It is common for patients with Alzheimer’s disease (AD) to take medications for other health problems, such as high blood pressure and bladder incontinence, in addition to treatment for their symptoms of AD. However, taking multiple medications at the same time can increase the risk of adverse effects. Therefore, it is important to consider which drugs to avoid when treating AD patients.
Antidepressants: Certain antidepressants, such as amitriptyline (Elavil), nortriptyline (Pamelor), and imipramine (Tofranil), can worsen cognitive function and cause sedation. These drugs have anticholinergic effects, meaning that they can further suppress the activity of acetylcholine, a brain chemical whose activity is already reduced in AD. For low mood and irritability in AD patients, antidepressants such as citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) may be more appropriate.
Sedatives and Sleep Aids: Certain sedatives or hypnotics, such as benzodiazepines and barbiturates, can cause drowsiness, confusion, increased cognitive impairment, slowed reaction time, and worsening balance, leading to falls. Sleep aids can also have similar effects. Examples of sedatives to avoid include diazepam (Valium), temazepam (Restoril), triazolam (Halcion), and sleep aids zolpidem (Ambien) and eszopiclone (Lunesta).
Antipsychotics: Antipsychotics, such as haloperidol (Haldol), risperidone (Risperdal), and olanzapine (Zyprexa), are sometimes used to treat behavioral symptoms in AD patients, including agitation, aggressiveness, and hallucinations. However, these drugs can cause serious side effects, such as sedation, confusion, and Parkinsonian-like symptoms. They should not be used routinely, and if needed, the minimum effective dose should be used for the shortest possible time, under the supervision of an experienced clinician.
Over-the-Counter Medications: AD patients should also be cautious when taking over-the-counter medications that contain diphenhydramine (Benadryl), an antihistamine that can cause drowsiness and has anticholinergic effects that may lead to confusion and worsen cognitive function. Diphenhydramine is found in sleep aids and in "nighttime" or "PM" versions of popular pain relievers, cold and sinus remedies.
In conclusion, AD patients are particularly vulnerable to the side effects of various medications. It is important to consult with doctors and pharmacists to learn about the benefits and potential adverse effects of any new treatment therapy, including seemingly benign over-the-counter remedies.
Domenico Praticò, MD, is the Scott Richards North Star Charitable Foundation Chair for Alzheimer’s Research, Professor and Director of the Alzheimer’s Center at Temple, and Professor of Pharmacology at the Lewis Katz School of Medicine at Temple University
You can find out more information on Dr. Domenico Pratico's research papers here.
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