The 7 common NHS drugs that raise dementia risk – as docs ‘prescribing meds to millions without warning them’

MILLIONS of Brits are being prescribed medications without being told that they may raise the risk of dementia, a shock investigation has revealed. NHS figures show that more than four million people over the age of 65 take at least one of a class of drugs known as anticholinergics. Anticholinergic drugs are medicines that block acetylcholine, a vital chemical that helps brain and muscle cells communicate with each other Credit: Getty – Contributor These are medicines that block acetylcholine, a vital chemical that helps brain and muscle cells communicate with each other. Common examples of anticholinergic drugs include oxybutynin and tolterodine for overactive bladder and incontinence, procyclidine for Parkinson’s disease symptoms and amitriptyline for depression. Sign up for the Health newsletter Thank you! But, studies have shown that taking such drugs may contribute to an increased risk of developing dementia later in life. All drugs are prescribed with patient information leaflets which include warnings about possible side-effects. However, while many common adverse effects of anticholinergics are included, such as falls, dry mouth and constipation, the link to dementia is usually not, The Sunday Times found. Experts say that patients should be explicitly warned and that doctors must consider safer alternatives. Lucy Pollock, a leading geriatrician based in Somerset, told the Sunday Times: “I feel very strongly about giving patients the right information about this. “We don’t audit it routinely and there’s often no flag in prescribing systems when an anticholinergic is prescribed.” Most read in Health She added: “We can’t wait for more evidence to build up because millions more people will take these medicines over the next few decades.” One of the most recent studies on the link between the drugs and dementia was published in 2023. The research, led by scientists at the University of Nottingham, showed those who took bladder anticholinergics such as oxybutynin were 18 per cent more likely to develop dementia than those who did not. One of the authors, Tony Avery, is now NHS England’s national clinical director for prescribing. In 2020, when he was a professor of primary health care at the University of Nottingham, he warned that “we should act now and advise colleagues not to use anticholinergics associated with dementia for bladder symptoms when there are alternatives that appear to be safer”. Another study, published in the British Medical Journal in 2018, found that people diagnosed with dementia were up to 30 per cent more likely to have been prescribed anticholinergic medications for Parkinson’s, bladder problems, or depression. However, there was no association between dementia and anticholinergic drugs used to treat other common conditions like hay fever, travel sickness, and stomach cramps. The research also found that people who developed dementia took the anticholinergic medication for between four and 20 years before being diagnosed, and the longer they took the drugs, the greater their risk. UK drugs watchdog, the Medicines and Healthcare Products Regulatory Agency (MHRA), reviewed the dementia risk posed by bladder anticholinergics earlier this year. However, it concluded that the dementia risk could not be ruled out but said the current evidence was not strong enough to require action. Which 7 anticholinergic drugs have been linked to dementia? Research has suggested there may be a link between frequently prescribed anticholinergic drugs and depression. One major 2018 study, published in the British Medical Journal, found that people diagnosed with dementia were up to 30 per cent more likely to have been prescribed anticholinergic medications for Parkinson’s, bladder problems, or depression. These specifically included seven drugs: Procyclidine (Kemadrin) for Parkinson’s Tolterodine, oxybutynin, and solifenacin (Vesicare) for urological conditions like overactive bladder or incontinence Amitriptyline, dosulepin, and paroxetine for depression Researchers compared the medical records of over 40,000 people between the ages of 65 and 99 who received a dementia diagnosis, with over 280,000 people who did not develop dementia. At the time, Dr Carol Routledge, Director of Research at Alzheimer’s Research UK, said: “This well conducted study adds to existing evidence of a link between certain anticholinergic drugs and an increased risk of dementia. “While the results don’t paint a straightforward picture, they do reveal a link between dementia risk and the use of certain drugs that may be prescribed to treat depression, urological conditions or the symptoms of Parkinson’s disease. “Not everyone with the conditions highlighted in the study will be prescribed these particular drugs, and the researchers did not find a link between dementia risk and anticholinergic drugs used to treat allergies, stomach problems or muscle spasms.” Source: The British Medical Journal The National Institute for Health and Care Excellence (Nice), which sets clinical guidelines for NHS care, has said the anticholinergic burden should be actively minimised and reviewed by doctors, particularly among older patients. It comes as an analysis of NHS figures earlier this month also found that at least 1,000 elderly Britons are admitted to A&E every day suffering preventable reactions to the cocktail of drugs they’ve been prescribed. The number of emergency admissions has risen by 40 per cent in eight years, figures showed. Roughly eight million people in the UK are also at risk of side effects because they are being prescribed five or more drugs to take daily. Taking more than five medicines is defined as “polypharmacy”, when the risk of dangerous side-effects increases. It is particularly dangerous in more frail patients and in some cases, could even be fatal. Alison Cave, the chief safety officer at the MHRA, said: “It is already known that taking more than one anticholinergic medicine increases the risk of experiencing side-effects, so these medicines should be limited where possible in older adults. “Patients should continue taking their medicines as prescribed and if they have any concerns, they should discuss these with their healthcare professional.” An NHS spokesman said: “Anticholinergic drugs must always be prescribed in line with clinical guidance and with the patient’s or carer’s agreement, following a discussion to ensure the risks and benefits are fully considered and understood. “The NHS is committed to stopping medications from being prescribed when no longer necessary and carried out 3.6 million medication reviews last year to ensure people living with frailty were only prescribed the medication they really needed; and with thousands of pharmacists working in GP practices, we expect this number to increase.” It is estimated that there are around 982,000 people with dementia in the UK, although a third do not have a formal diagnosis. The figure is expected to soar to 1.4 million by 2040. Comment now