New Study Finds that Some Drugs May Raise Dementia Risk — as Many as 20 Years Later

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Tori Marsh
Tori Marsh, MPH, is on the Research Team at GoodRx, and is the resident expert on drug pricing and savings.
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Turns out, taking a certain kind of drug today is associated with an increased chance of dementia as many as 20 years from now, according to a new study.

The study looked at people who had taken anticholinergic drugs that are frequently prescribed for depression, urinary incontinence, overactive bladder, asthma, Parkinson’s disease, and allergies. People who had taken drugs from specific classes of anticholinergics had as much as a 30% greater likelihood of being diagnosed with dementia later in life. Researchers found that dementia could appear as many as 15 to 20 years after using the medications.

The link between anticholinergics and dementia has been suggested in the past, but this is the first report that zeroed in on select classes of these drugs. An increased likelihood for dementia was found in people who had taken specific anticholinergics to treat depression, Parkinson’s, and urinary incontinence, while those who had taken other anticholinergics used to treat asthma and gastrointestinal issues did not show this association.

Here are some common anticholinergic drugs that were linked to dementia in this study, and some alternatives you may want to consider. Keep in mind that this is the first study linking anticholinergic drugs to dementia risk, and you should always speak with your doctor before switching your medication.

Anticholinergic alternatives
Drug Alternative
Amitriptyline Escitalopram (Lexapro), sertraline (Zoloft)
Paroxetine (Paxil) Duloxetine (Cymbalta), venlafaxine (Effexor)
 Oxybutynin (Ditropan) & tolterodine (Detrol) Myrbetriq
 Carbamazepine (Tegretol XR) Lamotrigine (Lamictal), gabapentin (Neurontin), divalproex (Depakote)
Diphenhydramine (Benadryl) Cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin)
Benztropine (Cogentin) Carbidopa/levodopa (Sinemet), ropinirole (Requip), pramipexole (Mirapex)

 

Amitriptyline

Amitriptyline is a popular tricyclic antidepressant used to treat depression and in some cases chronic pain. Antidepressant alternatives that don’t increase dementia risk include SSRI antidepressants like escitalopram and sertraline, that don’t have strong anticholinergic properties.

Amitriptyline is also prescribed off-label for some chronic pain symptoms like neuropathy, fibromyalgia, and chronic tension headaches. Alternative options for these indications include duloxetine (Cymbalta), pregabalin (Lyrica), capsaicin, or lidocaine patches.

Paroxetine

Just like amitriptyline, paroxetine is an antidepressant with strong anticholinergic properties. Alternative SSRI antidepressants with fewer anticholinergic effects include escitalopram and sertraline. Additionally, SNRI drugs like duloxetine or venlafaxine and atypical antidepressants like bupropion have few anticholinergic effects and are possible alternatives.

Oxybutynin (Ditropan) and Tolterodine (Detrol LA)

Both of these are prescribed to individuals who deal with overactive bladder symptoms and difficulty controlling urination. Myrabegron (Myrbetriq), which is a fairly new medication, is a better option as it has few anticholinergic properties. The only problem with Myrbetriq is the lack of insurance coverage and high cost — a 30-day supply can cost well over $400. Another alternative treatment is pelvic floor physical therapy, which is also a good option to try before resorting to any medications.

Carbamazepine

Commonly prescribed as an anti-epileptic/anti-seizure medication, carbamazepine has strong anticholinergic properties. Alternatives include lamotrigine (Lamictal) and gabapentin (Neurontin). Divalproex (Depakote) is another option for the prevention of seizures and has fewer anticholinergic effects.  

Diphenhydramine (Benadryl)

Long-term use of Benadryl, an over-the-counter allergy medication, has been linked to an increased dementia risk. In lieu of Benadryl, possible alternatives include cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (Claritin).

Benztropine (Cogetin)

Benztropine is an anticholinergic used to treat the movement problems associated with Parkinson’s disease. Options with fewer anticholinergic properties include carbidopa/levodopa, ropinirole, or pramipexole.

Information on alternatives come from Dr. Sharon Orrange, MD MPH, a contributor on the GoodRx Research Team.

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