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, âWe 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 65âs.
Medications Associated With A Lower Dementia Incidence
The four medications associated with a lower dementia incidence were all vaccines: hepatitis A, typhoid, hepatitis A and typhoid combined, and diphtheria. Previous studies of vaccines and dementia risk have led to hypotheses that immunological changes, modified by vaccination, may protect against dementia. However, the vaccines associated with a lower dementia incidence in our study were all travel vaccines, with similar HRs to several antimalarial drugs. This suggests that the observed association may be due to foreign travel, rather than a direct effect of the vaccines. The association could be due to reverse causation , confounding by education or residual confounding by socioeconomic status.
The Research Is Mixed But Whats Clear Is That The Benefits Of Statins Typically Outweigh The Risks In People Who Need Them
Experts know that statins are good for your heart they can lower “bad” LDL cholesterol and reduce your chances of having a heart attack or stroke by 25% to 30%. But what effect do statins have on your brain?
In 2012, questions surfaced when the FDA issued a warning that statin users had reported short-term cognitive impairment when taking the drugs.
A study published June 29, 2021, by the Journal of the American College of Cardiology aimed to shed some additional light on this issue. Researchers looked at data on statin use among 18,446 people, ages 65 or older, who had taken part in a large randomized trial of aspirin. The researchers found that over a follow-up period of almost five years, people who took statins werent any more likely than non-users to have dementia. The same was true when it came to other changes in cognition, memory, language, executive function, or a measure called psychomotor speed, which measures how quickly someone can process information. They also found no differences between different types of statins.
However, while these findings were good news, they may not be the final word on this issue. Although this particular study found no link between statins and dementia, the research into statins and brain-related effects over all is best described as inconsistent, says Dr. JoAnn Manson, chief of the Division of Preventive Medicine at Harvard-affiliated Brigham and Womens Hospital.
How Does Tamsulosin Work
Alpha-blockers work by relaxing the muscles and preventing them from tightening, and while we usually focus on the effects they can have on the heart, alpha-blockers also help treat BPH in the same way. Tamsulosin works by helping to relax the muscles in the prostate and near the opening of the bladder, which can help to increase the flow of urine. Specifically, tamsulosin works by blocking the action of alpha1 receptors that are located in and around the prostate, at the neck of the bladder, and at the top of the urethra. With the receptors blocked, they are unable to absorb alpha1, a hormone that tells the muscles to tighten. This in turn helps to improve urine flow and reduce symptoms. However, tamsulosin does not shrink the size of the prostate. The prostate will continue to grow over time.
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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Papers Of Particular Interest Published Recently Have Been Highlighted As: Of Importance Of Major Importance
Peters CA, Walsh PC. The effect of nafarelin acetate, a luteinizing-hormone-releasing hormone agonist, on benign prostatic hyperplasia. N Engl J Med. 1987 317:599604.
Kyprianou N, Isaacs JT. Expression of transforming growth factor-beta in the rat ventral prostate during castration-induced programmed cell death. Mol Endocrinol. 1989 3:151522.
Shapiro E, Becich MJ, Hartanto V, Lepor H. The relative proportion of stromal and epithelial hyperplasia is related to the development of symptomatic benign prostate hyperplasia. J Urol. 1992 147:12937.
Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol. 2004 171:102935.
Lepor H, Tang R, Meretyk S, Shapiro E. Alpha 1 adrenoceptor subtypes in the human prostate. J Urol. 1993 149:6402.
Lepor H, Tang R, Shapiro E. The alpha-adrenoceptor subtype mediating the tension of human prostatic smooth muscle. Prostate. 1993 22:3017.
Honda K, Miyata-Osawa A, Takenaka T. Alpha 1-adrenoceptor subtype mediating contraction of the smooth muscle in the lower urinary tract and prostate of rabbits. Naunyn Schmiedeberg’s Arch Pharmacol. 1985 330:1621.
About Dr Leslie Kernisan Md:
Leslie Kernisan, MD, is a practicing geriatrician who believes that it shouldnt be so hard for older adults and families to get the right kind of help with health concerns. For more practical tips and to get her free quick guide to checking aging parents visit her new blog at: HelpingOlderParents.com.
Do you have experience with or stories about how prescription drugs may cause memory loss? Share them with us in the comments below.
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Healthy Heart Healthy Brain
On the surface, it seems intuitive that statins would reduce the risk of cognitive problems, because many treatments that help your heart can also help your brain, says Dr. Manson. Conversely, high cholesterol levels, high blood pressure, and diabetes are all risk factors for heart disease, as well as for a condition called vascular dementia, in which impaired blood flow to the brain leads to cognitive changes.
“Statins also decrease inflammation, which has been implicated in Alzheimers disease and some other forms of dementia,” says Dr. Manson.
Although it seems to make sense that statins would bring brain benefits, the research doesnt always bear that out.
“While you would expect that statin use would reduce the risk of cognitive decline and dementia because statins lower cardiovascular risks and the risk of stroke, it hasnt been clearly shown to be the case,” says Dr. Manson. “Its surprising that theres not a clearer reduction seen. If anything, some of these studies have raised concerns about cognitive risks.”
Is Tamsulosin Related To Dementia In The Elderly
Lower urinary tract symptoms are caused by age-related changes in detrusor function and prostatic development, which were caused by changes in the ratio of circulating androgens to estrogens. Because they affect urethral tone and intra-urethral pressure, alpha-adrenergic receptor blockers were often used to treat LUTS. Molecular cloning investigations discovered three 1-adrenergic receptor subtypes . The 1Asubtype predominates in the human prostate but was also found in several regions of the brain that drive cognitive function. Tamsulosin is the most commonly used 1-adrenergic receptor antagonist, with 12.6 million prescriptions written in 2010. Tamsulosin is 10- to 38-fold more selective for the 1A subtype than the other major kinds of 1A-adrenergic receptor antagonists .
Men who used tamsulosin had a greater risk of acquiring dementia than men who took other -adrenergic antagonists or no -adrenergic antagonists at all .
Based on the findings, researchers believed that tamsulosin, due to its particular affinity for 1A-adrenergic receptors, might enhance the risk of dementia when administered over a lengthy period of time. If the findings are validated, they will have far-reaching ramifications for public health in an aging society.
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Time On Metoprolol Tartrate When People Have Dementia Alzheimer’s Type *:
- < 1 month: 100 %
* Approximation only. Some reports may have incomplete information.
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 neurotransmitterâs 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.
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How Long Can You Be On Tamsulosin
As noted, tamsulosins side effects in the elderly may include an increased risk of dementia. This only happens when you take tamsulosin as a long-term treatment.
In other words, when you take it for too long. So, how long can you take tamsulosin as an older adult without increasing your risk?
A recent study published in the journal Current Urology Reports evaluated the risk of dementia in seniors taking tamsulosin. They brought together many other studies and analyzed their findings.
However, the follow-up period of the most recent research was only 18 months. After this time, they found a significant increase in dementia and other cognitive impairments .
Another study had a longer follow-up, and the investigators found a significant association only between 48 and 72 months of follow-up.
As noted, the studies so far do not provide clear evidence about how long to take tamsulosin. But some urologists may decide to discontinue BPH treatment after 2-5 years. There are many cases of successful discontinuation in patients who have already found relief of their lower urinary tract symptoms .
Natural Alternatives To Tamsulosin
There are plenty of natural alternatives for benign prostatic hyperplasia. In some cases, patients with an enlarged prostate do not have a very severe condition. Thus, their symptoms improve with natural remedies only.
In other cases, patients with a more severe prostate condition use natural remedies to go along with medical treatment for better results.
These supplements and herbs can help with your urinary tract symptoms in benign prostate hyperplasia:
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Tamsulosin Side Effects Long Term
A 2005 study examined the long-term safety and effectiveness of tamsulosin, looking at a group of men who had been taking tamsulosin for six years. The researchers found that some of the most common adverse effects included infection, accidental injury, runny nose, pain, and sore throat other reported side effects included abnormal ejaculation, syncope, and orthostatic hypotension .
Interestingly, the side effects declined over the six-year period, with the highest levels occurring in the first two years of treatment. In fact, less than 5% of men reported these adverse effects after the first two years of treatment .
In summary, people taking tamsulosin to treat BPH urinary symptoms continued to have safe and well-tolerated relief of their symptoms for up to six years.
What This Study Adds
We found that almost a third of medications were associated with dementia. Drugs with differing mechanisms of action but the same indication appeared to have similar effect sizes, suggesting that many associations may be due to reverse causation as opposed to a direct causal effect. We have made our results publicly available with the intention that others may generate their own hypotheses based on these results.
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What The Studies Found
It’s important to note that neither of these studies was a randomized controlled clinical trial, so neither proved that either type of drug causes dementia.
The anticholinergic study. Researchers tracked nearly 3,500 men and women ages 65 or older who took part in Adult Changes in Thought , a long-term study conducted by the University of Washington and Group Health, a Seattle health care system. They used Group Health’s pharmacy records to determine all the drugs, both prescription and over-the-counter, that each participant took in the 10 years before starting the study. Participants’ health was tracked for an average of seven years. During that time, 800 of them developed dementia. When the researchers examined medication use, they found that people who used anticholinergic drugs were more likely to have developed dementia than those who didn’t 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 the drugs to alleviate early symptoms of undiagnosed dementia. For people who took anticholinergic bladder medications, the increased risk was just as high as for those taking tricyclic antidepressants, which are also anticholinergics.
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.
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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 .
What Dose Of Tamsulosin Should I Take
Tamsulosin is sold in 0.4 mg capsules in both its generic and brand name forms. Most patients start on an initial dose of 0.4 mg taken orally once per day. The maximum dose is 0.8 mg, or two capsules taken once per day. The dosage of tamsulosin prescribed to you by your doctor will vary depending on the severity of your symptoms, your age, other health conditions, and other medications you may be taking. Tamsulosin is generally taken about 30 minutes after a meal and should be taken at the same time each day.
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