Common medicines including cold and flu tablets, heartburn drugs and sleeping pills 'SHRINK the brain and slow down thinking'

• Ingredients promethazine and diphenhydramine 'slowed brain function'
• Block chemical acetylcholine involved in transmitting electrical impulses
• Researchers said the drugs had an effect for a month after treatment  
• A full list of implicated medications can be viewed at Ageing Brain Care 
• Or scroll down for a full list of the medications listed in the study
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By COLIN FERNANDEZ, SCIENCE CORRESPONDENT FOR THE DAILY MAIL

PUBLISHED: 10:00 EST, 18 April 2016 | UPDATED: 16:27 EST, 18 April 2016

Common over-the-counter medicines should be avoided by older people as they have been linked to memory loss and problems in thinking, scientists have discovered.

Treatments for colds and flu, hay fever, allergy and heartburn tablets containing anti-cholinergic drugs had the effect for one month after treatment, a study found.

Effects associated with taking the drugs included having slower brain processing times and smaller brains overall.

Well known treatments including the heartburn medicine Zantac, Night Nurse Liquid containing Promethazine and the sleeping tablet Nytol, containing diphenhydramine, are included among drugs that may result in the effects, the research said.

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Over the counter treatments for cold, flu, heartburn and sleeping tablets were found to block the chemical acetylcholine, which is involved in the transmission of electrical impulses between nerve cells

The drugs block the chemical acetylcholine, which is involved in the transmission of electrical impulses between nerve cells.

The treatments are prescribed for a wide range of conditions, including Parkinson’s disease, overactive bladder, chronic obstructive pulmonary disease, nausea and vomiting, sleeping problems, high blood pressure, depression and psychosis.

But the authors warn: ‘Use of AC [anti-cholinergic] medication among older adults should likely be discouraged if alternative therapies are available.’

Previous studies have linked the drugs with cognitive impairment, increased risk of dementia and falls.Previous

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However, the new study by Indiana University School of Medicine, is the first to explore their impact on brain metabolism and atrophy through brain scans.

Dr Shannon Risacher, the university’s assistant professor of radiology and imaging sciences, said: ‘These findings provide us with a much better understanding of how this class of drugs may act upon the brain in ways that might raise the risk of cognitive impairment and dementia,’

‘Given all the research evidence, physicians might want to consider alternatives to anticholinergic medications if available when working with their older patients.

‘The impact of these drugs have been know about for over a decade, with a 2013 study finding drugs with a strong anticholinergic effect cause cognitive problems when taken continuously for as few as 60 days. Drugs with a weaker effect could cause impairment within 90 days.’

Many over the counter medicines have been linked to slower brain processing times and smaller brains

The new study involved 451 participants, 60 of whom were taking at least one medication with medium or high anticholinergic activity.

The participants were drawn from a national Alzheimer’s research project - the Alzheimer’s Disease Neuroimaging Initiative - and the Indiana Memory and Ageing Study.

To identify possible physical and physiological changes that could be associated with the reported effects, researchers assessed the results of memory and other cognitive tests, positron emission tests (PET) measuring brain metabolism, and magnetic resonance imaging (MRI) scans for brain structure.

Patients taking anticholinergic drugs performed worse than older adults not taking the drugs on short-term memory and some tests of executive function, which cover a range of activities such as verbal reasoning, planning, and problem solving.

Anticholinergic drug users also showed lower levels of glucose metabolism - a biomarker for brain activity - in both the overall brain and in the hippocampus, a region of the brain associated with memory and which has been identified as affected early by Alzheimer’s disease.

The researchers also found significant links between brain structure revealed by the MRI scans and anticholinergic drug use, with the participants using anticholinergic drugs having reduced brain volume and larger ventricles, the cavities inside the brain.

Professor Risacher added: ‘These findings might give us clues to the biological basis for the cognitive problems associated with anticholinergic drugs, but additional studies are needed if we are to truly understand the mechanisms involved.’

The study was published in the journal JAMA Neurology.  

John Smith, Chief Executive of the Proprietary Association of Great Britain, which represents makers of over the counter medicines, said the medicines linked to the study were not intended to be used on a daily basis.

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Anticholinergic medicines include some over-the-counter allergy and cold and flu products. However they are intended for short term relief of symptoms only 

He said: ‘It is important to note that the JAMA study only involved people with a mean age of 73 in what the researchers conceded was a small sample. 

The study followed people who took medicines that were low, medium or high in anticholinergic activity, and concluded that the use of medication with medium or high anticholinergic activity should be discouraged in older adults if alternative therapies are available.

'However, due to the study limitations, the researchers propose that further and more advanced studies are needed.

‘Anticholinergic medicines include some over-the-counter allergy and cold and flu products but these are intended for short term relief of symptoms and not for continuous use as in the research.

‘If anyone has any concerns about their medicine, we would advise them to talk to their pharmacist. 

'There is a range of different allergy, cold and flu products on the market which contain different ingredients, many of which were not considered in this study, and a pharmacist will be able to recommend a suitable product.

‘All over-the-counter medicines in the UK have been approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) and are rigorously assessed for safety and efficacy. 

'Once on the market, their safety is continually monitored in light of any emerging evidence.’ 

FULL LIST OF IMPLICATED MEDICATIONS 

Drug	Prescribed for/Type of drug	US brand name	UK brand name	Other brand names
Alimemazine	Sedative, antihistamine		Zentiva	Theralen
Alverine	Gastrointestinal disorders		Spasmonal
Alprazolam	Sedative, anxiety	Xanax	Xanax	Niravam
Aripiprazole	Antipsychotic	Abilify	Abilify	Abilify Discmelt, Aristada
Asenapine	Schizophrenia	Saphris	Sycrest
Atenolol	Beta blocker, high blood pressure	Tenormin	Tenormin
Amantadine	Antiviral, flu	Symmetrel	Symmetrel
Amitriptyline	Antidepressant	Elavil	Elavil	Vanatrip, Endep
Amoxapine	Antidepressant	Asendin	Asendin
Atropine	Treats heart rhythms, stomach and bowel problems			Sal-Tropine, Atreza
Bupropion	Antidepressant, smoking cessation	Wellbutrin	Zyban
Belladonna	Leg, nerve pain and psychiatric disorders			Plant also known as deadly nightshade
Benztropine	Parkinson's disease	Cogentin
Brompheniramine	Antihistamine	Dimetapp
Captopril	High blood pressure, heart failure	Capoten	Capoten
Cetirizine	Antihistamine	Zyrtec	Zyrtec
Chlorthalidone	Diuretic	Diuril	Hygroton
Cimetidine	Stomach ulcer, gastroesophageal reflux disease (GERD)	Tagamet	Tagamet
Clidinium	Peptic ulcers	Librax		Quarzan
Clorazepate	Anxiety, partial seizures, alcohol abuse disorder	Tranxene
Codeine	Opioid painkiller	Contin	Nurofen Plus, Solpadeine Max, Panadol Ultra
Colchicine	Gout	Colcrys	Colchicine
Carbamazepine	Anticonvulsant, seizures	Tegretol	Tegretol
Cyclobenzaprine	Musculoskeletal pain, injury	Flexeril		Amrix, Fexmid
Cyproheptadine	Antihistamine	Periactin	Periactin
Carbinoxamine	Antihistamine	Histex		Carbihist
Chlorpheniramine	Antihistamine	Chlor-Trimeton	Piriton
Chlorpromazine	Anti-psychotic	Thorazine	Thorazine
Clemastine	Antihistamine	Tavist	Tavegil
Clomipramine	Antidepressant	Anafranil	Anafranil
Clozapine	Antipsychotic	Clozaril	Clozaril
Desloratadine	Antihistamine	Clarinex	Clarinex
Diazepam	Anxiety, alcohol abuse disorder, muscle spasm	Valium	Valium
Digoxin	Heart failure	Lanoxin	Lanoxin
Dipyridamole	Prevents blood clots	Persantine	Persantine
Disopyramide	Irregular heartbeat	Norpace	Norpace
Darifenacin	Overactive bladder	Enablex	Enablex
Desipramine	Antidepressant	Norpramin	Norpramin
Dicyclomine	Irritable bowel syndrome	Bentyl	Merbentyl
Dimenhydrinate	Anti-nausea	Dramamine	Arlevert
Diphenhydramine	Antihistamine	Benadryl	Benadryl
Doxepin	Depression, anxiety	Sinequan	Sinequan	Deptran
Doxylamine	Antihistamine	Unisom	Unisom
Fentanyl	Opioid painkiller	Duragesic	Duragesic	Actiq
Furosemide	Heart failure, liver disease	Lasix	Lasix	Frusol
Fluvoxamine	Antidepressant, obsessive compulsive disorder	Luvox	Faverin
Fesoterodine	Overactive bladder	Toviaz	Toviaz
Flavoxate	Bladder pain, incontinence	Urispas	Urispas
Haloperidol	Scizophrenia	Haldol	Haldol
Hydroxyzine	Antihistamine	Atarax	Atarax	Vistaril
Hyoscyamine	Muscle spasms, stomach and intestinal disorders	Anaspaz	Anaspaz	Levsin
Hydralazine	High blood pressure	Apresoline	Apresoline
Hydrocortisone	Steroid, treats eczema, psoriasis	Cortef	Cortaid
Iloperidone	Schizophrenia	Fanapt	Fanapt
Isosorbide	Angina	Isordil	Isordil	Ismo
Imipramine	Antidepressant	Tofranil	Tofranil
Levocetirizine	Antihistamine	Xyzal	Xyzal
Loperamide	Diarrhea	Immodium	Immodium
Loratadine	Antihistamine	Claritin	Claritin
Loxapine	Schizophrenia	Loxitane	Xylac
Metoprolol	Angina, high blood pressure	Lopressor	Lopressor	Toprol
Morphine	Opioid painkiller	MS Contin	MS Contin	Avinza
Meperidine	Opioid painkiller	Demerol	Demerol
Methotrimeprazine	Anti-psychotic	Levoprome	Levoprome
Molindone	Anti-psychotic	Moban	Moban
Meclizine	Nausea, vomiting, dizziness	Antivert	Antivert
Methocarbamol	Muscle relaxant	Robaxin	Robaxin
Nifedipine	High blood pressure, angina	Procardia	Adalat
Nefopam	Painkiller	Nefogesic	Acupan
Nortriptyline	Antidepressant	Pamelor	Pamelor
Oxcarbazepine	Epilepsy, anti-convulsant	Trileptal	Trileptal
Paliperidone	Anti-psychotic	Invega	Invega
Prednisone	Anti-inflammatory	Deltasone	Deltasone	Sterapred
Pimozide	Anti-psychotic	Orap	Orap
Olanzapine	Anti-psychotic	Zyprexa	Zyprexa
Orphenadrine	Muscle relaxant	Norflex	Norflex
Oxybutynin	Overactive bladder	Ditropan	Ditropan
Paroxetine	Antidepressant	Paxil	Seroxat
Perphenazine	Anti-psychotic	Trilafon	Fentazin
Promethazine	Antihistamine	Phenergan	Phenergan
Propantheline	Reduces stomach acid in patients with stomach ulcers	Pro-Banthine	Pro-Banthine
Propiverine	Incontinence	Detrunorm	Detrunorm
Quinidine	Heart rhythm disorders	Quinaglute	Quinaglute
Quetiapine	Anti-psychotic	Seroquel	Seroquel
Ranitidine	Stomach ulcers	Zantac	Zantac
Risperidone	Anti-psychotic	Risperdal	Risperdal
Scopolamine	Nausea, vomiting, motion sickness	Transderm Scop	Transderm Scop
Solifenacin	Overactive bladder	Vesicare	Vesicare
Theophylline	Asthma, bronchitis, emphysema	Theo-Dur	Uniphyllin
Trazodone	Antidepressant	Desyrel	Desyrel
Triamterene	Diuretic	Dyrenium	Dyrenium
Thioridazine	Anti-psychotic	Mellaril	Mellaril
Tolterodine	Urinary incontinence	Detrol	Detrol
Trifluoperazine	Anti-psychotic	Stelazine	Stelazine
Trihexyphenidyl	Parkinson's disease	Artane	Trihexyphenidyl Genus
Trimipramine	Depression	Surmontil	Surmontil
Trospium	Overactive bladder	Sanctura	Sanctura
Venlafaxine	Antidepressant	Effexor	Effexor
Warfarin	Prevents formation of blood clots	Coumadin	Warfarin
Source: Aging Brain Care

Read more: http://www.dailymail.co.uk/health/article-3545994/Common-medicines-including-cold-flu-tablets-heartburn-drugs-sleeping-pills-SHRINK-brain-slow-thinking.html#ixzz46EUvlWv4
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