Medications and Medications to Avoid
Courtesy of Alzheimer’s Association website
Therapeutic Research Center: http://www.pharmacistsletter.com
Therapeutic Research Center: http://www.prescribersletter.com
Medications Commonly Used to Treat Dementia Symptoms
As Alzheimer’s progresses, brain cells die and connections among cells are lost, causing cognitive symptoms to worsen. While these medications do not stop the damage Alzheimer’s causes to brain cells, they may help lessen or stabilize symptoms for a limited time by affecting certain chemicals involved in carrying messages among and between the brain’s nerve cells.
The following medications are prescribed to treat symptoms related to memory and thinking.
Cholinesterase inhibitors (Aricept, Exelon, Razadyne)
Cholinesterase (KOH-luh-NES-ter-ays) inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes. These medications prevent the breakdown of acetylcholine (a-SEA-til-KOHlean), a chemical messenger important for memory and learning. These drugs support communication between nerve cells.
Donepezil (Aricept): approved to treat all stages of Alzheimer’s disease.
Side Effects: Nausea, vomiting, loss of appetite, muscle cramps, and increased frequency of bowel movements.
Galantamine (Razadyne): approved for mild-to-moderate stages of Alzheimer’s disease.
Site Effects: Nausea, vomiting, loss of appetite, and increased frequency of bowel movements.
Rivastigmine (Exelon): approved for mild-to-moderate Alzheimer’s as well as mild-to-moderate dementia associated with Parkinson’s disease.
Side Effects: Nausea, vomiting, loss of appetite, and increased frequency of bowel movements.
Glutamate regulators (Namenda)
Glutamate regulators are prescribed to improve memory, attention, reason, language, and the ability to perform simple tasks. This type of drug works by regulating the activity of glutamate, a different chemical messenger that helps the brain process information.
Memantine (Namenda): approved for moderate-to-severe Alzheimer’s disease.
Side Effects: Headache, constipation, confusion, and dizziness.
Recent Development of Alzheimer Medication Treatment
Progress has been made in understanding the cause of Alzheimer’s dementia after years of research. We have identified abnormal protein deposits in brain cells that are commonly seen in patients with Alzheimer’s dementia. However, we are still not certain if those are markers of the disease or they are responsible for the cause of the disease. Ongoing active research is focusing on answering those questions. Similarly, there is also active research in looking at the molecular origins of other dementia types.
Recently, a medication that is specifically used to deplete one of those proteins (beta-amyloid) found in Alzheimer’s has been approved by the FDA for treatment. The approval process has been met with controversy. Although the medication is effective in depleting the protein, the effectiveness of the medication to slow down or stop the disease is still unknown. The drug was only tested in patients with the earliest stage of the disease and is never intended for use for moderate or advanced stages of dementia. The treatment also carries a risk for significant side effects. We are currently not recommended the treatment until a more definite result on the effectiveness of the medication is available.
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Medication to Avoid
There are medications (prescribed and over the counter) that may put patients at risk (especially over 65 years old) for side effects in affecting the memory. Patients with dementia are even more at risk.
Elderly people with dementia often tolerate drugs less favorably than healthy older adults. Reasons include increased sensitivity to certain side effects, difficulty with adhering to drug regimens, and decreased ability to recognize and report adverse events. Elderly adults with dementia are also more prone than healthy older persons to develop drug-induced cognitive impairment.
Many patients also ask for alternative medications and supplements for dementia. Please refer to the section on dietary supplements for additional information.
The medicines below should be avoided or used cautiously because older adults are sensitive to their side effects. If you see a drug that you are taking on the list below*, check with your physician. Do not stop taking any medication without first talking to your doctor. You can find additional information and a full list of medications to avoid or use with caution through the Health in Aging website.
| Medication | Reason |
|---|---|
|
Non-steroidal anti-inflammatory drugs (NSAIDs)
|
NSAIDs can increase the risk of indigestion, ulcers, and bleeding in your stomach or colon. They can also increase blood pressure, affect your kidneys, and make heart failure worse. |
| Digoxin (Lanoxin) in doses greater than 0.125 mg. | It can be toxic in older adults and people whose kidneys do not work well. |
|
Certain diabetes drugs
|
These can cause severe low blood sugar. |
|
Muscle relaxants
|
They can leave you feeling groggy and confused, increase your risk of falls, and cause constipation, dry mouth, and problems urinating. Plus, there is little evidence that they work well. |
|
Certain medications used for anxiety and/or insomnia Benzodiazepines such as:
Sleeping pills such as:
|
They can increase your risk of falls, as well as cause confusion. Because it takes your body a long time to get rid of these drugs, you could feel groggy and sleepy for a long time. |
|
Certain anticholinergic drugs Antidepressants such as:
|
They can cause confusion, constipation, problems urinating, blurry vision, and low blood pressure. Men with an enlarged prostate should be particularly cautious. |
| Pain Reliever meperidine (Demerol) | It can increase the risk of seizures and can cause confusion. |
|
Certain over-the-counter products
|
Although these medications are sold without a prescription, they are not risk-free. They can cause confusion, blurred vision, constipation, problems urinating, and dry mouth. |
|
If you are not being treated for psychosis, avoid using antipsychotics
|
They can increase the risk of stroke or even death. They can also cause tremors and other side effects, as well as increase your risk of falls. |
|
Estrogen pills and patches
|
They can increase your risk of breast cancer, blood clots, and even dementia. |
* Used with permission from the American Geriatrics Society: AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (2012). See the full list of medications at the American Geriatrics Society website.