Memory Loss Can Be Caused By Over-The-Counter Drugs

Did you know that common over-the-counter drugs or prescriptions can cause memory loss and cognitive impairment?

Mild cognitive impairment is a common, age-linked condition that is often an early sign of Alzheimer's disease. Its cardinal symptom is forgetfulness or impairment of short-term memory.

Numerous drugs have been shown to produce mild cognitive impairment (MCI). They may create or aggravate Alzheimer's-type symptoms.

(NOTE: You should NOT stop taking medications without first consulting your physician.)

Most of the drugs that cause MCI have a property called "anti-cholinergic." They inhibit activity of the neurotransmitter acetylcholine, which plays a critical role in memory and cognitive function.

Here's the problem: only a few of these drugs are officially classified as anti-cholinergic. The official anti-cholinergic drugs are mostly used for relieving intestinal cramps or bladder irritability and are labeled "anti-spasmodic." They're at the top of the list below.

But there are 17 additional types of drugs used for many other purposes that may also have anti-cholinergic effects. The list includes commonly used drugs like antihistamines, acid blockers and antidepressants. Unfortunately, many doctors and pharmacists are unaware of the anti-cholinergic properties of these medications.

In an address to the American Academy of Neurology at the 60th Annual Meeting, Dr. Jack Tsao, associate professor of neurology at Uniformed Services University in Bethesda, Maryland, said, "... a lot of medicines that are not advertised as anti-cholinergic in nature actually have anti-cholinergic properties." Dr. Tsao and his colleagues followed a group of nuns and clergy from the Rush Religious Orders for about eight years and found an accelerated rate of cognitive decline in those who began using anti-cholinergic drugs.

Several published studies have also shown that people taking drugs with hidden anti-cholinergic effects are at increased risk for MCI.

It is likely that these drugs have additive effects: the more anti-cholinergic drugs a person takes at one time, the greater the risk of side effects.

Because the list is long and includes drugs used for many different purposes, it is possible for an individual's total burden of anti-cholinergic drug activity to be much higher than expected.

In addition, advanced age is associated with increased susceptibility to anti-cholinergic drugs because of a reduction in acetylcholine activity with age.

If you're concerned about MCI in yourself or someone you know, check the list of drugs below to see if medication might be contributing to the problem.

Drugs with Anti-cholinergic Properties

Some of these are available without prescription and may be found alone or combined with other drugs, especially in over-the-counter cold and headache remedies. Don't just rely on the product's name. Check all ingredients. Bring this information to your doctor. Do not discontinue the use of any prescription drug without your doctor's approval.

Antispasmotics: used to relieve intestinal cramps or bladder symptoms, these are also found in numerous over-the-counter and prescription combination products used for colds and coughs, with various brand names:

o Atropine
o Belladonna (Donnatal and others)
o Clidinium (Quarzan)
o Dicyclomine (Bentyl and others)
o Flavoxate (Urispas)
o Glycopyrrolate (Robinul)
o Hyoscyamine (Levsin, NuLev, Cystospas and many others)
o Oxybutynin (Ditropan and others)
o Solifenacin (VesiCARE)
o Propantheline (ProBanthine and others)
o Scopolamine (Transderm-Scop and others)
o Tolterodine (Detrol)
o Trospium (Regurin and others)

Antihistamines: these are used in numerous over-the-counter and prescription products alone or in combination with other drugs for relieving symptoms of allergies, colds, dizziness or improving sleep:

o Azatadine (Optimine and others)
o Chlorpheniramine (Chlortimeton and others)
o Clemastine (Contac, Tavist and others)
o Cyproheptadine (Periactin)
o Desloratadine (Clarinex and others)
o Dimenhydrinate (Dramamine and others)
o Diphenhydramine (Benadryl and many others)
o Doxylamine (Unisom and others)
o Hydroxyzine (Atarax, Vistaryl)
o Loratadine (Claritin and others)
o Meclizine (Antivert and others)
o Pyrilamine

Note: Fexofenadine (Allegra) and cetirizine (Zyrtec) are antihistamines without anti-cholinergic effects, but may cause sedation.

Antacids: these are histamine H2 antagonists, used to relieve heartburn and stomach pain. For more on acid suppressing drugs, see my article "Stomach Acid and the Future of Health Care":

o Cimetidine (Tagamet)
o Famotidine (Pepcid)
o Nizatadine (Axid)
o Ranitidine (Zantac)

Note: Although these drugs have relatively weak anti-cholinergic activity, their use is associated with MCI in older adults.

Antidepressants:

o Amitriptyline (Elavil and others)
o Amoxapine (Asendin)
o Citalopram (Celexa)
o Clomipramine (Anafranil)
o Desipramine (Norpramin)
o Doxepin (Sinequan and others)
o Duloxetine (Cymbalta)
o Escitalopram (Lexapro)
o Fluoxetine (Prozac)
o Imipramine (Tofranil)
o Lithium
o Nortriptyline (Pamelor, Aventyl)
o Paroxetine (Paxil and others)
o Protriptyline (Vivactil)

Muscle relaxants:

o Carisoprodal (Soma and others)
o Chlorzoxazone (Parafon Forte and others)
o Cyclobenzaprine (Flexeryl and others)
o Methocarbamol (Robaxin and others)
o Orphenadrine (Norflex and others)

Antiarrythmics: used to treat cardiac arrhythmias:

o Digoxin
o Disopyramide (Norpace and others)
o Procainamide
o Quinidine (Quinaglute and others)

Antiemetics: used to suppress nausea or vomiting:

o Promethazine (Phenergan and others)
o Prochlorperazine (Compazine and others)
o Trimethobenzamide (Tigan)

Antipsychotics: used for severe psychiatric disorders:

o Chlorpromazine (Thorazine and others)
o Clozapine (Clopine and others)
o Mesoridazine (Serentil)
o Olanzapine (Zyprexa)
o Promazine
o Quetiapine (Seroquel)
o Thioridazine (Mellaril)

Antiparkinsonian: used in the treatment of Parkinson's disease and related disorders:

o Amantadine (Symmetrel)
o Benztropine (Cogentin)
o Biperiden (Akineton)
o Procyclidine (Kemadrine)
o Trihexyphenidyl (Artane and others)

Miscellaneous:

These drugs were shown to have anti-cholinergic effects at high concentration. They may exert clinically significant anti-cholinergic side effects when used at high doses or in people with impaired kidney function or a heightened susceptibility to anti-cholinergic side effects:

o Amoxicillin (an antibiotic)
o Carbamazepine (Tegretol, a drug for controlling seizures or chronic pain)
o Celecoxib (Celebrex, an anti-inflammatory pain reliever)
o Cephalexin (Keflex, an antibiotic)
o Diazepam (Valium, a tranquilizer)
o Diphenoxylate (Lomotil, a drug for diarrhea)
o Fentanyl (Duragesic, a narcotic pain reliever)
o Furosemide (Lasix, a diuretic used for fluid retention)
o Hydrocodone (a narcotic pain reliever, found in Vicodin)
o Lansoprazole (Prevacid, a proton pump inhibitor, used to reduce stomach acid)
o Levofloxacin (Levaquin, an antibiotic)
o Metformin (Glucophage, a drug that reduces blood sugar, used by diabetics)
o Phenytoin (Dilantin, a drug for controlling seizures)
o Temazepam (Restoril, a sleeping pill)
o Topiramate (Topimax, a drug used for preventing migraine headaches)

A medication does not have to be swallowed or injected to exert systemic effects.

Anti-cholinergic eye drops may affect the brain. They are used to dilate the pupils. These include:

o Cyclopentolate
o Homatropine
o Tropicamide

Anti-cholinergic Herbs: Numerous herbs and natural products have anti-cholinergic effects and may be more hazardous than medications. Here are those that have been studied the most:

o Amanita muscaria (fly agaric)
o Amanita pantherina (panther mushroom)
o Arctium lappa (burdock root)
o Atropa belladonna (deadly nightshade)
o Cestrum nocturnum (night blooming jessamine)
o Datura metel (yangjinhua, used in traditional Chinese remedies)
o Datura suaveolens (angel's trumpet)
o Datura stramonium (jimson weed)
o Hyoscyamus niger (black henbane)
o Lantana camara (red sage)
o Phyllanthus emblica (Indian gooseberry)
o Solanum carolinensis (wild tomato)
o Solanum dulcamara (bittersweet)
o Solanum pseudocapsicum (Jerusalem cherry)

Learn more about herbs, traditional uses and side effects in my Herb Guide

In addition to memory loss and cognitive impairment, anti-cholinergic drugs may cause nervousness, confusion, disorientation, hallucinations, restlessness, irritability, dizziness, drowsiness, blurred vision and light sensitivity.

Know What You Are Taking

You should know everything that you or people in your family are taking: drugs and supplements and their potential side effects and interactions. If cognitive impairment is a problem and you're taking one or more of the substances listed above, what you're taking may be a cause or contributor.

And to get information on vitamins, nutrition and brain health read my articles:

"Leptin Fights Alzheimer's Disease"

"Metabolic Syndrome Linked to Memory Loss"

"To B or Not to B Vitamins?" which looks at the complex relationship between B Vitamins and the brain.

Now I'd like to hear from you. Have you experienced any symptoms of cognitive impairment? Are you taking medications or herbs? Did you have any side effects?

Please let me know your thoughts by posting a comment below.

Best Health,
Leo Galland, M.D.

Important: "Share the health" with your friends and family by forwarding this article to them, and sharing on Facebook.

Leo Galland, M.D. is a board-certified internist, author and internationally recognized leader in integrated medicine. Dr. Galland is the founder of Pill Advised, a web application for learning about medications, supplements and food. Sign up for FREE to discover how your medications and vitamins interact. Watch his videos on YouTube and join the Pill Advised Facebook page.

References:

J Am Geriatr Soc. 2008 Jul;56(7):1333-41. "Anticholinergic activity of 107 medications commonly used by older adults." Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, Kirshner MA, Sorisio DA, Bies RR, Gharabawi G.

Eur J Pharmacol. 2005 Jan 4;506(3):257-64. "Comparative anticholinergic activities of 10 histamine H1 receptor antagonists in two functional models." Orzechowski RF, Currie DS, Valancius CA.

Pharmacoepidemiol Drug Saf. 2004 Nov;13(11):781-7. "Histamine2 receptor antagonist use and decline in cognitive function among community dwelling elderly." Hanlon JT, Landerman LR, Artz MB, Gray SL, Fillenbaum GG, Schmader KE.

Clin Interv Aging 2009.:225-33. Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, Schubert CC, Munger S, Fick D, Miller D, Gulati R "The cognitive impact of anticholinergics: a clinical review."

Arch Intern Med. 2009;169(14):1317-1324. "Drugs With Anticholinergic Properties, Cognitive Decline, and Dementia in an Elderly General Population The 3-City Study." Isabelle Carrière, PhD; Annie Fourrier-Reglat, PhD; Jean-François Dartigues, MD; Olivier Rouaud, MD; Florence Pasquier, MD; Karen Ritchie, PhD; Marie-Laure Ancelin, PhD

Psychogeriatrics. 2010 Mar;10(1):34-8. "Adverse effects of anticholinergic activity on cognitive functions in Alzheimer's disease." Konishi K, Hori K, Uchida H, Watanabe K, Tominaga I, Kimura M, Hosoyamada M, Shibasaki T, Kataoka A, Hachisu M.

This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine or the provision of health care diagnosis or treatment, (iii) or the creation of a physician-patient relationship. If you have or suspect that you have a medical problem, contact your doctor promptly.

 

 

 

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Comments

[nrthrndncr]

07:14 AM on 03/21/2011

OMG! Doctor, to say that I felt like I had been hit with a brick doesn't cover the impact of reading this article, which was sent to me via email from a friend in Texas. I cannot convey how extreme my "forgetfulness" has become. Worse, I am a Registered Nurse of 28 years & semi-retired in part because of the very symptoms described which, up until now, I assume tagged along with two tiny cerebral aneurysms (one in a Canyon, one atop the 51% occlusion at the bifurcation of the L Carotid) they are "watching". In that assumption & as the MCI worsened, I've grown increasingly depressed, highly anxious, & have been mulling over how to prepare my beloved 9 yo Granddaughter (we are inseperable). Doctor! I am on daily doses of THREE of the meds listed & have been for years. But now what? They're an Analgesic, Diuretic, & Anti-inflammatory. So bad are the symptoms that I've even called my best friend (another Nurse), weeping, to tell her how severe the short term memory was & ask if she thought I was having TIAs. These meds are intregal. Again, now what?

[jlnhjm]

08:31 PM on 03/20/2011

I won't get into who owns this country, except it surely ain't us! I notice that many people here do not use alternative medicine; a shame because there are many safe medications there that can take the place of many OTC medications, such as benadryl for sleep. There are valerian, hops, passion flower, combination pills to explore. For fibro there are the Dr. Teitelbaum formulas, which I am just beginning to look into myself. Memory loss may be ameliorated with the use of huperazine A, choline, and a host of others. Please look into these alternatives, and others, you may find more help than you now think is available. That said, I am a walking basket case of medical errors thru-out my life. The internet would have been a tremendous foil when all this started, over 50 years ago. Now I am tied to medications that have to step in because of missing organs; without them I would not be alive.

[Maeve ZahraHighfield]

07:55 PM on 03/19/2011

My husband has Alzheimers and I have often wondered if the meds he takes have played a part? He has been prescribed quite a few which he takes regularly. When I asked the memory clinic Dr if any of them could be causing it she read through the list but said she thought not.
Amongst others he takes Antihitaamines, Antidepressants and Antibiotics.
Another point of interest is something I found online. A lady Dr. who's husband had Alzheimers researched what was missing in the brain and found that it was contained in coconut oil. She gave him coconut oil daily and he has improved a great deal. ( I must add that she was not trying to sell coconut oil! ) She had put the info online in order to spread these facts and help others.
I thought I would try it on my husband and since taking it regularly it has slowed the progression!
Just shows how natural foods without side effects can cure!

[dr dharma]

07:42 PM on 03/20/2011

Dear Maeve, It's not surprising to us that you have noticed some improvements in your husband's condition after implementing even some simple lifestyle measures. At the Alzheimer's Research and Prevention Foundation, we have been advocating a brain-healthy lifestyle for close to 20 years as a way to reduce your risk of developing the disease and slow its progression. If you want to learn more about the 4 Pillars of Alzheimer's Prevention, please visit www.alzheimersprevention.org.

[Marcia Duncan]

09:34 AM on 03/19/2011

i have been taking lamictal for about 10 years .my memory was getting REALLY bad to the point i had to make an appointment at a memory clinic.i've been off the lamictal about 6 months.that was my problem.my memory isn't all the way back .but it is much improved.

[Laraine AbbeyKatzev]

08:43 PM on 03/19/2011

Truth is truth. Sticking your head in the sand can't help. I believe you can get off antihistamines with proper treatment, but orthodox medicine cannot provide that as they simply don't know how. Find a well reputed alternative medicine doctor (alternative medicine is much more than vitamins) and good acupuncturist to help you reduce and manage your allergies, and restore your health.

[Marilyn Shively]

08:51 PM on 03/19/2011

I am not a lover of medication believe me but there are people out there that rely on orthodox drugs to deal with whatever condition they may have.; alternative medicine certainly has value but there are medical conditions that require orthodox medical treatment and drugs.

[Raphael Prophet]

08:20 PM on 03/20/2011

I've had allergies & asthma most of my life. I was on chlortimaton for a long time, it made me a mental basket case; was always absent minded & spacy. Loratadin "Claritin" did not work. Allegra has been my life saver and it's now an OTC. On the asthma side Advair & similar medicines worked for a while but would eventually give me a respiratory infection...so I started looking at my environment.
I now use allegra a few times a month and my rescue inhaler a couple tmes a week. My solution: vacuum daily or preferably get rid of yr carpet, get a quality air purifier, an ionizer and rid yrself of all cat litter (if you have cats) even the natural kind. I now use "Breeze" a new litter system created by Tidy Cat. On the nutrition side, eat the purest foods and drink the cleanest water ... educate yrself!!! You have a PC, education can be an adventure.

[POKETNRJSH]

02:31 AM on 03/07/2011

I switched from Allegra to generic loratadine a few years back, and ever since I've felt like my memory has certainly been impacted. I didn't tie it in to the switch at first, but this is certainly interesting enough to look in to.

[alithegreat]

03:31 PM on 03/02/2011

i knew it was the benedryl! dangit, THAT'S why i sleep so good, stuff is knocking my brains fuzzy. rats.

[Alchemist65535]

02:06 PM on 03/02/2011

For decades I suffered cognitive impairment that was quite severe for 20 years ending almost 8 years ago. I was also taking $1500/month worth of drugs including many from the lists above to control all sorts of symptoms. After starting methylcobalamin, and later adenosylcobalamin (the only two active b12s) and Metafolin, and some other vitamins and supplements my hundreds of symptoms started healing and I was able to discontinue most of my prescription drugs. Now 8 years later, I am not quite back to normal with some neurological impairment caused by prolonged b12 and folate deficiencies despite taking cyanocobalamin and folic acid for decades. With my monthly pharmacy bill down below $100 I am doing tremendously better. Some of my problems were clearly caused by the drugs and some by the functional changes and damage caused by prolonged unrecognized deficiencies.

[Drmhp]

01:37 AM on 03/21/2011

Try Rhodiola Rosea to see if it may help.

[Susan Foley]

04:20 PM on 02/23/2011

Most of this is ridiculous, you have to take huge doses or have something else the matter with you for most of these drugs to have this effect. Read the article closely.

[Marcia Duncan]

09:38 AM on 03/19/2011

i never took huge doses. it got so bad i couldn't even remember when church was.this was a prescription drug. i was totally convinced i had to have .couldn't even remember my childrens birthdays.very sad if it ever happens to you.

[ElderThinker]

10:33 AM on 02/21/2011

I took Oxybutynin for bladder problems and got so lost I had to look up my own name on my email. This truly is an amazing list and more people need to know about it. Dr. Gallant's website and articles are very helpful too.

[Lane Simonian]

09:42 PM on 02/20/2011

Let me make one huge addition to the list: bisphosphonate osteoporosis drugs, such as Fosamax, Boniva, and Actonel. These drugs increase the risk of Alzheimer's disease not because they are anti-cholinergic, but because they increase peroxynitrite levels. Peroxynitrite-mediated damage is widespread in Alzheimer's disease and is held to be the cause of short-term impairment in people with the disease. Since Fosamax began to be prescribed (mostly to women) in the mid-1990s the number of cases of Alzheimer's disease has increased from approximately 4 to 5 million people. Some of the individuals who took bisphosphonate drugs may have developed the disease due to other risk factors (high glucose levels, high blood pressure, etc.), but may have developed the disease later. The mass prescription of bisphosphonate osteoporosis drugs may partly be the cause of the recent epidemic of Alzheimer's disease.

[IndependentNAllWays]

03:46 PM on 02/20/2011

When you are a medical writer and editor by trade and start losing the ability to "find" words you once found at ease, articles like this help.

My experience is with ranitidine and Benadryl due to GERD, back surgery and a reduction in estrogen. In other words, some days are better than others for "minding" my business.

Thank you for thinking outside that box that holds the "average" patient who can hold their medicines without suffering severe side effects. As a nation, Americans seems to accept ongoing misery in the name of stoicism. Instead, we should be accepting the fact that no one is "normal" and offering sympathy rather than tearing each other down.

[Kate Stoune]

03:09 PM on 03/21/2011

"As a nation, Americans seems to accept ongoing misery in the name of stoicism. Instead, we should be accepting the fact that no one is "normal" and offering sympathy rather than tearing each other down."

Beautifully said and I couldn't agree more.

[johmich5]

01:33 PM on 02/20/2011

Doctors are not trained to cure disease, they are trained to treat symptoms.
Alternative medicine cures disease.
Drugs are rarely the answer, as most simply treat symptoms and have side effects that are cause more harm then the benefit derived. Modern medicine is a for profit business intended to generate revenue not health.

[Anita Simpson]

11:28 AM on 02/20/2011

I take two, sometimes three, of the drugs listed. When I think about my mental skills of 10 or 15 years ago, I can tell that my cognitive abilities as well as my memory have been significantly reduced. Also, I had ECT in 2002, and that took some of my memories and also interfered with making new short-term memories.
Everyone should find out the facts about the drugs they are taking, and if they experience side effects, keep talking to their doctor about it until they get results.

[Choco Zeke]

05:16 AM on 02/20/2011

I have heard of this beofre....