What To Do If Your Older Adult Is Taking Anticholinergic Medications
Important: NEVER start, stop, or adjust the dosage for any medications without asking your older adults doctor for advice that can cause serious health problems.
The first step is to discuss any medication concerns with the doctor as soon as possible. Ask them to explain the risks versus the benefits and to make a recommendation.
Because many seniors have multiple health conditions, they may be taking more than one type of anticholinergic medication.
One anticholinergic drug might not be harmful, but the side effects and doses can add up across different medications.
Thats why its so important for a doctor to review all the medications that your older adult takes.
And if different drugs are being prescribed by different doctors, ask their primary physician to review the full medication list, including over-the-counter drugs and supplements.
This could also be a good opportunity for the doctor to safely discontinue drugs that are no longer needed.
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 Is Tamsulosin And What Are The Long Term Effects
Benign prostatic hyperplasia is one of the most common medical conditions affecting men as they age, with approximately 70 percent of men over the age of 70 affected by the condition. Benign prostatic hyperplasia is not indicative of the future likelihood of prostate cancer, but it can be inconvenient, embarrassing, and frustrating, no matter how common it may be. Recently, some reports have indicated that there may be a link between the long term use of certain medications used to treat benign prostatic hyperplasia, like tamsulosin, and cognitive decline and dementia.
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How To Take Tamsulosin
This dosage information is for tamsulosin oral capsule. All possible dosages and forms may not be included here. Your doctor will tell you what dosage is right for you. Your dosage, form, and how often you take the drug will depend on:
- your age
- the severity of your condition
- other medical conditions you have
- how you react to the first dose
What Risks Are Associated With Tamsulosin
Although there are many benefits associated with tamsulosin, there are also some risks and downsides associated with taking the medication. These include:
- Tamsulosin may cause an unsafe drop in blood pressure when moving from sitting to standing position. This is most likely to occur when first starting the medication or increasing the dose. Vertigo and syncope, a temporary loss of consciousness, can also occur. As a result, tamsulosin is associated with an increased risk of falls, which can be dangerous for elderly men.
- Some men experience a condition called priapism, which is a painful erection lasting longer than four hours. This condition can be serious and requires medical attention.
- Tamsulosin can cause an adverse reaction in people with a sulfa allergy.
- Tamsulosin can react with several different types of drugs, including CYP3A4 inhibitors like ketoconazole, CYP2D6 inhibitors like paroxetine, PDE5 inhibitors like Viagra, and blood thinners like warfarin.
- Some people feel very dizzy when they first wake up. People taking tamsulosin should be careful when moving from a lying position to sitting or standing.
- Tamsulosin can cause your blood pressure to become too low if other factors, such as vomiting, diarrhea, heavy sweating, heart disease, dialysis, dehydration, or a low-salt diet are present.
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Why The Drugs Affect Your Mind
Both anticholinergics and benzodiazepines affect the activity of neurotransmitterschemical messengers that work in the central nervous systembut the drugs work in slightly different ways.
Anticholinergic drugs block the action of acetylcholine. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates the autonomic nervesthose that regulate contractions of blood vessels, airways, and our cardiovascular and digestive systems. The strongest anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and sleeping pills.
Benzodiazepines boost another neurotransmitter’s effectiveness. They make gamma-aminobutyric acid which slows the activity of neurons in the brain-more potent. For that reason, they are used to calm anxiety and help people sleep.
What Are The Benefits Of Tamsulosin
Tamsulosin is a popular drug for the treatment of BPH and has several benefits. Benefits of tamsulosin include:
- Tamsulosin effectively improves urine flow rates and other symptoms of BPH including hesitancy, intermittency, incomplete emptying, and weak urine streams.
- Men with kidney or liver disease do not need to adjust their dosage of the medication, although it should be noted that the use of tamsulosin in men with end-stage kidney or liver disease has not been studied.
- More than 80 percent of patients who completed six years of treatment with tamsulosin had a consistently positive response to the medication and a low incidence of orthostasis.
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Tamsulosin Associated With Dementia Risk In Older Patients With Bph
Treatment with an 1adrenoceptor antagonist, tamsulosin, is associated with increased dementia risk among patients with symptomatic benign prostatic hyperplasia aged 65 years, according to a Medicare data analysis published in PharmacoepidemiologyDrugSafety.
Using Medicare data from 2006 to 2012, investigators obtained patient data for men 65 years who were actively taking tamsulosin . These patients were compared with propensity-score-matched patients who did not use BPH medications , as well as patients who used doxazosin , terazosin , alfuzosin , dutasteride , and finasteride . Investigators used International Classification of Diseases, Ninth Revision, diagnosis codes to determine and compare incident dementia rates between each group.
A greater number of men in the tamsulosin group had dementia at the median 19.8-month follow-up compared with men who were not taking BPH medications . In addition, patients taking tamsulosin had a significantly higher dementia risk than those taking doxazosin , terazosin , alfuzosin , dutasteride , and finasteride .
Dementia Risk Associated With Tamsulosin In Benign Prostatic Hyperplasia
- Pharmacoepidemiology and drug safety
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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.
Drug Tied To Dementia Overprescribed To Seniors
Lower cost might help drive doctors’ choice, researchers say
More than one-quarter of patients with the urinary problem had been prescribed the drug oxybutynin , an international team of investigators found.
Yet, “oxybutynin is a particularly poor drug for overactive bladder in elderly patients,” said study lead author Dr. Daniel Pucheril, a urologist at Henry Ford Hospital in Detroit.
Prior studies have linked the drug to thinking problems and increased risk of dementia in older people, possibly because of the way it affects brain chemicals, he said.
“It’s a great and effective drug for younger patients, but is a risky drug for older patients,” Pucheril said. It boosts dementia risk even when not taken indefinitely, he said.
Alternatives exist but they’re more expensive and may not be covered by insurance, at least initially, the study authors explained.
For instance, “most Medicare Part D plans have a tiered drug formulary, which means that patients must try and ‘fail’ oxybutynin before they will be eligible for the newer generation of antimuscarinic medications,” Pucheril said.
Also, there’s debate over the safety of alternatives.
“We cannot tell if patients are being monitored for neurologic problems in other ways,” Pucheril noted.
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How Much Does Tamsulosin Cost
Tamsulosin is available as a generic drug and under the brand name Flomax, and it is considered a moderately priced drug. A one-month supply of 30 capsules costs between $7.17 and $9.50 for the generic version of the medication, while the brand name version of the drug retails for approximately $250 for a one month supply. Tamsulosin is widely available in the generic form and is typically prescribed as a generic unless there is a medical reason to use the brand name version of the drug. Although some people express concern over the quality of generic drugs, these concerns are unfounded the FDA subjects generic forms of the medication to the same stringent testing as the brand name form of the drug. The generic medication uses the same active ingredient as the brand name form of the medication in the same amount but may use different inactive ingredients that affect the color, size, shape, or taste of the medication. However, you will receive the same treatment when using a generic medication of the same form and strength as you would with a brand name medication.
Concern Over High Us Prescribing Levels Of Common Drug Linked To Dementia
- European Association of Urology
- A new analysis raises concern over high prescription rates in the USA of a common drug used to treat overactive bladder. The drug, oxybutynin, when taken orally, is consistently linked with cognitive impairment and dementia in the elderly. The analysis shows that oxybutynin, is prescribed in more than a quarter of cases of overactive bladder , even though other more suitable drugs are available.
A new analysis raises concern over high prescription rates in the USA of a common drug used to treat overactive bladder. The drug, oxybutynin, when taken orally, is consistently linked with cognitive impairment and dementia in the elderly. The analysis shows that oxybutynin, is prescribed in more than a quarter of cases of overactive bladder , even though other more suitable drugs are available. This work is presented at the European Association of Urology conference in London, where concerns are also being expressed about the lack of funded alternatives to oxybutynin in Europe.
Around 16% of US adults suffer from overactive bladder, which translates into tens of millions of sufferers in the US.
According to Dr Pucheril, “We looked at a representative sample, but when you extrapolate to the US population the figures are huge. We estimate that over the six years of our analysis, 47 million individuals in the USA were taking various types of antimuscarinic drugs for OAB, with around 55% of new prescriptions going to the over 65’s.
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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.
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
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How To Read A Research Paper: An Exercise In Critical Thinking In The Context Of An Epidemiologic Study On Tamsulosin And The Risk Of Dementia
J Clin Psychiatry 2018 79:18f12660
To cite: Andrade C. How to read a research paper: an exercise in critical thinking in the context of an epidemiologic study on tamsulosin and the risk of dementia. J Clin Psychiatry. 2018 79:18f12660.
To share: https://doi.org/10.4088/JCP.18f12660
Benign prostatic hyperplasia is a common condition in the aging male. Pathological evidence of BPH is present in 8% of men in the fourth decade of life and in 50% of those in the sixth decade.1 The prevalence of BPH with lower urinary tract symptoms varies widely, depending on the operational definition of the disorder and on the risk factors in the sample.2-4
A peak urinary flow rate of 20 mL/s and above is generally considered normal. In this context, a community-based study found that 6% of men aged 40-44 years had peak urinary flow rates that were < 10 mL/s this figure was 35% in men aged 75-79 years.5 In the same study, 13% of men aged 40-49 years and 28% of men aged > 70 years had moderate to severe LUTS, as assessed using a validated urinary symptom scale.6 A recent review concluded that the prevalence of BPH/LUTS was 50%-75% in men aged 50 years and above and 80% in men aged 70 years and above.3
Six classes of drugs are used to treat BPH7 the commonest are the blockers and the 5-reductase inhibitors.8 One among these, tamsulosin, was recently associated with an increased risk of incident dementia.9,10
Note to the Reader
Thinking Critically: 1
Thinking Critically: 2
Dosage For Benign Prostatic Hyperplasia
Typical dosage: 0.4-mg capsule daily.
Dosage increase: If your body doesnt respond to the 0.4-mg dose after two to four weeks, your dosage may be increased to 0.8 mg daily.
Your body may process this drug more slowly. Your doctor may start you on a lowered dosage so that levels of the drug dont build up too high in your body. High levels of this drug in your body can be dangerous.
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.
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