A medicine cabinet can get complicated quickly when someone is living with dementia. Some medications that are helpful for other people may cause added side effects or other concerns in people with Alzheimer’s disease or another type of dementia. That’s why it’s useful to know about which ones to avoid or use with extra caution.

This article covers eight classes of medications that may require special considerations for people with dementia. However, none of these medication classes is automatically unsafe for everyone with dementia.

The potential risks and benefits depend on factors such as the specific medication, dose, overall health, and individual needs. Never stop taking a prescription medication or change your dose without first talking with the doctor or other healthcare professional who prescribed it.

🗳️ What helps you most when managing medications for someone with dementia?

Setting up a consistent medication routine

Using a pill organizer, app, alarm, or chart

Regular medication reviews with a healthcare professional

Something else

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These medications are used to relieve anxiety and insomnia. They slow down brain activity and can have stronger effects in older adults.

Examples of medications in this class include:

• Alprazolam
• Diazepam
• Lorazepam

In people with dementia, benzodiazepines can lead to increased confusion, daytime drowsiness, and a higher risk of falls. If these medications are needed, health experts recommend using the lowest effective dose for the shortest amount of time possible.

Because of these risks, doctors may try to avoid benzodiazepines in people with dementia when other options are appropriate. Nondrug approaches for managing anxiety include:

• Practicing relaxation or deep breathing exercises
• Planning structured activities
• Creating a calm, quiet environment with fewer distractions
• Addressing possible sources of discomfort, such as pain, hunger, thirst, or fatigue

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
• Doxylamine
• Oxybutynin

For people living with dementia, these medications can lead to worsening confusion, dizziness, falls, 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.

Doctors sometimes prescribe antipsychotic medications when a person with dementia has severe agitation, aggression, or hallucinations. These drugs can have serious risks, particularly for older adults with dementia.

Antipsychotics carry a U.S. Food and Drug Administration (FDA) boxed warning because they’re associated with an increased risk of death in older adults with dementia-related psychosis.

Examples of antipsychotics include:

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

Brexpiprazole (Rexulti) is the first FDA-approved medication for agitation associated with dementia due to Alzheimer’s disease. However, this approval doesn’t remove its boxed warning.

In people living with dementia, antipsychotics can also increase the risk of stroke, worsen memory and thinking, and increase the risk of falls. When these medications are appropriate, health experts recommend using the lowest effective dose for the shortest time needed.

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

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

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

Sleeping pills may help someone fall asleep or stay asleep, but they can cause added problems for people living with dementia. Some sleep medicines may cause next-day confusion, drowsiness, and an increased risk of falls. They also may not address the underlying problem disrupting a person’s sleep-wake cycle.

Examples of sleep medicines include:

• Diphenhydramine
• Doxylamine
• Eszopiclone
• Zaleplon
• Zolpidem

Before prescribing a sleep medicine, a doctor may look for underlying causes of disrupted sleep, such as pain, anxiety, depression, sleep apnea, or another medication. Nondrug sleep strategies may also help. These include:

• Following a regular sleep and wake schedule
• Staying active during the day and limiting daytime naps
• Limiting caffeine later in the day
• Keeping the sleeping area dark, quiet, and comfortable

Opioids are strong prescription medicines used to treat pain. Examples include:

• Hydrocodone/acetaminophen
• Morphine
• Oxycodone
• Oxycodone/acetaminophen

In people living with dementia, opioids can worsen memory and thinking, cause drowsiness and constipation, and increase the risk of falls. Dementia can also make it harder for a person to tell others when they’re in pain. Caregivers and healthcare professionals may need to watch for nonverbal signs, such as groaning, grimacing, or unusual body positions, and carefully assess possible pain.

If pain needs ongoing management, ask the doctor about other approaches that may be appropriate, such as:

• Physical therapy
• Stretching
• Gentle massage

Acetaminophen may be appropriate for some people, but it also needs to be used carefully. Taking more than the recommended amount or taking several products that contain acetaminophen can cause serious liver damage.

These medications help reduce urinary urgency and incontinence. Some of these drugs have strong anticholinergic effects, which can worsen memory and thinking and interfere with some medications used to treat dementia.

Examples in this group include:

• Darifenacin
• Fesoterodine
• Oxybutynin
• Tolterodine

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

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

Medication alternatives for bladder control that have less effect on memory and thinking, include:

• Mirabegron
• Solifenacin
• Trospium

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

Muscle relaxants are used to treat muscle spasms and related discomfort. In older adults, these medications can cause drowsiness, dizziness, and confusion. In people with dementia, they may also worsen memory and thinking and increase the risk of falls.

Examples in this class include:

• Carisoprodol
• Cyclobenzaprine
• Methocarbamol

Ask your healthcare provider whether other approaches may help manage muscle pain or discomfort. Options may include physical therapy and massage.

Tricyclic antidepressants (TCAs) are one class of older antidepressants. Although they can be helpful for depression, migraine, or nerve pain, TCAs can be problematic for people living with dementia. They have anticholinergic effects, which can worsen memory and thinking or interfere with some memory medications.

Examples in this group include:

• Amitriptyline
• Desipramine
• Imipramine
• Nortriptyline

These medications can cause confusion, blurred vision, dry mouth, constipation, and dizziness.

Doctors may consider selective serotonin reuptake inhibitors (SSRIs) because they generally have fewer anticholinergic effects than TCAs. However, SSRIs still require monitoring for side effects and may not be appropriate for everyone.