Pharmaceutical drugs are known to have issues in many cases. That's why some are advertised with serious warnings, and we can laugh at them as we here them pass on TV commercials. "May cause death" would be the most serious one that you would have to be so desperate to take the drug to ignore.

Even without direct death from taking a drug, some drugs contribute to deaths. The current opioid epidemic is a large factor in deaths from accidental use or suicide. What about lesser health concern that don't cause or contribute to death?

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Credit: Dawn McIlvain Stahl/flickr, CC BY 2.0

Dementia and Anticholinergic Drugs

Some new research has come out that casts a light on the dark shadow of anticholinergic drugs, with some antidepressants and incontinence medications belonging to that type of drug. The use of these types of drugs correlates with an increased risk of dementia. And this risk lasts a long time. Even if you stopped taking the drug for 20 years, the risk of developing cognitive impairment is still present.

Data from 27 million prescription of 40,770 patients over 65 years old with dementia in the USA, UK and Ireland were analyzed in comparison to records from 283,933 older adults without dementia. Those who had taken anticholinergic antidepressants, anticholinergic bladder medications and anticholinergic Parkinson's disease medications had the greatest incidence of dementia.

These anticholinergic drugs block the nervous system neurotransmitter called acetylcholine, and lead to an increase in cognitive decline. Their harm emerges before an official dementia diagnosis is made, as the brain and cognition are affected progressively.

In order to preserve brain health (which you should), people need to carefully weight the pros of even taking anticholinergic drugs at all. Depressions and bladder conditions affect 13% of men and 30% women in the USA and UK. These afflictions usually get "treated" with by doctors prescribing pills.

It's not known exactly how these anticholinergic drugs are causing dementia. But to be on the safe side, make sure you know what pills you are taking and avoid these if you can. If you are on them, talk to your doctor to find a way to un-prescribe from using them and use something else.

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Reasons for Using Anticholinergic Drugs

The anticholinergic drugs mentioned were for depression, bladder control issues and Parkinson's disease movement problems, but anticholinergic drugs can also be found in medication for:

• Dizziness (including vertigo and motion sickness-related symptoms)
• Extrapyramidal symptoms, a potential side-effect of antipsychotic medications.
• Gastrointestinal disorders (e.g., peptic ulcers, diarrhea, pylorospasm, diverticulitis, ulcerative colitis, nausea, and vomiting)
• Genitourinary disorders (e.g., cystitis, urethritis, and prostatitis)
• Insomnia, although usually only on a short-term basis
• Respiratory disorders (e.g., asthma, chronic bronchitis, and chronic obstructive pulmonary disease [COPD])
• Sinus bradycardia due to a hypersensitive vagus nerve

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Credit: MLIAO/wikimedia, CC BY 3.0

List of Anticholinergic Drugs

For an overview of some anticholinergic drugs, here is a list some people might recognize now or in the past:

Higher anticholinergic drugs:

• 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)

Lower anticholinergic drugs:

• 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)

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Credit: Phantom Open Emoji/wikimedia, CC BY 3.0

Side Effects of Anticholinergic Drug Use

• Poor coordination
• Dementia
• Decreased mucus production in the nose and throat; consequent dry, sore throat
• Dry-mouth with possible acceleration of dental caries
• Stopping of sweating; consequent decreased epidermal thermal dissipation leading to warm, blotchy, or red skin
• Increased body temperature
• Pupil dilation; consequent sensitivity to bright light (photophobia)
• Loss of accommodation (loss of focusing ability, blurred vision – cycloplegia)
• Double-vision
• Increased heart rate
• Tendency to be easily startled
• Urinary retention
• Urinary incontinence while sleeping
• Diminished bowel movement, sometimes ileus (decreases motility via the vagus nerve)
• Increased intraocular pressure; dangerous for people with narrow-angle glaucoma.

Other side effects are associated with symptoms of delirium:

• Confusion
• Disorientation
• Agitation
• Euphoria or dysphoria
• Respiratory depression
• Memory problems
• Inability to concentrate
• Wandering thoughts; inability to sustain a train of thought
• Incoherent speech
• Irritability
• Mental confusion (brain fog)
• Wakeful myoclonic jerking
• Unusual sensitivity to sudden sounds
• Illogical thinking
• Photophobia
• Visual disturbances
  • Periodic flashes of light
  • Periodic changes in visual field
  • Visual snow
  • Restricted or "tunnel vision"
• Visual, auditory, or other sensory hallucinations
  • Warping or waving of surfaces and edges
  • Textured surfaces
    "Dancing" lines; "spiders", insects; form constants
  • Lifelike objects indistinguishable from reality
  • Phantom smoking
  • Hallucinated presence of people not actually there
• Rarely: seizures, coma, and death
• Orthostatic hypotension (severe drop in systolic blood pressure when standing up suddenly) and significantly increased risk of falls in the elderly population.

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Note that one of the "rare" side effects is death. These medications are something to take with serious caution. If you know someone who is affected by any of the listed medical conditions, and they are taking pharmaceuticals to treat their condition, please do them the favor of informing them about the potential for risks in the drugs they take. They need to do some research to see if it's worth it, and talk to their doctor about possible alternatives.

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References:

• More Evidence Anticholinergic Meds Boost Dementia Risk
• Patients told not to stop anticholinergic drugs after study links them to dementia
• Common class of drugs linked to dementia even when taken 20 years before diagnosis
• Anticholinergic drugs and dementia in older adults
• Kathryn Richardson et al. Anticholinergic drugs and risk of dementia: case-control study, BMJ (2018). DOI: 10.1136/bmj.k1315
• Anticholinergic and Antispasmodic Drugs
• Anticholinergic
• List of Anticholinergic Drugs

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Thank you for your time and attention. Peace.

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