June 27, 2008

People With Dementia Should Avoid Certain Drugs

By Jeanine Kendle

The elderly with dementia generally tolerate drugs more poorly than healthy older individuals. Increased sensitivity to certain side effects, difficulty following drug regimens and decreased ability to recognize and report adverse events are common reasons.

The elderly with dementia also are susceptible to develop drug- induced cognitive impairment (loss of the ability to reason) than other healthy adults.

Medications with strong anticholinergic side effects, such as antihistamines that cause drowsiness, are well known for causing acute cognitive impairment in individuals with dementia. Anticholinergic-like effects, such as urinary retention and dry mouth, also have been identified in drugs not typically associated with major AC side effects such as narcotics (powerful pain relievers) and benzodiazepines (generally used as tranquilizers or for sleep).

These drugs also are important causes of acute confusional episodes. The factors that may determine whether a patient will develop cognitive impairment when exposed to ACs include: 1. the number of AC drugs and the doses of the drugs used; 2. baseline cognitive function (determines susceptibility); 3. the individual's response to medications (sensitivity and metabolic processing as determined by their liver and kidney function status).

Cholinergic transmission (acetylcholine) is a chemical compound that occurs in various organs and tissues of the body. It is thought to play an important role in the transmission of nerve impulses. is suggested to play a key role in the development of Alzheimer's dementia. The development of cholinesterase inhibitors, (acetylcholine is quickly destroyed by an enzyme, cholinesterase).

When used appropriately, the CIs (donepezil, Aricept, rivastigmine (Exelon) and galantamine (Razadyne) may slow the decline of cognitive and functional impairment in people with dementia. To gain maximum effectiveness, these medications should not be used in combination with ACs, agents known to have an opposing effect on the CIs.

In view of the devastating impact Alzheimer's and dementia, in general, have on individuals and loved ones, a list of medications to be avoided might be helpful.

Narcotic analgesics, such as, Meperidine (Demerol), Pentazocine (Talwin) and Propoxyphene (Darvon or Darvocet) should be avoided.

The antiarrythmic disopyramide (Norpace), should be avoided.

Antidepressants Tricyclic Antidepressants, such as Amitriptyline (Elavil), Amoxapine (Asendin), Clomipramine (Anafranil), Doxepin (Sinequan), Imipramine (Tofranil), Protriptyline (Vivactil) and Trimipramine (Surmontil) should be avoided.

Antiemetics (antivomiting agents) such as Cyclizine (Marezine), Dimenhydrinate Dramamine), Meclizine (Antivert), Promethazine (Phenergan) and Trimethobenzamide (Tigan) should be avoided.

Antiparkinsonian, anticholinergic such as Benztropine (Cogentin), Biperiden (Akineton), Procyclidine (Kemadrin) and Trihexyphenidyl (Artane), should be avoided.

Antipsychotics, such as Chlorpromazine (Thorazine), Clozapine (Clozaril), Mesoridazine (Serentil), Pimozide (Orap), Promazine (Sparine), Thioridazine (Mellaril) and Triflupromazine (Vesprin) should be avoided.

Anxiolytics recognized as Benzodiazepines should be avoided.

Antihistamines, single or combination products, such as Azatadine (Optimine), Brompheniramine (Dimetane), Carbinoxamine, Chlorpheniramine (Chlor-Trimeton), Clemastine (Tavist), Cyproheptadine (Periactin), Dexchlorpheniramine (Polaramine), Diphenhydramine (Benadryl or Sominex), Hydroxyzine (Atarax), Phenindamine (Nolahist), Promethazine (Phenergan) and Tripolidine (Actifed/Myidyl) should be avoided.

Gastrointestinal/urinary antispasmodics, single or combination products, such as Belladonna alkaloids, Atropine, Hyoscyamine (Levsin), Scopolamin, Dicyclomine (Bentyl), Flavoxate (Urispas), Oxybutynin (Ditropan) and Tolterodine (Detrol) should be avoided.

Muscle relaxants such as Carisoprodol (Soma), Chlorzoxazone (Parafon Forte), Cyclobenzaprine (Flexeril), Metaxalone (Skelaxin), Methocarbamol (Robaxin) and Orphenadrine (Norflex) should be avoided.

Hopefully, this list will assist you in keeping your loved one safe. There are safer alternatives for nearly every class of medications listed, just ask your pharmacist for assistance.

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