close

List of Anticholinergic Drugs and Why Some of Them are Dangerous for Seniors

If you or someone you love is 60+ years and takes over-the-counter allergy, mood, or sleep aid medications, consult your doctor or pharmacist immediately. There’s a good chance the drug is an anticholinergic. These drugs are linked to dementia.

The American Geriatrics Society strongly recommends avoiding over-the-counter antihistamines and other anticholinergic medications.

What's the concern with anticholinergic medications?

Many over-the-counter drugs have anticholinergic properties. Drugs with anticholinergic properties block the action of the neurotransmitter chemical, acetylcholine. Acetylcholine helps send signals to other cells affecting muscle contraction, learning, and memory.

Those over 65+ already have diminishing numbers of neurons or receptors in the brain so blocking the acetylcholine adds insult to injury.

Plus, medications stay in an older person’s system longer. The kidneys and liver clear drugs slower in an aging body. Drug levels in the blood remain higher for longer. The result is a build-up of anticholinergic properties blocking acetylcholine.

Anticholinergics also decrease how much you sweat. It’s easy for older adults to become dehydrated and for their core body temperature to rise. They’re at risk for stroke, blurred vision, dizziness, drowsiness, dry mouth, urine retention, constipation, delirium, and hallucinations. Although technology like pill dispensers and medical alert systems are a partial solution for senior safety and independence, it’s still important to supervise anticholinergic usage.

Did you know most pharmacists will review your medications for free?

Older adults should frequently ask their pharmacist or doctor to audit their drugs. Seniors tend to take two or more medications at a time. Medical professionals will screen for drug combinations that create high anticholinergic levels. Periodic and thorough reviews minimize the risk for adverse drug effects.

Be sure to include alcohol on your list of drugs. Taking anticholinergic drugs with alcohol can result in unconsciousness or even death.

If you want to stay clear-headed as you age, be wary of drugs with anticholinergic properties. Their continued use increases risk of short-term memory loss, poor reasoning, confusion, and irreversible dementia.

A Comprehensive List of Anticholinergic Drugs

Here's a comprehensive list of Anticholinergic Drugs (AC) (allergy and sleep-aid medications). This list is courtesy of The People's Pharmacy and were included in Dr. Shelly Gray's study at the University of Washington:

  • Amitriptyline (Elavil)
  • Atropine
  • Benztropine (Cogentin)
  • Chlorpheniramine (Actifed, Allergy & Congestion Relief, Chlor-Trimeton, Codeprex, Efidac-24 Chlorpheniramine, etc.)
  • Chlorpromazine (Thorazine)
  • Clomipramine (Anafranil)
  • Clozapine (Clozaril)
  • Cyclobenzaprine (Amrix, Fexmid, Flexeril)
  • Cyproheptadine (Periactin)
  • Desipramine (Norpramin)
  • Dexchlorpheniramine
  • Dicyclomine (Bentyl)
  • Diphenhydramine (Advil PM, Aleve PM, Bayer PM, Benadryl, Excedrin PM, Nytol, Simply Sleep, Sominex, Tylenol PM, Unisom, etc.)
  • Doxepin (Adapin, Silenor, Sinequan)
  • Fesoterodine (Toviaz)
  • Hydroxyzine (Atarax, Vistaril)
  • Hyoscyamine (Anaspaz, Levbid, Levsin, Levsinex, NuLev)
  • Imipramine (Tofranil)
  • Meclizine (Antivert, Bonine)
  • Nortriptyline (Pamelor)
  • Olanzapine (Zyprexa)
  • Orphenadrine (Norflex)
  • Oxybutynin (Ditropan, Oxytrol)
  • Paroxetine (Brisdelle, Paxil)
  • Perphenazine (Trilafon)
  • Prochlorperazine (Compazine)
  • Promethazine (Phenergan)
  • Protriptyline (Vivactil)
  • Pseudoephedrine HCl/Triprolidine HCl (Aprodine)
  • Scopolamine (Transderm Scop)
  • Thioridazine (Mellaril)
  • Tolterodine (Detrol)
  • Trifluoperazine (Stelazine)
  • Trimipramine (Surmontil)

Other Anticholinergic Drugs (with lesser AC effect)

Here are some other anticholinergic drugs to watch out for but they have fewer effects on the brain.

  • Alprazolam (Xanax)
  • Amantadine (Symmetrel)
  • Baclofen
  • Carisoprodol (Soma)
  • Cetirizine (Zyrtec)
  • Cimetidine (Tagamet)
  • Clorazepate (Tranxene)
  • Codeine
  • Colchicine
  • Digoxin (Lanoxicaps, Lanoxin)
  • Diphenoxylate (Lomotil)
  • Fluphenazine (Prolixin)
  • Furosemide (Lasix)
  • Hydrochlorothiazide (Esidrix, Dyazide, HydroDIURIL, Maxzide & literally scores of other medications for high blood pressure)
  • Loperamide (Imodium)
  • Loratadine (Alavert, Claritin)
  • Maprotiline
  • Nifedipine (Adalat, Procardia)
  • Ranitidine (Zantac)
  • Thiothixene (Navane)
  • Tizanidine (Zanaflex)

Why are Anticholinergic drugs used?

Drugs with anticholinergic properties have been used in medicine for decades to treat conditions such as:

  • Diarrhea
  • Asthma
  • Overactive bladder and urinary incontinence
  • Chronic obstructive pulmonary disease (COPD)
  • Surgery and anesthesia for muscle relaxation
  • Insomnia
  • Motion sickness
  • Toxicity of certain poisonings
  • Parkinson’s disease symptoms
  • Psychiatric disorders
  • Gastrointestinal disorders
  • Some symptoms of Parkinson’s disease
  • Anesthesia during surgery

What are the signs of a possible overdose?

  • Dizziness
  • Severe drowsiness
  • Fever
  • Severe hallucinations
  • Confusion
  • Trouble breathing
  • Clumsiness and slurred speech
  • Fast heartbeat
  • Flushing and warmth of the skin

Tell your doctor if you have any of these conditions. Also, tell your doctor if you have a history of allergies to anticholinergics.

Besides the elderly, who else shouldn’t use anticholinergics?

People with a diagnosis of:

  • Myasthenia gravis
  • Hyperthyroidism
  • Glaucoma
  • Enlarged prostate
  • Hypertension (high blood pressure)
  • Urinary tract blockage
  • Increased heart rate (tachycardia)
  • Heart failure
  • Severe dry mouth
  • Hiatal hernia
  • Severe constipation
  • Liver disease
  • Down syndrome

Summary

The lists of drugs above is daunting. You might feel you’ll just have to suffer with your allergy and cold symptoms or sleeplessness.

But that’s not the case. There are safe effective alternatives. Check with your doctor or pharmacist. Discuss your symptoms and get recommendations for other options that are safe for older adults.