Anticholinergics and dementia

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biacuplasty

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http://archinte.jamanetwork.com/mobile/article.aspx?articleid=2091745

Very interesting read. Have had a few patients bring this up in clinic. Is there any medication we prescribe that is not harmful?


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always best to stay natural when possible.

The points brought up in this study aren't new and it certainly doesn't prove that anticholinergics cause dementia, just that you shouldn't give them to the elderly, to which I say duh, I knew this 17 years ago and I never prescribe TCAs or other broadly acting anticholinergics to patients over 60.
 
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I think there were a few studies that discussed benzo use and increased risk for dementia.
 
there are non-medications that have shown moderate evidence for long term benefit (which is better than the evidence for medications...)
 
So- for pain docs, this means stop prescribing:
Trazodone (33% dry mouth, constipation is common) and
  • Antiemetics:
    • Dimenhydrinate - Dramamine®
    • Meclizine - Antivert®, Bonine®
    • Trimethobenzamide - Tigan®
    • Prochlorperazine -Compazine®
  • Antihistamines:
    • Azatadine - Optimine®
    • Chlorpheniramine - Chlor-Trimeton®
    • Clemastine - Tavist®
    • Diphenhydramine - Tylenol PM®, Sominex®, Benadryl®
    • Hydroxyzine - Atarax®, Vistaril®
    • Promethazine - Phenergan®
  • Antipsychotics:
    • Chlorpromazine - Thorazine®
    • Clozapine - Clozaril®
    • Mesoridazine - Serentil®
    • Olanzapine - Zyprexa®
    • Promazine - Sparine®
    • Quetiapine - Seroquel®
    • Thioridazine - Mellaril®
  • Antispasmotics:
    • Atropine - Sal-Tropine®
    • Belladonna alkaloids - Donnatal®, Bellatal®, Barbidonna®
    • Dicyclomine - Antispas®, Bentyl®
    • Flavoxate - Urispas®
    • Hyoscyamine - Anaspaz®, Levbid®, Cystospaz®, Levsin/SL®
    • Oxybutynin - Ditropan®
    • Scopolamine
    • Tolterodine - Detrol®
  • Skeletal muscle relaxants:
    • Carisoprodal - Soma®
    • Chlorzoxazone - Parafon®, Forte®
    • Cyclobenzaprine - Flexeril®
    • Methocarbamol - Robaxin®
    • Orphenadrine - Norflex®
  • Tricyclic Antidepressants:
    • Amitriptyline - Elavil®
    • Desipramine - Norpramin®
    • Doxepin - Sinequan®
    • Imipramine - Tofranil®
    • Nortriptyline -Aventyl®, Pamelor®
 

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