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Aricept, Zantac, Detrol, other Anticholinergic Drugs Lined to Mental Impairment in Elderly

May 6, 2008 | Parker Waichman LLP

Two separate reports written by researchers at Wake Forest University School of Medicine support findings released recently concerning anticholinergic medications like Aricept, Zantac and Detrol.  The studies found that anticholinergic drugs may be adversely affecting the thinking skills of older patients, a phenomenon not observed in those patients studied who do not take these medications.  The studies also indicate that anticholinergics may cause older patients to experience a decrease in their daily physical activities.

Anticholinergic drugs are a commonly prescribed group of drugs prescribed for the treatment of a variety of diseases and conditions, including acid reflux, Parkinson’s Disease, and urinary incontinence. Anticholinergic drugs work by stopping acetylcholine—a chemical that enhances communication between nerve cells in the brain—from binding to its receptors in nerve cells.

In the first Wake Forest study, older adults taking anticholinergic medications became more likely to walk more slowly and required help in other daily activities.  "These results were true even in older adults who have normal memory and thinking abilities," said study author Dr. Kaycee M. Sink. "For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function was similar to that of someone three to four years older."  Sink is an assistant professor of internal medicine-gerontology at Wake Forest University.

Common anticholinergic medicines mentioned in the review included the blood pressure medication nifedipine (Adalat or Procardia), the stomach antacid ranitidine (Zantac), and the incontinence medication tolterodine (Detrol).  The study involved over 3,000 people who were an average of 78 years of age.  The study’s findings were scheduled to be presented this Saturday at the American Geriatrics Society annual meeting, taking place in Washington, D.C.

In the second Wake Forest study, which was published online in April in the Journal of the American Geriatrics Society, Sink found that older nursing home residents who were taking medications for dementia as well as who were taking anticholingerics for incontinence experienced function decline at a rate of 50 percent faster than those patients who were only receiving drug therapy treatment for dementia.  The patients studied completed at least two consecutive prescriptions for cholinesterase inhibitors—a grouping of drugs used to treat dementia by increasing levels of acetylcholine—that include donepezil (Aricept), glantamine (Razdyne), rivatigmine (Exelon), and tacrine (Cognex). 

About 10 percent of those patients studied were also taking either oxybutynin or tolterodine, the two most commonly prescribed drugs for urinary incontinence.  "Over a year's time, the decline we observed would represent a resident going from requiring only limited assistance in an activity to being completely dependent, or from requiring only supervision to requiring extensive assistance in an activity," said Sink.  "The two drugs are pharmacological opposites, which led us to hypothesize that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs, Sink said.

Alarmingly, an estimated 33 percent of people with dementia are also taking a medication to control incontinence.  The two studies suggest that physicians should carefully consider the implications when prescribing anticholinergic medications to older adults.

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