June 13, 2015

June 13, 2015
10 Drugs that May Cause Memory Loss


Welcome to another day in my life. Today is Saturday and I hope you had a beary safe and great week. Dab the AIDS Bear is on the road doing events again this weekend while you're enjoying yours.

Memory loss is normal to some extent as we age but did you know there are also medications which can cause memory loss. I'll be blogging about ten of them today and tomorrow.

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.

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. The good news is that the memory loss from medications can often be relieved by stopping the medication, lowering the dose or using an alternative treatment.

1. Antianxiety drugs (Benzodiazepines)

Why they are prescribed: Benzodiazepines are used to treat a variety of anxiety disorders, agitation, delirium and muscle spasms, and to prevent seizures. Because benzodiazepines have a sedative effect, they are sometimes used to treat insomnia and the anxiety that can accompany depression.

Examples: Alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), quazepam (Doral), temazepam (Restoril) and triazolam (Halcion).

How they can cause memory loss: Benzodiazepines dampen activity in key parts of the brain, including those involved in the transfer of events from short-term to long-term memory. Indeed, benzodiazepines are used in anesthesia for this very reason. When they're added to the anesthesiologist's cocktail of meds, patients rarely remember any unpleasantness from a procedure. Midazolam (Versed) has particularly marked amnesic properties.

Alternatives: Benzodiazepines should be prescribed only rarely in older adults, in my judgment, and then only for short periods of time. It takes older people much longer than younger people to flush these drugs out of their bodies, and the ensuing buildup puts older adults at higher risk for not just memory loss, but delirium, falls, fractures and motor vehicle accidents.

If you take one of these meds for insomnia, mild anxiety or agitation, talk with your doctor or other health care professional about treating your condition with other types of drugs or nondrug treatments. If you have insomnia, for instance, melatonin might help. Taken before bedtime in doses from 3 to 10 mg, melatonin can help to reestablish healthy sleep patterns.

Be sure to consult your health care professional before stopping or reducing the dosage of any benzodiazepine. Sudden withdrawal can trigger serious side effects, so a health professional should always monitor the process.

2. 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:
The safest way to lower your risk of cardiovascular disease is to follow a Mediterranean diet, exercise and maintain a healthy weight. The latest recommendations are that many people over 75 may not derive much benefit from statins unless they have cardiovascular disease or very high LDL (bad cholesterol) with significant risk factors for cardiovascular disease. Lower doses of statins or less potent ones may be more appropriate for some individuals and can reduce the likelihood of adverse effects like memory impairment. Also a new study indicates that Zetia (ezetimibe) can lower LDL and cardiovascular disease when added to statin drugs, so that a lower dose or less potent statin may be able to be used. You should discuss these options with your doctor or other health care provider.

3. Antiseizure drugs

Why they are prescribed: Long used to treat seizures, these medications are increasingly prescribed for nerve pain, bipolar disorder, mood disorders and mania. Examples: Acetazolamide (Diamox), carbamazepine (Tegretol), ezogabine (Potiga), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), rufinamide (Banzel), topiramate (Topamax), valproic acid (Depakote) and zonisamide (Zonegran).

How they can cause memory loss: Anticonvulsants are believed to limit seizures by dampening the flow of signals within the central nervous system (CNS). All drugs that depress signaling in the CNS can cause memory loss.

Alternatives: Many patients with seizures do well without memory problems on a different antiseizure drug . Many patients with chronic nerve pain find that venlafaxine (Effexor) which uncommonly impairs memory alleviates their pain.

4. Antidepressant drugs (Tricyclic antidepressants)

Why they are prescribed: TCAs are prescribed for depression and, increasingly, anxiety disorders, eating disorders, obsessive-compulsive disorder, chronic pain, smoking cessation and some hormone-mediated disorders, such as severe menstrual cramps and hot flashes.

Examples: Amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil) and trimipramine (Surmontil).

How they can cause memory loss: About 35 percent of adults taking TCAs report some degree of memory impairment and about 54 percent report having difficulty concentrating. TCAs are thought to cause memory problems by blocking the action of serotonin and norepinephrine two of the brain's key chemical messengers.

Alternatives: Talk with your health care provider about whether nondrug therapies might work just as well or better for you than a drug. You might also want to explore lowering your dose (the side effects of antidepressants are often dose-related) or switching to a selective serotonin/norepinephrine reuptake inhibitor (SSRI/SNRI). Of the drugs in this category, I find venlafaxine (Effexor) to have the fewest adverse side effects in older patients.

5. Narcotic painkillers

Why they are prescribed: Also called opioid analgesics, these medications are used to relieve moderate to severe acute or chronic pain, such as the pain caused by 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. Both these actions are mediated by chemical messengers that are also involved in many aspects of cognition. 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.

I will finish the other five in tomorrow's blog... well unless I forget. LOL. Hope you have a beary safe and great Saturday!

Until we meet again; here's wishing you health, hope, happiness and just enough.



big bear hug,





Daddy Dab