Medications Archive

If you have high blood pressure, there may be better alternatives.

Anticholinergics, a group of medications that includes many over-the-counter and prescription drugs, are well known for causing confusion in older adults. Common medications with anticholinergic properties include medications to treat overactive bladder, such as oxybutynin (Ditropan); medications to treat allergies and sleeping problems, such as diphenhydramine (Benadryl, Sominex, Unisom); and medications used to treat depression, such as amitriptyline (Elavil). It's generally believed that confusion that may develop from anticholinergics clears up when someone stops taking the drugs. But now it appears that the medications are associated with a more permanent effect. A study published online Jan. 26, 2015, in JAMA Internal Medicine linked daily anticholinergic use among older adults for three or more years to an increased risk for developing dementia and Alzheimer's disease.

The study didn't prove that anticholinergics cause dementia; it only found an association between people who take the medications and people who develop dementia. Nevertheless, the researchers suggest that doctors avoid prescribing anticholinergics when possible, or at least limiting the medications to the lowest doses possible. If you're taking an anticholinergic, talk to your doctor about the risks the medication poses, including the risk of falls as a result of confusion.

Although these powerful pain relievers can be addictive, opioids are safe for most people when used properly.

Medications called anticholinergics are used to treat a host of conditions—overactive bladder, depression, allergies, and Parkinson's disease. They usually aren't recommended for older adults because one of the most common side effects is confusion and difficulty reasoning. Early studies have also indicated that long-term anticholinergic use is associated with an increased risk of dementia, and a recent study by researchers at the University of Washington adds more evidence to support that connection. The results were published online Jan. 26, 2015, by JAMA Internal Medicine.

The researchers tracked almost 3,500 men and women ages 65 and older who were free of dementia. When they matched prescription data for the previous 10 years with the participants' health outcomes, they determined that using anticholinergics was associated with an increased risk of developing dementia. Moreover, dementia risk increased with the dosage of the drugs and the length of time they were used. While people who had taken these drugs daily for the equivalent of three months had no increase in risk, those who had used them for over three years had a 54% greater risk than nonusers.

Adding medications to foods and trying new swallowing techniques can help.

Swallowing pills can be difficult and downright unpleasant. It causes one in three people to gag, vomit, or choke. That may keep people from sticking to their medication routines, which can make them sicker. "We often see people who can swallow food and liquid just fine, but have difficulty with pills," says Denise Ambrosi, director of the Speech-Language Pathology Department at Harvard-affiliated Spaulding Rehabilitation Hospital.

Simple strategies can help you regain control.

As men age, the simple act of urinating can get complicated. Prostate surgery often leaves men vulnerable to leakage when they cough, sneeze, or just rise from a chair. Or the bladder may become impatient, suddenly demanding that you find a bathroom right now. "Thousands of years ago, it was not as much of an issue," observes Dr. Anurag Das, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center. "There were lots of trees, and you could just find one and go."

But tricky bladders can be whipped into shape. The first step is a careful assessment of what triggers those difficult moments. Then your doctor can suggest helpful strategies and possibly medication to improve urinary control.

Q. My doctor recently put me on Tenormin because my blood pressure was getting high. Now, when I run or row, I can't get my heart rate much above 115 beats per minute even though my peak heart rate should be 136. Is the beta blocker keeping me from getting the full benefit of exercise?

A. Although your heart now beats more slowly when you run and row, rest assured that your heart, arteries, lungs, muscles, and the rest of you are getting the full benefit of exercise.

Q. I took a low dose of the antidepressant desipramine for more than two years for chronic pain. Once I started physical therapy, my pain improved so much that I quickly tapered off the medication. I have been off of it for a month now, but am still experiencing "discontinuation symptoms." I can't sleep well and feel a little dizzy. What can I do for this?

A. It can be liberating to realize that you no longer need to take a medication. However, sometimes you can't just throw your pills away. There are many medications (both psychoactive and otherwise) that require you to taper off slowly when it's time to stop them. Stopping such a medication too quickly will cause what are called rebound side effects. Desipramine (Norpramin) is a tricyclic antidepressant, one of the drug categories that require a slow taper.

Be mindful of risks for fracture, low B12, and a spike in stomach acid.

Proton-pump inhibitors (PPIs) help treat symptoms of heartburn, but these powerful medications also carry their share of risks. "The risks are for long-term use," says Dr. Jacqueline Wolf, a Harvard Medical School associate professor. "Three months of use should be okay, but if someone needs a PPI longer than that, a doctor should be supervising use."

Don't let misconceptions about these medications prevent you from taking them.