Aging can affect the way medications are absorbed and used by the body, increasing the
effects of some and decreasing the effects of others. As a result, senior citizens are more
likely to suffer from side effects and adverse drug interactions than younger people. Many
popular drugs, including over-the-counter antihistamines, increase the risk of both mental
decline and death in people aged 65 and older.
Especially worrisome are drugs that rate high on a scale for anticholinergic activity, a family of drugs that work by blocking acetylcholine, a nervous system transmitter. They include popular over-the-counter drugs containing antihistamines such as Dimetapp, and Tylenol Cold and Cough Nighttime.
A British study found that seniors who took medications that rated high for anticholinergic activity showed a reduction in brain function, and were almost three times as likely to die as seniors who didn't take the medications.
The researchers studied 80 medications — both prescription and over-the-counter — and rated each drug on a scale from zero to three for their anticholinergic activity. They then studied the prescription drugs taken by more than 13,000 people over the age of 65. They found that 20 percent of the people who took drugs with a combined rating of four or more had died by the end of the two-year study compared to only 7 percent of those who took no anticholinergic drugs.
"Our results show a potentially serious effect on mortality," said Chris Fox, of University of East Anglia's Norwich Medical School. An additional concern is the drugs' effect on mental function, since reduced mental ability often portends the onset of Alzheimer's disease and other forms of dementia.
Since people tend to take more drugs as they age, and the average senior citizen takes more than five medications, they are at a higher risk for side effects from anticholinergic drugs.
The Beers Criteria for Potentially Inappropriate Medication in Older Adults, known simply as the Beers list, pinpoints medications whose benefits may outweigh their advantages when treating older adults. Created in 1991 by the late Dr. Mark H. Beers, a geriatrician, the list has been updated by the American Geriatrics Society.
According to the Beers list, the following medications, which include both prescription and over-the-counter drugs, are particularly anticholinergic and should be taken with caution:
• Antihistamines: Either as a single medication or as a component of a combination product, all of the following drugs, with a few name-brand examples, are highly anticholinergic: brompheniramine (Dimetapp), carbinoxamine, chlorpheniramin (Triaminic Allergy), clemastine (Tavist), cyproheptadine , dexbrompheniramine, dexchlorpheniramine, diphenhydramine (oral), doxylamine (Tylenol Cold and Cough Nighttime), Hydroxyzine (Vistaril), promethazine, and triprolidine (Sudafed Sinus Nighttime).
• Antiparkinson medications: benzitropine and trihexyphenidyl
• Antispasmodics: belladonna alkaloids, clidinium-chlordiazepoxide, dicyclomine
hyoscyamine, propantheline, and scopolamine
A study by Duke University suggested that as many as 7 million Americans over the age of 65 are taking dangerous drugs, even when much safer alternatives are available.
Other drugs on the Beers list that are more likely to cause problems such as drowsiness or mood changes in seniors include mood-altering drugs such as Elavil, Librium, and Valium, and painkillers such as codeine.
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