If you want to protect your brain—or the brain of someone you love—it’s important to understand how certain medications can affect memory and thinking. One group of drugs in particular, called anticholinergics, deserves special attention.
How Anticholinergics Work in the Brain and Body
Anticholinergics block acetylcholine, a chemical messenger vital for brain and body function. Reduced acetylcholine activity can cause drowsiness, confusion, and slowed thinking. While mild sedation may be useful in some cases, older adults are more vulnerable to its harmful effects.
These medications act in direct opposition to drugs prescribed for memory conditions such as Alzheimer’s disease. Medicines like donepezil, rivastigmine, and galantamine are designed to increase acetylcholine, not suppress it.
Research links anticholinergics to a higher risk of Alzheimer’s disease and hospitalizations in older adults. The American Geriatrics Society includes them on the Beers List—drugs that seniors should avoid or use cautiously.
Because acetylcholine also affects the eyes, mouth, bladder, and digestive system, these medications commonly cause side effects such as dry eyes, dry mouth, constipation, and urinary problems.
Common Types of Anticholinergic Medications
Here are seven categories of drugs with anticholinergic effects that older adults should be cautious about:
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Sedating antihistamines – Example: diphenhydramine (Benadryl). Safer alternatives include non-sedating antihistamines like loratadine (Claritin).
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Night-time pain relievers – “PM” versions of acetaminophen or ibuprofen often include sedating antihistamines. Cold and flu medicines like Nyquil may also contain them.
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Bladder medications – Drugs such as oxybutynin (Ditropan) and tolterodine (Detrol).
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Motion sickness or vertigo medications – Example: meclizine (Antivert).
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Strong antihistamines for itching – Such as hydroxyzine (Vistaril) and doxepin.
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Older antidepressants used for nerve pain – Tricyclics like amitriptyline and nortriptyline.
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Muscle relaxants – Such as cyclobenzaprine (Flexeril).
Additionally, the antidepressant paroxetine (Paxil) has strong anticholinergic activity, which is why geriatric specialists rarely prescribe it. Other SSRIs—like escitalopram, citalopram, or sertraline—are safer alternatives.
Who Should Be Most Careful?
Anticholinergics should be avoided or minimized if you:
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Are concerned about memory loss
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Have mild cognitive impairment or dementia
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Want to lower your risk of developing Alzheimer’s disease
Reducing Risk From Anticholinergics
If you or a loved one takes these medications, don’t panic—but do take action. Ask your doctor or pharmacist to review your prescriptions and over-the-counter medications. In many cases, the dosage can be lowered, a safer drug can be substituted, or a non-drug therapy can be tried.
Tools such as the anticholinergic burden scale can also help identify risky medications. Research shows that long-term and cumulative use may increase dementia risk, making it even more important to stay informed.
Final Takeaway
Anticholinergic drugs are common in everyday medications, but they carry risks that older adults should not ignore. Awareness, regular medication reviews, and open discussions with healthcare providers are the best steps toward protecting long-term brain health.