Medications to Avoid

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It is always good try to non-drug interventions before turning to medications but sometimes medications are necessary. Certain types of medications may actually increase confusion, and people with cognitive problems may be particularly sensitive to these effects. In addition, they may interfere with the medications used to treat cognitive problems. Below is information about medications to try to avoid if you have cognitive problems.

Anxiety

What medications are commonly used for anxiety?
The class of drugs includes things like valium and is referred to as benzodiazepines. Unfortunately, in older adults these medicines often cause more confusion and falls.

What other interventions can be used?
Non-drug alternatives to cope with anxiety include relaxation techniques, meditation and physical activity.

Are there any other drug alternatives to these class of medications?
Currently, the selective serotonin re-uptake inhibitors (SSRIs) that are typically used for depression have been demonstrated to be helpful in managing anxiety. Some examples include citalopram (Celexa) or escitalopram (Lexapro).

Incontinence

What medications are commonly used for incontinence?
The most common drug used for incontinence is oxybutynin (Ditropan) which may unfortunately worsen the chemical imbalance that is common in memory problems and counteract the effects of most memory medicines.

What other interventions can be used?
Avoiding the intake of bladder irritants with caffeine, such as coffee or chocolate is recommended. Regular, timed trips to the restroom may avoid the bladder becoming too full and accidents.

Are there any other drug alternatives to this medication?
Being sure of the cause of the incontinence is important as this medication does not usually help with incontinence due to prostate enlargement, and there are effective medications for that condition which do not affect thinking or memory.

Insomnia

What medications are commonly used for sleep?
Many over the counter medications have diphenhydramine (Tylenol PM, Advil PM, Benadryl) which can worsen the chemical imbalance common in memory problems and cause significant confusion and a risk of falls. It may also counteract the effects of memory medicines. Ambien is a prescription medication that may also increase confusion and the risk of falls.

What other interventions can be used?
Soothing nighttime routines, including warm baths or warm milk may be helpful. Avoiding food or drinks with caffeine late in the day. Being active and avoiding daytime napping can help in promoting sleep. Exposure to bright light during the day and darkness at night has also been demonstrated to be helpful.

Are there any other drug alternatives to this medication?
Melatonin is an over the counter supplement that has been shown to be effective in helping people get to sleep with minimal side effects. Trazodone is a prescription medication, initially studied as an antidepressant which is often used for sleep in the elderly due to low risk of side effects.

Depression

What medications are commonly used for depression?
Currently the SSRIs (selective serotonin re-uptake inhibitors) are the most commonly prescribed medications for mood symptoms. However, paroxetine and nortriptyline are 2 other common antidepressants which may worsen the cholinergic imbalance in the brain and interfere with the effectiveness of memory medicines.

What other interventions can be used?
Physical activity is often helpful in counteracting mood symptoms. Therapy and counseling can be helpful in supporting an individual with depressive symptoms.

Are there any other drug alternatives to this medication?
The newer class of SSRIs do not have these side effects and can be used safely.

Pain

What medications are commonly used to treat pain?
Narcotics and opiates such as vicodin or oxycontin are often used for pain relief. Unfortunately, they often can cause confusion and falls in older adults.

What other interventions can be used?
Meditation has been found to be helpful in coping with pain, especially more chronic situations. Local therapy (heat, ointments) do not usually have the systemic effect on cognition and thinking.

Are there any other drug alternatives to this medication?
Regular around the clock use of Tylenol can be very helpful in controlling pain with minimal side effects. Significant alcohol history or any decrease in liver function must be considered in determining dosage and length of therapy.

July 23, 2012