April 19, 2011
Medications and Patients with Alzheimer’s Disease – What to Avoid
Gaby T. Thai, M.D.
Doctors are often asked whether there are any medications that someone with Alzheimer’s disease should avoid. Patients with Alzheimer’s disease may need medicines to treat symptoms of the disease, as well as for other health problems such as bladder incontinence, mood disturbances, high blood pressure, etc… However, when a person takesmany medications, there is an increased risk of adverse effects, including confusion, mood swings, sleepiness, andworsening memory problems. Some medications can worsen symptoms of Alzheimer’s disease and should be avoided,if at all possible.
Sedatives and Sleep Aids: Some sedatives or hypnotics, such as benzodiazepines and barbiturates, can cause drowsiness, confusion, increasedcognitive impairment, slowed reaction, and worsening balance leading to falls. Sleep aids usually have the same effects. Examples of sedatives to avoid include the benzodiazepines diazepam (Valium), lorazepam (Aivan), temazepam(Restoril), triazolam (Halcion), and sleep aids zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata).
Antidepressants: Certain antidepressants, such as the older tricyclic antidepressants amitriptyline (Elavil), nortriptyline (Pamelor), andimipramine (Tofranil), can cause sedation and worsening cognition. The tricyclic antidepressants have anticholinergiceffects, meaning that they can further suppress the activity of acetylcholine, one of the main brain cell messenger chemicals whose activity is reduced by Alzheimer’s disease. For low mood and irritability in patients with Alzheimer’s,the SSRI (selective serotonin reuptake inhibitor) antidepressants including citalopram (Celexa), fluoxetine (Prozac),paroxetine (Paxil), sertraline (Zoloft) and the SARI (serotonin antagonist reuptake inhibitor) such as trazodone (Desyrel)can be considered instead.
Antipsychotics: Antipychotics are sometimes given to treat behavioral symptoms such as agitation, aggressiveness, hallucinationsand delusions. However, both the older antipsychotic drugs such as haloperidol (Haldol) and the newer atypicalantipsychotics such as resperidone (Risperdal), olanzepine (Zyprexa) can cause serious side effects including sedation, confusion, and sometimes Parkinsonian-like symptoms. Studies have shown that both atypical and older antipsychoticsare associated with increased risk of death in elderly dementia patients. These drugs should not be used routinely,and if needed, the minimum dosage should be used for the minimum amount of time, under careful supervision of anexperienced clinician.
Patients and caregivers should also be cautious of over the counter medicine containing diphenhydramine (Benadryl). Diphenhydramine is an antihistamine that tends to make people drowsy. It also has anticholinergic effects that mayresult in confusion and worsening cognition. Diphenhydramine is found in sleep aids such as Compoz, Nytol, Sominex,Unisom, and also in “night time” or “pm” version of popular pain relievers, cold and sinus remedies.
In essence, patients with Alzheimer’s disease are particularly vulnerable to side effects from various medications. It is best to consult with your doctors and pharmacists to learn about the benefits and potential adverse effects of any newtreatment therapy, including seemingly benign over the counter remedies.