antihistamines, insomnia and dementia

[ellamental]

Hi. My sister has asthma and has taken phenergan for a long time.. because she has a cat and because she has insomnia but is now worried about the connection between these meds and dementia. Our Mum has dementia and it has been hard for many years now. My sister is very worried about getting Dementia anyway but not sleeping and having her asthma worse because of the cat is not an option. It seems, having looked about Google, that newer antihistamines do not have the connection with Dementia but they seem to be non drowsy. Does anyone know if there is a drowsy one that won't possibly increase dementia in later life? Thanks

[janedivney]

Hello ellamental 👋 I didn’t know there’s a connection between antihistamines and dementia - do you have a link to any research on the subject?

There’s a new, non-addictive drug available to treat insomnia, called daridorexant. It’s very expensive & only approved for people who’ve already tried CBT-i. My gp told me about it because I have terrible insomnia at times, but unfortunately it’s contraindicated for me because I take antifungals.

I don’t know if your sister takes antidepressants but mirtazapine helps with sleep

[Phoenix1992 in reply to janedivney]

This is all news to me too. So, thank you ellamental, for mentioning it.

I just checked it out and it is relating to medications with an anticholinergic effect. There are many.

I found a calculator for medical professionals to calculate the ACB - anticholinergic burden of a person's prescribed medications. Different medications have different loads. If the total load is over 3 there is a risk. It mentions for people over 65. So, I don't know the risk for 65 and under. It is to give the prescriber the opportunity to prescribe alternative medications if available or appropriate for that person's situation.

Here are 2 links to that site (updated July 2024.) I'm going to continue researching this. It doesn't give doses of medications, so that will be good to find.

acbcalc.com/pages/about

acbcalc.com/

Just to add, Hull University Hospital stated in a leaflet -

Anticholinergic burden is the cumulative effect on an individual of taking one or more medications with anticholinergic activity.

The ACB effects are proportionate to the dose and duration of exposure. ACB score of 3 or more may increase the risks of cognitive impairment, functional impairment, falls and mortality in older adults (> 50 – 65 years). Increased doses and long duration of use are associated with increased risk of dementia. Long term effects of anticholinergics on cognition is unknown.

[ellamental in reply to Phoenix1992]

Thanks for this Phoenix1992. Interesting stuff. She has been taking them for many years so not ideal.

[ellamental in reply to Phoenix1992]

And is in her 50s so that, the antihistamines and family with dementia does not bode well.

[janedivney in reply to Phoenix1992]

This is an incredibly helpful link, thanks Phoenix! I’m already at risk because a recent brain scan, to confirm a diagnosis of essential tremor, showed “severe small vessel disease” (I was annoyed to be told this, as there’s nothing I can do about it, so it’s just another worry!) My score is 3 so I’m definitely going to look at alternative drugs. If you ever find a website which allows you to put in different dosages, please let us know

[Phoenix1992 in reply to janedivney]

I will keep looking janedivney.

I agree with you, if you can't do anything about something, it's best not to know. But it is good to know what we can do, where possible.

[Phoenix1992 in reply to janedivney]

Hi janedivney, so I have been mooching around the web and found another 'measure' of anticholinergic burden - called Anticholinergic Drug Scale. (ADS)

It has been explored in small studies and measures, dose, exposure and blood or saliva samples. I can't find anything conclusive or later than 2018 or a calculator for entering our own information. There is obviously a lot of med talk in these studies etc., so I am understanding the gist of it.

I repeatedly found prompts for doctors - can an alternative medication be used? can a lower dose be used? etc.

Anticholinergics reduce acetylcholine levels and interestingly, treatment for alzheimers and other dementias can be medications to increase this.

Here is a link below all about acetylcholine that I found really informative. I am going to personally explore this around the web, looking at really good sources for how to increase this naturally. Food sources are listed on this link too.

my.clevelandclinic.org/heal...

Anyone reading this, I am not a medical person, so please recognise that I am a layperson exploring this (I just love being curious!) 🙂 I am sure there is more knowledge out there.

[ellamental in reply to Phoenix1992]

This is great.. sending most of the replies to my sister. Always good to have some research to go through. 😀

[Phoenix1992 in reply to ellamental]

Definitely! And as long as we find something we can do to mitigate the possible outcome!

I am so pleased you opened this can of worms ellamental, with your questions. And I hate the thought of fixing one problem to only create a new one, especially when it comes to pharmaceuticals.

[ellamental in reply to Phoenix1992]

Yes as Kurty2 said … I look ( sometimes) at side effects and don’t take them seriously - I just think they are covering themselves by mentioning everything but a parent with Dementia means a dread that this will be my future. I had a brain scan as I have a cyst in my head so I know I don’t have dementia now but it seems the luck of the draw for older age. My mums brother is a year younger and pin sharp. 🤞

[Patk1 in reply to Phoenix1992]

Very interesting, thanku x

[janedivney in reply to Phoenix1992]

Another fascinating link, thank you! It’s worrying how these drugs can impact our brains years into the future, yet we’re in happy ignorance. No-one has mentioned these risks to me, even though I expressed concerns about my brain scan to the neurologist and my gp. I need to read this carefully but from a quick skim I’m definitely interested in gingko biloba 😊

[Phoenix1992 in reply to janedivney]

You're welcome ☺️ Hopefully, gingko biloba is compatible with your meds! I'm looking at choline quantities in my food. (Choline converts to acetylcholine) Interestingly, UK have no guidelines and barely mention it as it's not fully researched. So, I'm going to compare US, Australian (if they have any info) and European guidelines and increase food with choline in. I'm vegetarian, so looking forward to getting into this. What with my post menopausal brain too, any help is needed.

Good to chat with you janedivney!

[ellamental in reply to janedivney]

Hi Jane. Thanks for that. No she is not on antidepressants and has had cbt but the new drug might promp her to give cbt a try . I have not looked at studies/research and am currently on a train. I was just going on what she said. Thanks for your reply and info. Will pass it on. 😊

[janedivney in reply to ellamental]

CBT-i seems to involve totally changing your sleep pattern. To do this you have to commit to some sleep restriction for a while. Unless your sis lives in an area where it can be nhs-funded by her surgery, she’d have to pay for it (£160). I’m in two minds whether to dip into my savings - not sure I can cope with sleep restriction along with poor health 😕sleepstation.org.uk

[ellamental in reply to janedivney]

Hi Jane. Will check it out. Thank you. 😊

[Kurty2]

Crikey I had no idea and I take fairly regularly chlorphenamine (old style piriton) to help me with sleep or asthma and just googled it and that's linked to dementia too. Not taking that anymore! Thank you for this post. It's criminal how they don't let you know.

[ellamental in reply to Kurty2]

Hi Kyrty2. Thanks for the reply. I don’t know if its a big risk ir a small one tbh. Insomnia is awful but so in Dementia! I hope you can find something that helps with sleep but has no connection to dementia. X

[Kurty2 in reply to ellamental]

From what I read it's a 50% risk increase for a lot of the antihistamines, fortunately as I said on the other reply there are some antihistamines that have a much lower risk I think I read 4% increase.

[ellamental in reply to Kurty2]

4% is a lot more like it, thanks for that x

[peege]

Eek, I'm worried now. I've been taking Certirizine antihistamine for the purpose of being drowsy enough in the night to fall back asleep. Otherwise I only get 4 hours if I'm lucky and I just cannot function with that. What to do? I know someone who takes Nightnurse to help her sleep.

[ellamental in reply to peege]

Hi Peege. Sorry to worry you. Threre must be an alernative. 4 hours sounds exhausting. I used to take night nurse in my 20s but I felt groggy in the day. My sister,Mum and I have all struggled with insomnia. I take quetiapine which knocks me out and suits me but may also have a dementia risk. Will need to get onto google. I take quetiaine because I have bipolar II and since taking it (17 years) I am mentally well and sleep well but I remember with each night of little sleep the more unhinged I would feel.

[peege in reply to ellamental]

Yes it sounds as though the quetiaine is perfect for you and keeping on an even keel. My son in France has bipolar so I understand. Thank you for the heads up, I'll try to wean myself down to half a certerizine, it's been 2 tablets for tge past week at had a whole lot of stress (water pouring through the roof 😳, three floors soaked). ×

[ellamental in reply to peege]

Oh dear - water pouring through the roof !! That will cause enough stress to disturb your sleep. It is hard reducing meds. I hope to reduce mine too but have to find the balance. Your son having bipolar must be hard too. I think quetiapine and good therapy has worked for me and aging - there ‘s a can’t be arsed feeling about me now. And accepting support. Airports and stations used to cause anxiety. Lovely husband came with me on the train yesterday to London and I slept all the way on his shoulder. 😊

[Kurty2 in reply to peege]

Cetirizine being one of the newer antihistamines has a much lower link to dementia according to sources via Google. The ingredient in night nurse that makes you sleepy is promethazine which is one of the bad antihistamines linked to dementia, again according to sources via Google.

[ellamental in reply to Kurty2]

That is good to know! Thanks for that. 😊

[peege in reply to Kurty2]

Bless you for that information Kurt's, I'm so relieved to hear that 🙏👏👍👌

[Kurty2 in reply to peege]

You're welcome, I think we all have to be alert to just what all medicine side effects could be, we're often shown the side effects or you look at the list on the leaflet and just tend to ignore it, but this is quite serious I'll certainly be changing my ways. I actually have used night nurse in the past and noticed the sleep help, and I found out the sleepy thing was promethazine and ordered a packet of just the promethazine alone just last year to help sleep, I believe it's the same that's in some travel sickness tablets. All the best.

[keisha2001 in reply to peege]

Cetirizine is one of the new generation antihistamines and doesn’t carry this risk. Cetirizine is also non-drowsy. It’s one of the antihistamines that drs suggest changing over to

[peege in reply to keisha2001]

That's good to hear. It certainly makes me drowsy though, even half of one!