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drugs to avoid in patients with dementia
In general, avoid anticholinergic agents & sedatives.
Also see Beers criteria & inappropriate medications in the elderly
1) anticholinergic agents may interfere with cholinesterase inhibitors donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl)
2) analgesics
a) avoid propoxyphene, meperidine, pentazocine, droperidol
b) use acetaminophen, tramadol, hydrocodone, oxycodone, morphine
3) antidepressants
a) avoid tricyclic antidepressants
b) try SSRI or venlafaxine
4) antipsychotics (see psychosis & agitation in the elderly)
a) avoid chlorpromazine, thioridazine, clozapine
b) use potent dopamine receptor antagonists
1] atypical antipsychotics may be agents of choice
- risperidone (Risperdal)
- olanzapine (Zyprexa)
- quetiapine (Seroquel)
2] haloperidol (Haldol)
5) anxiolytics
a) avoid benzodiazepines, especially long-acting (diazepam)
b) use SSRI or buspirone
6) antihistamines
a) avoid
b) loratadine (Claritin), desloratadine (Clarinex) & fexofenadine (Allegra) may be OK
7) antispasmodics
a) avoid atropine, hyoscyamine, dicyclomine
b) for urinary incontinence, use tolterodine rather than oxybutynin
8) vitamin D supplementation increased Abeta deposition & exacerbates Alzheimer's disease [2]
Related
Beers criteria
inappropriate medications in the elderly (by disorder)
References
- Prescriber's Letter 10(8):44 2003
Detail-Document#: 190183
(subscription needed) http://www.prescribersletter.com
- Lai RH, Hsu CC, Yu BH et al
Vitamin D supplementation worsens Alzheimer's progression:
Animal model and human cohort studies.
Aging Cell. 2022. July 11
PMID: 35822270
https://onlinelibrary.wiley.com/doi/full/10.1111/acel.13670