Medications for symptoms or issues that come from dementia

The following symptoms are commonly associated with Alzheimer’s and dementias.

1. Anxiety - Common medications for anxiety include diazepam (Valium®) and other drugs in this class called benzodiazepines. Unfortunately, in older adults, these medications often cause more confusion, excessive sedation or drowsiness, and increase the risk of falls. However, certain antidepressants can help with anxiety such as citalopram (Celexa®), escitalopram (Lexapro®), venlafaxine (Effexor®), mirtazapine (Remeron®), or buspirone (Buspar®).

2. Incontinence - Some of the common drugs used for incontinence can worsen the chemical imbalance that is associated with memory problems and counteract the effects of most memory medications. Being sure of the cause of the incontinence is important. For example, it could be due to a urinary tract infection, high blood sugar causing frequent urination, diuretic medications or, in men, an enlarged prostate. Identifying and treating underlying causes of incontinence is important to preventing and managing incontinence. Safer incontinence medications to consider include trospium (Sanctura®), solifenacin (Vesicare®) and mirabegron (Myrbetriq®). They are less likely to affect memory and thinking and also less likely to interfere with memory medications.

3. Insomnia - Many prescription and non-prescription or over-the-counter medications (e.g., diphenhydramine [Tylenol PM®, Advil PM®, Benadryl®]) can worsen the chemical imbalance common in memory problems and cause significant confusion and a risk of falls. Some of these medications can also counteract the effects of memory medications. In addition, identifying and treating underlying causes of insomnia or disturbed sleep such as depression, anxiety, high blood sugar leading to frequent urination or use of medications that affect sleep is important to managing insomnia. Safer medications to consider include Melatonin, which is a dietary supplement that can help with your sleep/wake cycle when taken at bedtime. Alternative prescription medications include ramelteon (Rozerem®), low dose trazodone (Oleptro®, Desyrel®) or low dose mirtazapine (Remeron®).

4. Depression - Currently, SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed medications for mood symptoms in persons with dementia. SSRIs may be useful in reducing the aggressive impulses, poor impulse control, apathy and improving mood in people with dementia. However, some antidepressants such as paroxetine (Paxil®), amitriptyline (Elavil®) and nortriptyline (Pamelor®) are other common antidepressants which may worsen the cholinergic imbalance in the brain and worsen memory, thinking or the effectiveness of memory medications. Fluoxetine (Prozac®) is sometimes used, but it has many drug interactions and stays in the body for a long time.

   Examples of SSRIs include

   • citalopram (Celexa®)

   • escitalopram (Lexapro®)

   • fluoxetine (Prozac®)

   • sertraline (Zoloft®)

   • vortioxetine (Trintellix®)

   Other antidepressants (not SSRIs) that may be useful:

   • bupropion (Wellbutrin®)

   • duloxetine (Cymbalta®)

   • mirtazapine (Remeron®)

   • trazodone (Desyrel®)

   • venlafaxine (Effexor®)

5. Pain - Several narcotics, opiates, muscle relaxants are not recommended for people with Alzheimer’s and dementia since they can cause confusion, falls and other issues in older adults. Non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding stomach ulcers, raise your blood pressure, affect your kidneys and worsen heart failure when used long term.

   Regularly scheduled acetaminophen (Tylenol®) can be helpful. Significant alcohol history or any decrease in liver function must be considered in determining dosage and length of therapy.

   Certain antidepressants such as duloxetine (Cymbalta®), mirtazapine (Remeron®), and venlafaxine (Effexor®) may also be helpful for both pain and mood.

6. Hallucinations, Delusions, Severe Agitation or Aggression - Antipsychotic medications block the effects of dopamine, a chemical messenger in your brain that can increase hallucinations and delusions (false beliefs) and can alter rational thought. Low doses of these medications can help manage aggressive, irrational and compulsive behaviors that may develop in persons with dementia, more commonly with frontotemporal dementia or dementia with Lewy bodies. The potential benefit of antipsychotics must be weighed against potential risks including weight gain, slowing of movement and thinking, accelerating heart disease and, in rare instances, death. Typical or first-generation antipsychotics such as haloperidol (Haldol®) are associated with muscle problems and should be avoided in people who already experience muscle stiffness or trembling.

   Memory drugs and antidepressants are first-line treatments and can be very helpful with few adverse effects.

   Atypical or second-generation antipsychotics are second line and should be used at the lowest effective dose for the shortest duration to minimize adverse effects. These incude:

   quetiapine (Seroquel®)

   risperidone (Risperdal®)

   aripiprazole (Abilify®)

   olanzapine (Zyprexa®)

   clozapine (Clozaril®)

Before starting or stopping medication, please consult with the patient’s health professional. This information is intended to make you aware of potential solutions and challenges with common medications taken for dementia.

Source: J Neurol Neurosurg Psychiatry. 2007 Mar; 78(3): 233–239

Related Posts