Some of the ACT participants have agreed to have their brains autopsied after they die. However, while there are not many alternatives to oxybutynin for increasing bladder control, she suggests behavioral changes may be an option. And there are second generation antihistamines like loratadine (Claritin) for allergies. For example, to treat depression there are the selective serotonin re-uptake inhibitor (SSRI) like citalopram ( Celexa) or fluoxetine (Prozac).
Gray says there are alternative non-anticholinergic drugs for doxepin and chlorpheniramine. 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.” 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. The results showed that the most commonly used medications were tricyclic antidepressants (for example, doxepin or Sinequan), first-generation antihistamines (chlorpheniramine, Chlor-Trimeton), and antimuscarinics for bladder control (oxybutynin, Ditropan). Over the period of the study, nearly 800 participants developed dementia. This was updated as participants were followed up for an average of 7 years. To assess how much exposure the participants had to anticholinergic drugs, the researchers used computer records from the pharmacies that dispensed them.įrom 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. The participants were part of the Adult Changes in Thought (ACT) study in Group Health, an integrated health care delivery system in Seattle. Gray and colleagues tracked nearly 3,500 men and women aged 65 and over with no dementia symptoms at the start of the study. Taking anticholinergics for more than 3 years linked to higher dementia riskįor their study, Prof. That is, the higher the cumulative amount of drug taken, the higher the risk of developing dementia.Īnd another first for the study, is that it also shows that dementia risk linked to anticholinergics may persist long after people stop taking the drugs. It is also the first study to show a dose-response effect, note the authors. By accessing pharmacy records, the researchers were also able to include non-prescription use of anticholinergics in their data.
If providers need to prescribe anticholinergics to their patients because they offer the best treatment, then “they should use the lowest effective dose, monitor the therapy regularly to ensure it’s working, and stop the therapy if it’s ineffective,” she adds.Īlthough the link between raised risk of dementia and anticholinergics has been found before, the new study uses more rigorous methods – including over 7 years of follow-up – to establish the strength of the link. “Health care providers should regularly review their older patients’ drug regimens – including over-the-counter medications – to look for chances to use fewer anticholinergic medications at lower doses,” she says. Gray urges people not to stop their therapy based on the findings of this study – they should talk to their health care provider, and also tell them about all their over-the-counter drug use. People should not stop their therapy but talk to their health care provider
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