Some medications can be unsafe for people living with dementia, including Alzheimer’s disease. This is because dementia affects how the brain works, and certain medicines can worsen symptoms like memory loss, confusion, or trouble staying alert. Certain drugs may increase the risk of falls, cause sleepiness, or lead to distressing side effects like hallucinations. Drug interactions — when medications affect each other in harmful ways — can also create serious problems.

It’s important for caregivers and families to know which medicines to watch out for. Talking with doctors and pharmacists can help you make safe choices. Keeping an up-to-date list of medications and reviewing it regularly can go a long way in protecting your loved one.

Below are eight types of medications that are often unsafe for people with Alzheimer’s or another type of dementia. Understanding these can help you ask the right questions and keep your loved one safe.

1. Benzodiazepines

These medications are used to relieve anxiety. They slow down brain activity, which can be dangerous for someone already experiencing memory issues or confusion.

Examples of medications in this class include:

• Alprazolam (sold under brands including Xanax)
• Diazepam (e.g., Valium)
• Lorazepam (including Ativan)

In people with dementia, benzodiazepines can lead to increased confusion, daytime drowsiness, and a higher risk of falls. While they may offer short-term relief, long-term or frequent use can cause more harm than good.

Health experts often recommend that people living with dementia avoid benzodiazepines whenever possible. Nondrug approaches for managing anxiety or sleep issues include:

• Practicing breathing exercises
• Playing calming music
• Following a consistent bedtime routine

2. Anticholinergics

Anticholinergic drugs are commonly used to treat allergies, help with sleep, and manage bladder problems. However, they work by blocking acetylcholine, a brain chemical important for memory and learning. This can make dementia symptoms worse.

Examples in this class include:

• Diphenhydramine (sold under brand names including Benadryl)
• Diphenhydramine/acetaminophen (such as Tylenol PM)
• Doxylamine (often found in nighttime cold and flu products)
• Oxybutynin (used for overactive bladder)

For people living with dementia, these medications can lead to worsening confusion, dizziness, and difficulty thinking clearly. Many over-the-counter (OTC) sleep aids, cold medicines, and bladder treatments fall into this category, so it’s important to read labels carefully and talk with a pharmacist or doctor if you’re unsure.

3. Antipsychotics

Doctors sometimes prescribe antipsychotic medications when a person with dementia shows signs of severe agitation, aggression, or hallucinations. But these drugs carry serious risks, especially for older adults with dementia.

Examples of antipsychotics include:

• Aripiprazole
• Clozapine
• Haloperidol
• Olanzapine
• Quetiapine
• Risperidone

In people living with dementia, these medications can increase the risk of stroke and can make someone more sedated and confused. Health experts suggest using these only when absolutely needed and in the lowest dose possible.

Consider exploring nondrug strategies first to help manage agitation, restlessness, or emotional distress. These may include:

• Music therapy
• Guided touch or hand massage
• Redirection to to a calming activity

A dementia care specialist may be able to offer more personalized guidance and support.

4. Sleeping Pills

Sleeping pills may help people fall asleep, but for someone living with dementia, they often cause more harm than good. These medications can leave people feeling groggy and confused. They may also make it harder to wake up fully, increasing the risk of falls or nighttime wandering, which can be dangerous.

Examples in this group include:

• Diphenhydramine (found in sleep aids like Sominex or medications with “PM” in the name; sometimes combined with acetaminophen, such as the aforementioned Tylenol PM)
• Doxylamine
• Eszopiclone
• Zaleplon
• Zolpidem (sold under brand names including Ambien)

Sometimes, sleeping pills are used before fully exploring the root cause of the sleep issue — such as pain, anxiety, or a disrupted routine. Safer, nondrug sleep strategies include:

• Following a calming bedtime routine
• Reducing screen time in the evening
• Limiting caffeine, especially in the afternoon and evening
• Creating a quiet, comfortable sleep environment

5. Strong Pain Medicines

Opioids are powerful drugs used to manage severe pain, especially after surgery or injury. Examples in this group can include:

• Hydrocodone (sometimes combined with acetaminophen, as in Vicodin)
• Morphine
• Oxycodone (often sold as OxyContin or in combinations like Percocet)

But in people with dementia, the medications can cause increased confusion, drowsiness, and a higher risk of constipation and falls. If someone has trouble communicating how much pain they’re in, they may be given more medication than they actually need.

If pain needs long-term management, ask the doctor about safer options like:

• Physical therapy
• Stretching
• Massage
• OTC pain relievers like acetaminophen alone

6. Certain Bladder-Control Medications

These medications help reduce urgency and incontinence. However, they can affect brain chemicals involved in memory and thinking. As a result, they may make dementia symptoms worse.

Examples in this group include:

• Darifenacin
• Fesoterodine
• Oxybutynin
• Tolterodine

People with dementia may become more confused or agitated after taking these medications, or they may have difficulty thinking clearly. Safer ways to manage bladder problems might include:

• Timed bathroom visits
• Reminders or scheduled toileting
• Pelvic floor exercises
• Absorbent or incontinence products

There are also safer medication alternatives for bladder control that have less effect on memory and thinking, including:

• Mirabegron
• Solifenacin
• Trospium

Talk with your doctor about which approach may be safest and most effective for your loved one.

7. Muscle Relaxants

Muscle relaxants are prescribed for short-term pain or muscle spasms. Unfortunately, they often cause excessive drowsiness, dizziness, and increased confusion, especially in older adults. In people with dementia, this can lead to dangerous falls or even worsen confusion.

Examples in this class include:

• Carisoprodol
• Cyclobenzaprine
• Metocarbamol

Ask your healthcare provider if safer options might help relieve muscle pain without the same risks, such as:

• Stretching
• Heat therapy
• Light exercise
• Massage

8. Older Antidepressants

These medications are part of an older class of antidepressants known as tricyclic antidepressants (TCAs). While they can be helpful for depression, migraine, or nerve pain, TCAs can be problematic for people living with dementia. They tend to have strong anticholinergic effects, meaning they interfere with brain chemicals needed for memory and thinking.

Examples in this group include:

• Amitriptyline
• Desipramine
• Imipramine
• Nortriptyline

Side effects may include:

• Confusion
• Blurred vision
• Dry mouth
• Constipation
• Dizziness

All of these can be troubling in someone already experiencing changes in cognitive function, such as memory loss, confusion, or trouble concentrating. Doctors may recommend newer antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), which are generally safer and better tolerated in older adults with dementia.

Tips for Caregivers

Caring for someone living with dementia often means managing their medications carefully. Consider these practical strategies to keep their medication routine safe and effective and support their overall well-being.

Keep an Updated Medication List

Bring a full list of medications to every doctor’s visit. This includes prescription drugs, OTC items, vitamins, and supplements.

Stick to One Pharmacy

Use one pharmacy when possible. Pharmacists can help track drug interactions and flag risky medications.

Ask Questions About Every Drug

Talk with the doctor about every medication. Ask if it’s still needed, whether it could be causing side effects, or if there’s a safer alternative.

Watch for Side Effects

Keep an eye on your loved one for confusion, tiredness, or behavior changes. These could be side effects of a medication and should be shared with the doctor or pharmacist.

Use Tools To Stay Organized

Try pill organizers, reminder apps, alarms, or printed charts. These tools help keep medications on track and prevent missed doses.

Review Medications Regularly

Schedule a medication checkup with your doctor or pharmacist. This helps identify and remove unnecessary or harmful drugs.

Learn and Speak Up

Take time to understand each medication your loved one takes. If something doesn’t seem right, speak up. You are their advocate.

Caregivers play a key role in making sure medications are safe. These tips can help protect brain health and prevent avoidable problems.

Talk With Others Who Understand

On myALZteam, members come together to ask questions, give advice, and share their stories with others who understand life with Alzheimer’s disease.

Have you ever wondered about any of the medications on this list and whether or not they may affect dementia? Share your experience in the comments below, or start a conversation by posting on your Activities page.