Key takeaways:
Some medications can make thinking and memory more challenging for people with dementia. People with dementia are also at greater risk of falls, confusion, and other common medication side effects.
People with dementia may need to avoid certain medications that treat insomnia, overactive bladder, depression and agitation, and chronic pain. And this can be challenging, as these are all conditions that commonly occur alongside dementia.
There are many ways for people with dementia to take these medications in a safer way. This includes taking the lowest dose possible, and only when necessary. It’s important to work with a healthcare team that’s particularly sensitive to the unique needs of people with dementia.
As people age, health challenges become more common. Treatments for pain, sleep, bladder control, and mental health can help people to live more comfortably. But some of these treatments also come with the risk of side effects — especially for older adults with dementia.
It’s important to work with a healthcare team who understands the risks and benefits of medications for older adults with dementia. Here are five medications to avoid or ask about.
1. Older antihistamines
First-generation antihistamines are common over-the-counter (OTC) medications. They treat allergies, colds, motion sickness, and insomnia. Some common ones include:
Diphenhydramine (Benadryl, Wal-Dryl, Unisom, ZzzQuil, Advil PM, Tylenol PM)
Chlorpheniramine (Aller-chlor, Chlorphen-12)
Dimenhydrinate (Dramamine)
Doxylamine (Unisom)
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Prescription first-generation antihistamines include:
Hydroxyzine (Vistaril)
Promethazine (Promethegan)
People who take these medications may have a higher risk of Alzheimer’s dementia. Occasional use likely isn’t a problem. But the risk goes up with higher doses and longer periods of use.
These medications can also cause sleepiness, confusion, and problems with coordination. This could make symptoms worse for people who already have dementia.
Newer antihistamines are safer for people with dementia. These include loratadine (Claritin), fexofenadine (Allegra), and Xyzal (levocetirizine).
2. Sleep medicines
Some studies suggest that dementia is more common in people who take sleep medications. But poor sleep itself is also a risk factor. So it’s hard to know if the medication puts people at risk. Or if not sleeping well is the problem.
Either way, the goal of sleep medications is to make people sleepy. For people with dementia, this increases the risk of confusion and falls. So, it’s best to use the lowest dose possible, or avoid sleep aids altogether.
Common sleep medications include:
“Z-drugs” like zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta)
First-generation antihistamines, such as diphenhydramine and doxylamine
Benzodiazepines, including temazepam (Restoril), triazolam (Halcion), and lorazepam (Ativan)
Trazodone (Desyrel)
Doxepin (Silenor) at higher doses
A calming and regular bedtime routine is helpful. If medication is necessary, some experts recommend low-dose doxepin, ramelteon (Rozerem), or suvorexant (Belsomra).
3. Overactive bladder treatments
Urinary conditions like overactive bladder (OAB) are more common with age. But over time, some medications that treat OAB could worsen dementia, including:
Oxybutynin (Ditropan)
Tolterodine (Detrol)
Solifenacin (Vesicare)
Darifenacin (Enablex)
Fesoterodine (Toviaz)
Trospium (Sanctura)
Safer options for those who want treatment include mirabegron (Myrbetriq) and vibegron (Gemtesa).
4. Mental health medications
People with dementia often experience changes in mood, energy, and perception. Some common symptoms include:
Depression
Anxiety
Hallucinations (seeing or hearing things that aren’t there)
Delusions (believing something that isn’t true)
Agitation or aggression
Losing inhibitions
Sometimes mental health medications can manage symptoms that are progressive or severe. But they may also come with side effects that are risky for people with dementia. Below are some examples:
Antipsychotics: These medications treat agitation, hallucinations, and delusions — symptoms that put patients or caregivers at risk. But antipsychotics may also increase the risk of falls, hospitalizations, and even death.
Tricyclic antidepressants: These are older treatments for depression, anxiety, and chronic pain. They can impair thinking and memory, and cause sleepiness and problems with coordination.
Serotonin selective reuptake inhibitors (SSRIs): At low doses, these antidepressants may be safer options to treat depression and anxiety. But they don’t always work. And for some people, they could further impair thinking and memory. Paroxetine (Paxil) is one SSRI to avoid in people with dementia.
Mental health medications can play a helpful role in supporting someone’s quality of life. But it’s important to work with your healthcare team to find the safest and most effective option for you. They can guide you about taking these medications only when needed, and at the lowest effective dose.
5. Strong pain medications and muscle relaxers
Treating pain is also an important part of improving quality of life. Older adults, especially those with dementia, may experience stronger pain. But they are also more sensitive to the side effects of some pain medications.
People with dementia may experience more serious side effects from pain medications like opioids and opiate, such as:
Breathing problems
Falls and fractures
Confusion and hallucinations
Dizziness and sleepiness
Severe constipation
Worsening dementia
Muscle relaxers — like cyclobenzaprine (Amrix) and methocarbamol (Robaxin) — can also be problematic. With long-term use of muscle relaxers, dementia may become worse. Other side effects include sleepiness, confusion, and falls.
Frequently asked questions
In the past, there was a concern that statins might increase the risk of dementia. But recent studies and reviews suggest that statins are more likely to lower the risk. Treating factors like high cholesterol helps to do this.
Some studies suggest proton pump inhibitors (PPIs) may increase dementia risk after taking them for many years. But other studies find no significant link. If you take PPIs, talk with your healthcare team about the risks and benefits specific to you.
There’s no cure for dementia. But some medications may help. Common treatments for dementia include:
Cholinesterase inhibitors like donepezil (Aricept) and rivastigmine (Exelon). These are usually the first treatments that are started.
N-methyl-D-aspartate (NMDA) receptor antagonists like memantine are sometimes added as dementia progresses.
Anti-amyloid therapies are the newest type of dementia treatment. They are the only dementia medications that have the potential to slow its progression. The two that are available are donanemab (Kisunla) and lecanemab (Leqembi).
In the past, there was a concern that statins might increase the risk of dementia. But recent studies and reviews suggest that statins are more likely to lower the risk. Treating factors like high cholesterol helps to do this.
Some studies suggest proton pump inhibitors (PPIs) may increase dementia risk after taking them for many years. But other studies find no significant link. If you take PPIs, talk with your healthcare team about the risks and benefits specific to you.
There’s no cure for dementia. But some medications may help. Common treatments for dementia include:
Cholinesterase inhibitors like donepezil (Aricept) and rivastigmine (Exelon). These are usually the first treatments that are started.
N-methyl-D-aspartate (NMDA) receptor antagonists like memantine are sometimes added as dementia progresses.
Anti-amyloid therapies are the newest type of dementia treatment. They are the only dementia medications that have the potential to slow its progression. The two that are available are donanemab (Kisunla) and lecanemab (Leqembi).
The bottom line
Brain changes can put people with dementia at higher risk of side effects from certain medications. And other medications can increase the risk of dementia over time. People with dementia may want to avoid certain medications, such as older antihistamines, sleep medicines, pain medications, and muscle relaxers. But, keep in mind that the benefits of treatment may outweigh the risks. So, it’s best to talk with your healthcare team about using the lowest dose possible for the shortest period of time, or find an alternative treatment with fewer risks and side effects.
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References
AlDawsari, A., et al. (2022). Use of sedative-hypnotic medications and risk of dementia: A systematic review and meta-analysis. British Journal of Clinical Pharmacology.
Dudas, R., et al. (2018). Antidepressants for treating depression in dementia. Cochrane Database of Systematic Reviews.
Dykewicz, M. S., et al. (2020). Rhinitis 2020: A practice parameter update. The Journal of Allergy and Clinical Immunology.
Emad, B., et al. (2025). Proton pump inhibitor use and risk of dementia: An umbrella review of systematic reviews and meta-analyses. Digestive Diseases and Sciences.
Rahkonen, A., et al. (2023). The cumulative use of muscle relaxants and the risk of Alzheimer's disease: A nationwide case-control study. Journal of Alzheimer’s Disease.
Reimers, A., et al. (2024). Drug-induced cognitive impairment. Drug Safety.
Rekatsina, M., et al. (2022). Opioids in the elderly patients with cognitive impairment: A narrative review. Pain and Therapy.
Tampi, R. R., et al. (2022). Dementia is more than memory loss: Neuropsychiatric symptoms of dementia and their nonpharmacological and pharmacological management. The American Journal of Psychiatry.
Thant, P. E., et al. (2026). The consequences of antipsychotic medication use for people living with dementia: a systematic review and meta-analysis. Frontiers in Psychiatry.
Welk, B., et al. (2020). Increased risk of dementia among patients with overactive bladder treated with an anticholinergic medication compared to a beta-3 agonist: A population-based cohort study. BJU International.
