DrG's Medisense Feature Article
17092-Anticholinergic_Drugs
Memory-Impairing Drugs
by Ann Gerhardt, MD
August 2017
Print Version
The cholinergic nervous system is activated by acetylcholine. It
facilitates bodily functions that we don’t consciously
control. These include memory, attention, heart rate, lung air
flow, saliva and tears production and movement of food and fluid
through the stomach and intestine.
Diseases that damage the cholinergic nervous system, like
Parkinson’s, Huntington’s and schizophrenia have a
detrimental impact on memory. Medications and herbs that block
the cholinergic system also impair memory.
Substances that inhibit the cholinergic system, called
anticholinergics, include many commonly prescribed drugs and
herbs. They inhibit cholinergic nerve impulses by blocking
acetylcholine’s activation of nerve cells.
We use some medications and herbs primarily to work as an
anticholinergic. These include motion sickness drugs,
anti-spasmodics, anti-diarrheal medication and remedies for excessive
tearing, runny nose or salivation, asthma and overactive bladder.
Other remedies have multiple mechanisms of action, with only minor
anticholinergic activity.
When we use these medications, we may be acutely aware of the common
side effects of dry eyes and mouth and constipation. We may not
be aware that they also impair memory for facts, concentration and
movement speed. The cumulative load of anticholinergic
exposure seems to be correlated with worse memory and
attention.
Thankfully, most people with anticholinergic memory impairment do not
develop full-blown dementia. Anticholinergics don’t impair
intelligence, working memory, logic, speech, reasoning, understanding
concepts and ability to move and feel. For example, scopolamine,
the drug in motion sickness patches, makes young people have what we
think of as old-age memory problems, but not full-blown dementia.
The elderly risk more trouble with anticholinergic effects, because
they may already have some age-related memory loss and often have
slower drug clearance and interactions with other
medications. They also commonly take medicines for nausea,
Parkinson’s disease, muscle relaxants, ulcer and acid reflux and
psychiatric problems, many of which have anticholinergic
effects.
As with any medication, one must weigh the risks and benefits to decide
whether or not to take it. Anyone taking an anticholinergic who
is not aware of any effect on their memory and appreciates the benefit
of the medication (for example, being able to breathe or not have to
wear diapers for incontinent urine) might decide to continue
it. Anyone taking more than one of the strongly
anticholinergic substances could consider alternatives, with the help
of their doctor. Remember that herbs that might replace an
anticholinergic medication are likely anticholinergic also.
Consider the total anticholinergic
load before deciding to make changes, and never stop prescription
medication before consulting with your doctor.
Here is a list of medications (the generic names) and herbs with
anticholinergic effects.
Marked anticholinergic effect: amitriptyline, amoxapine,
atropine, benztropine, brompheniramine, carbinoxamine,
chlorpheniramine, chlorpromazine, clemastine, clomipramine, clozapine,
darifenacin, desipramine, dicyclomine, dimenhydrinate, diphenhydramine,
doxepin, flavoxate, glycopyrrolate, hydroxyzine, hyoscyamine,
imipramine, meclizine, mepenzolate, methscopolamine, nortriptyline,
olanzapine, orphenadrine, oxybutynin, perphenazine, promethazine,
propantheline, protriptyline, scopolamine, thioridazine, thiothixene,
tizanidine, tolterodine, trifluoperazine, trihexyphenidyl,
trimipramine, trospium. Herbs (considered to be poisonous
plants): Atropa belladonna (deadly nightshade), Brugmansia,
Datura, henbane (Hyoscyamus niger) and mandrake (Mandragora
officinarum.)
Moderate anticholinergic effect:
amantadine, baclofen, carbamazepine, carisoprodol, cetirizine,
cimetidine, clidinium, cyclizine, cyclobenzaprine, cyproheptadine,
disopyramide, fluphenazine, loperamide, loratadine, loxapine,
meperidine, methocarbamol, oxcarbazepine, pimozide, prochlorperazine,
pseudoephedrine, quetiapine, trimethobenzamide. Herbs:
There are some Chinese remedies for asthma that contain alkaloids, but
I couldn’t confirm that they were belladonna (anticholinergic)
alkaloids.
Mild anticholinergic effect:
alprazolam, aripiprazole, asenapine, captopril, chlordiazepoxide,
chlorthalidone, clonazepam, clorazepate, codeine, diazepam, digoxin,
dipyridamole, famotidine, fentanyl, fluoxetine, flurazepam,
fluvoxamine, furosemide, haloperidol hydralazine, iloperidone,
isosorbide, mirtazapine, morphine, nifedipine, nizatidine, oxycodone,
paroxetine, prednisone, quinidine, ranitidine, risperidone, temazepam,
tramadol, trazodone, triamterene, warfarin, ziprasidone.╣