Dr Van Dam’s phone log – a typical Monday morning:

BEEEEP
1. Dr Van Dam. I take Benadryl to sleep every night. Will I get Alzheimers Disease?
2. Dr. Van Dam. Should I take Claritin or Allegra instead? But they’re still allergy medicines?  Are they safer?
3. Dr. Van Dam. I only take my allergy medicines a few months a year. Should I worry?

There have been several studies linking anticholinergic medicines to dementia. The most popularized of them was a prospective cohort study published by health researchers at the University of Washington. The group followed a few thousand people for approximately seven years, and quantitatively tracked their use of anticholinergic medicines. The researchers demonstrated a clear dose-response relationship between the cumulative exposure to anticholinergics and the presence of dementia and Alzheimers Disease.

Now, from this study, and others, tremendous confusion has developed, related in part to misleading and imprecise headlines promulgated by the popular press.

Let me help!

Here are six things you need to know:

1. Not all allergy medicines (antihistamines) have equal anticholinergic effect. Remember, it is the anticholinergic effect that we are worried about. Benadryl, an older antihistamine, has strong anticholinergic effect. Claritin, Zyrtec, and Allegra, the new generation non-sedating antihistamines, have a significantly weaker anticholinergic effect. So, YES, you should choose the newer non-sedating allergy medicines.

2. The more you are exposed to anticholinergics, the greater your risk. I tell my patients that taking a Benadryl tablet twice a week is probably enough to introduce some risk over a decade or so.  (This is admittedly imprecise, but the best I can do.)

3. If you take your allergy medicines for a few months per year, then obviously you have a lower risk, maybe even negligible. Nevertheless, choose a new generation non-sedating antihistamine, They have far less anticholinergic effect.

4. Many types of medicines have anticholinergic effects, not just allergy medicines. Some common examples include some sleeping pills, antidepressants, drugs used to treat Parkinsons Disease, and drugs used to treat overactive bladder syndrome.

5. Use this website to look up your medicines’ anticholinergic burden:

anticholinergic meds

6. Please don’t stop taking a medicine prescribed for you without discussing it with your doctor. Remember, every medicine has risks and benefits, and these must be weighed against each other to make the safest decision.

As always, I hope this helps!

Off to the pharmacy,
Dr. Van Dam