Most risky drugs:
- Anti-anxiety drugs, which depress the nervous system, already compromised by Lewy bodies.
- Anticholinergic drugs, which decrease acetylcholine, a neurotransmitter already compromised by Lewy bodies:
- antipsychotics
- cold and allergy drugs
- older antidepressants
- some Parkinson's drugs
- Inhaled anesthetics, used with major surgery, which depress the nervous system even more than the anti-anxiety drugs. Many elderly who have surgery have symptoms of dementia for up to 6 months afterwards. If Lewy bodies are present, the dementia may be permanent.
Find a more comprehensive list of these drugs here. Click this link
Although we encourage people to find alternatives to drugs whenever they can, there are times when they can be helpful and should be considered. See the 4/3/2015 Rollercoaster blog for more about drugs useful with LBD.
People at risk:
Drug sensitivity is a hidden symptom. It appears only after a person has taken a drug, often one they may have used safely in the past. People at risk include anyone with:
- Any Lewy body disorder. Although drug sensitivity is seldom present with early PD or RBD, its likelihood increases as Lewy bodies increase.
- Any type of dementia. Although the risk is greater with LBD, experts now include all dementia in the warning against using these drugs.[i]
- Any person over the age of 70. Age also puts people at risk for drug sensitivity.[ii]
Always try non-medical remedies first [iii] with BPSD, such as hallucinations, delusions, agitation or other symptoms where drugs known to be less than safe with Lewy body disorders are the usual drugs of choice. When these drugs are used, Lewy-savvy physicians will choose the mildest one, start with a very low dose and monitor carefully.
For more, read the August 2013 Rollercoaster blogs
Both A Caregiver's Guide to Lewy Body Dementia and Managing Cognitive Issues have long chapters on drug management. Read both. The information is compatible but not repetitive.
References:
[i] Pharmacist's Letter. (2008) Drugs to Avoid in Patients with Dementia. Detail Document #24510.
[ii] Cane, M. (2015) Elderly at risk when antipsychotic drugs used to treat dementia. The Columbus Dispatch • Monday November 2, 2015.
[iii] [1] ABIM Foundation. (2013) Antipsychotic Drugs for People with Dementia. Choosing Wisely.org, Consumer's Report Health.
