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   Certain Allergy, Depression Meds Tied to Higher Odds for Dementia   
      
   WebMD News from HealthDay    
   Prices varied four-fold between pharmacies, and   
   By Robert Preidt   
      
   HealthDay Reporter   
      
   MONDAY, Jan. 26, 2015 (HealthDay News) -- Long-term and/or high-dose use of a   
   class of medications used for hay fever, depression and other ills has been   
   linked in a new study to a higher risk of dementia.   
      
   The drugs -- called anticholinergics -- include nonprescription    
   iphenhydramine (Benadryl) and tricyclic antidepressants like doxepin   
   (Sinequan). This class of medications also includes older antihistamines like   
   chlorpheniramine (Chlor-Trimeton) and "   
   antimuscarinic" drugs for bladder control, such as oxybutynin (Ditropan).   
      
   However, the study could only point to an association between long-term or   
   high-dose use of these drugs and a higher risk of dementia, it could not prove   
   cause-and-effect.   
      
      
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   Also, the relationship "did not occur at the lowest dosage range but did occur   
   at higher dosages used long-term," said one expert, Dr. Alan Manevitz, a   
   clinical psychiatrist at Lenox Hill Hospital in New York City. He was not   
   involved in the new study.   
      
   Manevitz also stressed that consumers "should not abruptly stop any current   
   medication treatment but rather should first consult with their physician."   
      
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   The new study was led by Shelly Gray of the Group Health Research   
   Institute-University of Washington. Her team explained that the    
   nticholinergic class of medications work by blocking a neurochemical called   
   acetylcholine, in both the brain and body.   
      
   Manevitz noted that people "suffering from Alzheimer's disease typically show   
   a marked shortage of acetylcholine."   
      
   The new study tracked outcomes for more than 3,500 seniors who were followed   
   for more than seven years. Gray's group found that people who took at least 10   
   milligrams per day of Sinequan, 4 mg per day of Chlor-Trimeton, or 5 mg per   
   day of Ditropan for    
   more than three years were at greater risk for developing dementia.   
      
   Manevitz noted that occasional use of these medications did not seem to be   
   tied to a rise in dementia risk. "The risk of dementia was due to a cumulative   
   total of exposure, not to an acute short course of treatment," he said.   
      
   And, Gray said in an institute news release, "Older adults should be aware   
   that many medications -- including some available without a prescription, such   
   as over-the-counter sleep aids -- have strong anticholinergic effects. And   
   they should tell their    
   health care providers about all their over-the-counter [drug] use," she added.   
      
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   However, "no one should stop taking any therapy without consulting their   
   health care provider," said Gray, director of the geriatric pharmacy program   
   at the University of Washington's School of Pharmacy.   
      
   Instead, "health care providers should regularly review their older patients'   
   drug regimens -- including over-the-counter medications -- to look for chances   
   to use fewer anticholinergic medications at lower doses," she advised.   
      
   The study, published Jan. 26 in JAMA Internal Medicine, is the first to link   
   higher use of anticholinergic medications to increased risk of dementia, the   
   researchers said. It is also the first to suggest that the dementia risk   
   associated with these drugs    
   may not be reversible even years after people stop taking them.   
      
   Manevitz called the new study "well designed," and said the reversibility   
   issue is a troubling one.   
      
   "The general view has been that mild cognitive impairment is reversible in   
   discontinuation of anticholinergic medication therapy," he said, but this   
   study seems to find otherwise.   
      
   According to Manevitz, "we need to educate patients and their families about   
   over-the-counter medicines and alternative therapies. Also, elderly people in   
   nursing homes tend to have a long list of medicines that need to be reviewed   
   periodically for need    
   to continue, interactions and redundancy."   
      
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   He believes doctors should think about substitutes for anticholinergics when   
   possible, prescribe the lowest dose possible, and stop the medication as soon   
   as is medically advisable.   
      
   Gray offered similar advice. "If providers need to prescribe a medication with   
   anticholinergic effects because it is the best therapy for their patient, they   
   should use the lowest effective dose, monitor the therapy regularly to ensure   
   it's working, and    
   stop the therapy if it's ineffective," she suggested.   
      
   She said that substitutes are available for some anticholinergic drugs,   
   including a selective serotonin re-uptake inhibitor (SSRI) antidepressant like   
   citalopram (Celexa) or fluoxitene (Prozac) for depression, or a    
   econd-generation antihistamine such as    
   loratadine (Claritin) for allergy relief.   
      
      
      
   http://www.m.webmd.com/a-to-z-guides/news/20150126/use-of-certai   
   -allergy-depression-meds-tied-to-higher-odds-for-dementia   
      
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