Some Drugs That May Cause Memory Loss
Having trouble remembering things? One of these meds may be the problem
by Dr. Armon B. Neel Jr., Updated June 2015
For a long time doctors dismissed forgetfulness and mental confusion as a normal part of aging. But scientists now know
that memory loss as you get older is by no means inevitable. Indeed, the brain can grow
new brain cells and reshape their connections throughout life.
Most people are familiar with at least some
of the things that can impair memory, including alcohol and drug abuse, heavy
cigarette smoking, head injuries, stroke, sleep deprivation, severe stress,
vitamin B12 deficiency, and illnesses such as Alzheimer's disease and
depression.
Forgetful? Your prescription meds could be
interfering with your memory. — Larry Williams/Corbis
But what many people don't realize is that
many commonly prescribed drugs also can interfere with memory. Here are 10 of
the top types of offenders.
Cholesterol-lowering drugs
(Statins)
Why they are prescribed: Statins are used to treat high cholesterol.
Examples: Atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor),
pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
How they can cause memory loss: Drugs that lower blood levels of cholesterol may impair memory and
other mental processes by depleting brain levels of cholesterol as well. In the
brain, these lipids are vital to the formation of connections between nerve
cells — the links underlying memory and learning. (The brain, in fact, contains
a quarter of the body's cholesterol.)
A study published in the journal Pharmacotherapy
in 2009 found that three out of four people using these drugs experienced
adverse cognitive effects "probably or definitely related to" the
drug. The researchers also found that 90 percent of the patients who stopped
statin therapy reported improvements in cognition, sometimes within days. In
February 2012, the Food and Drug Administration ordered drug companies to add a
new warning label about possible memory problems to the prescribing information
for statins.
Alternatives: If you're among the many older Americans without known coronary disease
who are taking these drugs to treat your slightly elevated LDL
("bad") cholesterol and low HDL ("good") cholesterol), ask
your doctor or other health care provider about instead taking a combination of
sublingual (under-the-tongue) vitamin B12 (1,000 mcg daily), folic acid (800
mcg daily) and vitamin B6 (200 mg daily).
Narcotic painkillers
Why they are prescribed: Also called opioid analgesics, these medications are used to relieve
moderate to severe chronic pain, such as the pain caused by rheumatoid
arthritis.
Examples: Fentanyl (Duragesic), hydrocodone (Norco, Vicodin), hydromorphone
(Dilaudid, Exalgo), morphine (Astramorph, Avinza) and oxycodone (OxyContin,
Percocet). These drugs come in many different forms, including tablets,
solutions for injection, transdermal patches and suppositories.
How they can cause memory loss: These drugs work by stemming the flow of pain signals within the
central nervous system and by blunting one's emotional reaction to pain. Chemical
messengers that are also involved in many aspects of cognition mediate both
these actions. So use of these drugs can interfere with long- and short-term
memory, especially when used for extended periods of time.
Alternatives: In patients under the age of 50 years, nonsteroidal anti-inflammatory
drugs (NSAIDs) are the frontline therapy for
pain. Unfortunately, NSAID therapy is less appropriate for older patients, who
have a much higher risk of dangerous gastrointestinal bleeding. Research shows
the risk goes up with the dosage and duration of treatment.
Talk with your doctor or other health care
provider about whether tramadol (Ultram), a nonnarcotic painkiller, might be a
good choice for you. In my practice, I often recommend supplementing each 50 mg
dose with a 325 mg tablet of acetaminophen (Tylenol). While there are
prescription drugs that combine tramadol and acetaminophen, these products have
only 37.5 mg of tramadol, and in my practice I've found that patients generally
need the larger dose.
Hypertension drugs (Beta-blockers)
Why they are prescribed: Beta-blockers slow the heart rate and lower blood pressure and typically are
prescribed for high blood pressure, congestive heart failure and abnormal heart
rhythms. They're also used to treat chest pain (angina), migraines, tremors
and, in eyedrop form, certain types of glaucoma.
Examples: Atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor,
Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic) and some
other drugs whose chemical names end with "-olol."
How they can cause memory loss: Beta-blockers are thought to cause memory problems by interfering with
("blocking") the action of key chemical messengers in the brain,
including norepinephrine and epinephrine.
Alternatives: For older people, benzothiazepine calcium channel blockers, another
type of blood pressure medication, are often safer and more effective than
beta-blockers. If the beta-blocker is being used to treat glaucoma, I recommend
talking with your health care professional about potentially using a carbonic
anhydrase inhibitor, such as dorzolamide (Trusopt), instead.
Sleeping aids (Nonbenzodiazepine
sedative-hypnotics)
Why they are prescribed: Sometimes called the "Z" drugs, these medications are used to
treat insomnia and other sleep problems. They also are prescribed for mild anxiety.
Examples: Eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien).
How they can cause memory loss: Although these are molecularly distinct from benzodiazepines (see No. 1
above), they act on many of the same brain pathways and chemical messengers,
producing similar side effects and problems with addiction and withdrawal.
The "Z" drugs also can cause
amnesia and sometimes trigger dangerous or strange behaviors, such as cooking a
meal or driving a car — with no recollection of the event upon awakening.
Alternatives: There are alternative drug and nondrug treatments for insomnia and
anxiety, so talk with your health care professional about options. Melatonin,
in doses from 3 to 10 mg before bedtime, for instance, sometimes helps to
reestablish healthy sleep patterns. Before stopping or reducing the dosage of
these sleeping aids, be sure to consult your health care professional. Sudden
withdrawal can cause serious side effects, so a health professional should
always monitor the process.
Incontinence drugs
(Anticholinergics)
Why they are prescribed: These medications are used to relieve symptoms of overactive bladder and reduce episodes of urge incontinence, an urge to urinate so sudden
and strong that you often can't get to a bathroom in time.
Examples: Darifenacin (Enablex), oxybutynin (Ditropan XL, Gelnique, Oxytrol),
solifenacin (Vesicare), tolterodine (Detrol) and trospium (Sanctura). Another
oxybutynin product, Oxytrol for Women, is sold over the counter.
How they can cause memory loss: These drugs block the action of acetylcholine, a chemical messenger
that mediates all sorts of functions in the body. In the bladder, anticholinergics
prevent involuntary contractions of the muscles that control urine flow. In the
brain, they inhibit activity in the memory and learning centers. The risk of
memory loss is heightened when the drugs are taken for more than a short time
or used with other anticholinergic drugs.
A 2006 study of oxybutynin ER, for example,
found its effect on memory to be comparable to about 10 years of cognitive
aging. ("In other words," as the study's lead author put it, "we
transformed these people from functioning like 67-year-olds to
77-year-olds.")
Older people are particularly vulnerable to
the other adverse effects of anticholinergic drugs, including constipation
(which, in turn, can cause urinary incontinence), blurred vision, dizziness,
anxiety, depression and hallucinations.
Alternatives: As a first step, it's important to make sure that you have been
properly diagnosed. Check with your doctor or other health professional to see
if your urinary incontinence symptoms might stem from another condition (such
as a bladder infection or another form of incontinence) or a medication (such
as a blood pressure drug, diuretic or muscle relaxant).
Once these are ruled out, I'd recommend
trying some simple lifestyle changes, such as cutting back on caffeinated and
alcoholic beverages, drinking less before bedtime, and doing Kegel exercises to
strengthen the pelvic muscles that help control urination.
If these approaches don't work out, consider
trying adult diapers, pads or panty liners, which can be purchased just about anywhere.
They can be worn comfortably (and invisibly) under everyday clothing and
virtually eliminate the risk of embarrassing accidents. In my experience, many
patients are reluctant to try this approach, but once over the initial hurdle,
come to prefer it for security and peace of mind.
Correction: An earlier version of this article mistakenly implied that mirabegron
(Myrbetriq), which the FDA approved last year for the treatment of overactive
bladder, is an anticholinergic drug; in fact, it is in a new class of
medications called beta-3 adrenergic agonists and is not expected to cause
memory loss seen with anticholinergic medications. There currently are no data
describing the effect of Myrbetriq on cognition.
Antihistamines (First-generation)
Why they are prescribed: These medications are used to relieve or prevent allergy symptoms or
those of the common cold. Some antihistamines are also used to prevent motion
sickness, nausea, vomiting and dizziness, and to treat anxiety or insomnia.
Examples: Brompheniramine (Dimetane), carbinoxamine (Clistin), chlorpheniramine
(Chlor-Trimeton), clemastine (Tavist), diphenhydramine (Benadryl) and
hydroxyzine (Vistaril).
How they can cause memory loss: These medications (prescription and over-the-counter) inhibit the
action of acetylcholine, a chemical messenger that mediates a wide range of
functions in the body. In the brain, they inhibit activity in the memory and
learning centers, which can lead to memory loss.
Alternatives: Newer-generation antihistamines such as loratadine (Claritin) and
cetirizine (Zyrtec) are better tolerated by older patients and do not present
the same risks to memory and cognition.
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