drugs to avoid in patients with dementia

Introduction

In general, avoid anticholinergic agents & sedatives.

Also see Beers criteria & inappropriate medications in the elderly

• anticholinergic agents may interfere with cholinesterase inhibitors donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl)
• analgesics
  • avoid propoxyphene, meperidine, pentazocine, droperidol
  • use acetaminophen, tramadol, hydrocodone, oxycodone, morphine
• antidepressants
  • avoid tricyclic antidepressants
  • try SSRI or venlafaxine
• antipsychotics (see psychosis & agitation in the elderly)
  • avoid chlorpromazine, thioridazine, clozapine
  • use potent dopamine receptor antagonists
    • atypical antipsychotics may be agents of choice
      • risperidone (Risperdal)
      • olanzapine (Zyprexa)
      • quetiapine (Seroquel)
    • haloperidol (Haldol)
• anxiolytics
  • avoid benzodiazepines, especially long-acting (diazepam)
  • use SSRI or buspirone
• antihistamines
  • avoid
  • loratadine (Claritin), desloratadine (Clarinex) & fexofenadine (Allegra) may be OK
• antispasmodics
  • avoid atropine, hyoscyamine, dicyclomine
  • for urinary incontinence, use tolterodine rather than oxybutynin
• vitamin D supplementation increased Abeta deposition & exacerbates Alzheimer's disease

Additional terms

• Beers criteria
• inappropriate medications in the elderly (by disorder)