk to their doctor. They may be able to recommend a different solution.
Before using Advil PM, people should consult a doctor or pharmacist if they also take the following medications:
- another sedative or sleep aid
- another medicine that contains an antihistamine
- a diuretic
- aspirin for heart attack prevention
Before taking Tylenol PM, people should also speak with a doctor or pharmacist if they use blood thinners or other sedatives.
A person should not take Tylenol PM with other medications that contain acetaminophen or diphenhydramine.
In addition, Advil PM and Tylenol PM may interact with other drugs. People should talk to their doctor if they take other prescription medications to make sure they can safely take these products.
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Commonly Prescribed Meds Could Raise Dementia Risk
MONDAY, June 24, 2019 — Doctors often prescribe anticholinergic drugs for a variety of ills. But a new study suggests stronger forms of these drugs may increase the risk of dementia in older patients.
These medicines include everything from milder medicines such as Benadryl to more potent medicines, such as certain antipsychotics and Parkinson’s meds. They’re used to treat a wide range of other conditions, including depression, chronic obstructive pulmonary disease, overactive bladder, allergies, and gastrointestinal disorders.
Anticholinergic drugs help contract and relax muscles, and work by blocking acetylcholine, a chemical that transmits messages in the nervous system.
But the new British study found that people aged 55 and older who took strong anticholinergic medications daily for three years or more had a 50% increased risk of dementia.
“Our study adds further evidence of the potential risks associated with strong anticholinergic drugs, particularly antidepressants, bladder antimuscarinic drugs, anti-Parkinson drugs and epilepsy drugs,” said study author Carol Coupland. She works in the division of primary care at the University of Nottingham.
Anticholinergics are known to cause short-term side effects — including confusion and memory loss — but it’s unclear if long-term use increases the risk of dementia.
There was no increased risk of dementia among patients who took other types of anticholinergic drugs such as antihistamines and gastrointestinal drugs.
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What Is The Most Important Information I Should Know About Tylenol Pm
Ask a doctor before taking medicine that contains acetaminophen if you have ever had liver disease, or if you drink more than 3 alcoholic beverages per day.
Ask a doctor or pharmacist if this medicine is safe to use if you have ever had:
- liver disease
- an enlarged prostate or urination problems
- asthma, chronic obstructive pulmonary disease , emphysema, or other breathing disorder
- glaucoma or
- a condition for which you take warfarin .
Ask a doctor before using this medicine if you are pregnant or breastfeeding. Diphenhydramine may slow breast milk production.
Physiologic Changes With Aging
Because of pharmacokinetic and pharmacodynamic changes with aging, opioids should be started at the lower dose, about 25%50% of the dose given to younger patients . Opioids that should be avoided in the older patients include meperidine, propoxyphene, and tramadol. Meperidine has active metabolites which can cause neuroexcitation, nervousness, and seizures. Prophoxyphene has not been shown to be more effective than placebo. Tramadol is not recommended in patients who are taking serotonergic medications or in those with underlying seizure disorders. Tramadol binds to opioid receptors and inhibits the reuptake of both norepinephrine and serotonin . Codeine can be used, however there should be recognition that there is individual variability in its effectiveness dependent upon drug metabolism into its seven active metabolites. Up to 30% of the population has been reported to be poor hydroxylators of debrisoquine required for Codeine activation .
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Common Drugs Can Cause Dementia
The primary ingredient in Benadryl and the secondary ingredient in Tylenol PM is reported to have a cumulative effect in the human brain which can cause as much as a 54% increase in the likelihood of dementia or Alzheimers in consumers who use it regularly. This is according to a study , Jan. 26. 2015. 11% of Americans 65 years and older have Alzheimers or dementia. A big increase in the likelihood of getting dementia is important.
Before we all panic, Benadryl and Tylenol PM did not show any relationship to cognitive impairment if used for 3 months or less in one continuous time frame. But if used for 3+ years or at higher doses, there were significant risks for increased cognitive impairment.
Gary Alony, president of Thompson Chemists, a pharmacy in NYC, is not surprised by the findings. You have to be careful with Benadryl. The ingredient in Benadryl, diphenhydramine, increases the effect of many other drugs, particularly pain relievers and opioids. Junkies have been known to take Benadryl along with heroin to increase and extend the high.
The active ingredient in Benadryl is diphenhydramine, which is an older antihistamine. There are newer drugs on the market that can replace it if there is a need to use it long-term. Even better, why not try to relieve symptoms with non-drug alternatives? Mother Earth News has a good article on alternatives such as sinus flushing, sublingual immunotherapy and herbal remedies.
Optimal Aging Portal Blog Team
The latest scientific evidence on this topic was reviewed by the McMaster Optimal Aging team. Blog Posts are written by a professional writer, assessed for accuracy by Dr. Maureen Dobbins, an expert in interpreting and communicating the scientific literature, and edited by a professional editor. There are no conflicts of interest.
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Do People With Dementia Sleep A Lot During The Day
Some people with dementia sleep excessively during the daytime. They may feel like they cant stay awake, and they may take long naps that interfere with nighttime sleep and overall quality of life.
Excessive daytime sleepiness is more common in people with Parkinsons disease dementia or Lewy body dementia than in those with Alzheimers. Some factors that may contribute to excessive daytime sleepiness include:
- Insufficient sleep at night
- Damage to brain cells caused by dementia
- Changes in sleep pattern caused by dementia
- Mental health conditions, such as depression
- Other sleep disorders, such as sleep apnea
Who Is Tylenol Pm For
This sleeping aid is for people who are struggling to sleep on their own. Its mostly marketed towards people who cant sleep due to pain or discomfort.
Its very important to mention who this product is not for. It should never be used by children who are younger than 5 years old.
If an older child wants to use Tylenol PM, it should be run by your general health care practitioner first. The dose might need to be altered.
This product is not for suicidal people because if you take it in excess, its easy to have a fatal overdose.
If you have any of these conditions, you should not take Tylenol PM unless you consult your doctor first:
- Glaucoma
- Problems urinating
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What Should Someone Who Cannot Sleep Do To Protect Their Brain Health
If limited sleep may cause dementia and taking sleep medications could increase dementia risk, what should someone who has difficulty sleeping do if they want to protect their brain health?
Dr. Chad Yucus, a neurologist at NorthShore University HealthSystem, said he would not recommend using sleep aids like Tylenol PM or Benadryl because they may cause increased confusion.
Similarly, Doxepin, an antidepressant, has been shown to improve sleep quality in some studies, while others have reported drowsiness and weight gain as side effects, which have both been found to increase dementia risk.
Seroquel is often used to treat conditions like schizophrenia, bipolar I disorder and severe depression. While some studies have found Seroquel may improve sleep quality, reported side effects actually include difficulty sleeping, as well as weight gain, which is often linked to an increased dementia risk. Seroquel is an antipsychotic drug and researchers found some safety concerns about using it to treat insomnia. Instead, they suggest it should be prescribed for more serious conditions like schizophrenia and bipolar disorder.
The side effects of some sleep drugs may become even more pronounced in dementia patients, depending on the severity of their condition.
Dementia And Sleep Problems: Causes
Researchers and doctors dont understand exactly why dementia affects sleep, but up to 70% of people with cognitive impairment have sleep disturbances, according to a review of studies on disturbed sleep and dementia. Changes in the brain associated with dementia seem to affect the structure of sleep and the circadian rhythm, which helps regulate the physical, mental, and behavioral changes the body goes through in 24 hours.
Other factors that may contribute to poor sleep in dementia include:
- Less exposure to sunlight, which affects the sleep cycle
- Physical or mental exhaustion at the end of the day
- Chronic pain
- An environment that is inadequate for sleep, such as a noisy or bright room before bedtime
- Medication side effects
- Diet, such as excessive caffeine or alcohol
Sleep problems in people with dementia often have multiple causes. Talk to the doctor about your loved ones specific symptoms. The doctor may have questions about your parents sleep habits, medications, diet, and any other health conditions to diagnose whats disrupting their sleep.
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Doctors Thought She Had Dementia Then They Investigated The Common Medications She Was Using
Certain medicines — prescription and over-the-counter — are linked with dementia symptoms. But getting off these drugs requires supervision.
But Malaz Boustani, a professor of aging research at Indiana University School of Medicine, suspected that something else might be going on. The patient was taking Benadryl for seasonal allergies, another antihistamine for itching, Seroquel for mood fluctuations, as well as medications for urinary incontinence and gastrointestinal upset.
To various degrees, each of these drugs blocks an important chemical messenger in the brain: acetylcholine. Boustani thought the cumulative impact might be causing the womans cognitive difficulties.
He was right. Over six months, Boustani and a pharmacist took the patient off those medications and substituted alternative treatments. Miraculously, she appeared to recover completely. Her initial score on the Mini-Mental State Exam had been 11 of 30 signifying severe dementia and it shot up to 28, in the normal range.
An estimated 1 in 4 older adults take anticholinergic drugs a wide-ranging class of medications used to treat allergies, insomnia, leaky bladders, diarrhea, dizziness, motion sickness, asthma, Parkinsons disease, chronic obstructive pulmonary disease, and various psychiatric disorders.
Heres what older adults should know about these drugs:
What Are The Side Effects Of Tylenol Pm
Get emergency medical help if you have signs of an allergic reaction: hives difficult breathing swelling of your face, lips, tongue, or throat.
In rare cases, acetaminophen may cause a severe skin reaction that can be fatal. This could occur even if you have taken acetaminophen in the past and had no reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. If you have this type of reaction, you should never again take any medicine that contains acetaminophen.
Stop using the medicine and call your doctor at once if you have:
- severe drowsiness
- painful or difficult urination or
- liver problemsloss of appetite, stomach pain , tiredness, itching, dark urine, clay-colored stools, jaundice .
Common side effects may include:
- drowsiness
- dry eyes, blurred vision or
- dry mouth, nose, or throat.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
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