Medications: Some Drugs Make Dementia Worse

IMPORTANT! This information is meant to be used only for general information, in accordance with current medical information and the practice experience of this geriatrician and should never be used alone, outside of the medical advice of one’s personal physician.

Most drugs specifically developed to improve dementia seek to increase the levels of “choline,” a chemical that brain cells need to communicate with each other. Yet several common medicines are “anti-cholinergic,” that is, they decrease levels of choline. Thus, these drugs can make dementia worse, resulting in more confusion and agitation. They can also cause dry mouth, constipation, and difficulties urinating.

These include:
  • Benadryl, found in cough syrups and over-the-counter allergy and sleeping pills such as Tylenol PM®. Sometimes, a single dose of Benedryl may be needed for an allergic reaction, but there are usually better choices.
  • Bladder pills such as Tolterodine/Detrol®, Oxybutynin/Ditropan®
  • Tropsium/Sanctura®, do help when patients need to urinate often. However, they cause a lot of confusion and agitation. It’s better to take more basic measures: Stop caffeine.Take the person to the bathroom every two hours. Provide activities that are interesting. Nortriptyline (low dose) can be helpful, but may cause less dry mouth, and if taken as an overdose cardiac complications.
  • Glycopyrrolate/Robinul® dries secretions, causes confusion and agitation.
  • Atropine/AtroPen eye drops, should be used with caution in dementia. It is used in hospice to dry secretions; but it’s best not not to use it unless the person is unconscious.
  • Amitriptyline, a medicine used in the past to treat depression and now prescribed to treat neuropathy and irritable bowel conditions. Nortriptyline can be used for these problems with less anticholinergic side effects.
  • Diphenoxylate and atropine/Lomotil®, a medicine prescribed for diarrhea, may be OK if it’s only used once or twice. But if used regularly, its anticholinergic effects may cause problems for dementia patients.
  • Various steroids—medicines commonly used to reduce inflammation of various sorts—may also pose a problem for a person with dementia:

    • Prednisone® and other steroids used to treat emphysema and other lung diseases may cause confusion, agitation (also called delirium in medical contexts) and insomnia. If needed to treat an emphysema attack, they should be tapered off quickly. A recent study reports little benefit continuing this drug more than two weeks.