Spring blooms can cause pollen allergies, but some common remedies can trigger problems in aging adults. Though these drugs are safe for younger people, older bodies metabolize them differently, sometimes leading to falls and even psychotic behavior.
Learn more about the allergy medicines that you should avoid and how to find safer alternatives for your parents — and maybe for yourself, too.
Allergy Medicines to Avoid or Use With Caution
Professor Judith Beizer, PharmD, serves on the American Geriatrics Society (AGS) Beers Criteria panel that regularly reviews how medications affect older adults.
The AGS Beers Criteria makes recommendations for doctors and pharmacists and it recommends avoiding chlorpheniramine and diphenhydramine use in people over 65:
Chlorpheniramine is an antihistamine used in common OTC medicines like Chlor-Trimeton and Chlor-Tabs.
These ingredients are in other drugs, too. “Any over the counter products that have ‘PM,’ like Advil and Tylenol PM, stay away from. The PM part means it has Benadryl in it, for sleep,” Beizer says.
Diphenhydramine is the main ingredient in some of the most popular over-the-counter allergy medicines, including Benadryl and generic or house-brand alternatives like Wal-Dryl. It’s used for seasonal allergies.
It’s also used for first-aid for acute, severe allergic reactions like hives or swelling, and “that’s when Benadryl is OK,” Beizer states, so it’s wise to keep some on hand for emergencies.
Why Should Seniors Avoid These Medications?
Chlorpheniramine and diphenhydramine belong to a class of drugs called anticholinergics. They block the neurotransmitter acetylcholine, which helps control learning, memory and muscle contractions. As we age, our brain’s ability to use acetylcholine declines, so reducing it further with these drugs can cause trouble.
“Their side effects are just not well-tolerated in older adults and they can exacerbate existing conditions,” Beizer says.
Pharmacy students learn these effects as:
- Blind as a bat. “These medications can dilate the pupils and make it hard to see,” Beizer states. “That can put people at risk for falls.”
- Dry as a bone. “If you’re taking medications, dry mouth can make it hard to swallow them. If you wear dentures they might rub. ‘Dry as a bone’ also includes constipation and urinary retention,” especially in men with an enlarged prostate.
- Mad as a hatter. “Instead of making you drowsy, the anticholinergic effects can be excitatory and cause confusion. I’ve seen issues with psychotic behavior from these types of medications.” For people with dementia, “these medications can make their symptoms and confusion worse.”
- Red as a beet. “You don’t sweat as well, and that can put you at risk for heat stroke.”
These side effects can happen even if your parents took these medicines safely when they were younger. Why? “Your body changes and your reaction to medications changes as you age. You may not notice it, but then you can end up falling. That’s the concern,” Beizer adds.
Chlorphenamine and diphenhydramine aren’t the only anticholinergic drugs to be aware of. Some older medicines for depression and irritable bowel disease are anticholinergics, too.
Other drugs that have small amounts of anticholinergics can add up to side effects. “If you’re taking several of these, the effects could add up to be like taking a Benadryl,” Beizer states.
Ways to Find Safer Medicine
If a doctor prescribed or recommended these medications for your parent, “don’t stop immediately,” Beizer cautions. “Bring it up with the doctor to discuss. Is there a safer alternative? There are times when these drugs are right — like a dose of Benadryl when you get a bee sting and you can’t breathe or are swelling up. But there are times when people have been on these medications a long time and no ones stopped and thought about it, and maybe there are safer alternatives.”
Beizer says newer types of antihistamines like Claritin, Allegra and Zyrtec have fewer side effects for older adults. However, “there will still be some drying, so you should only be using them if nothing else has worked.” She states that steroid nasal sprays like Flonase should be the first option for most people with seasonal allergies.
Whatever over-the-counter medicines you’re considering buying for a parent, Bezier suggests talking to the pharmacist where your parents get their prescriptions filled. “Bring your choices up to the pharmacy counter, ask them to look at your parent’s prescriptions and ask which one is the safest.” That’s especially important for OTC allergy medicines that contain decongestants because some can raise blood pressure.
One more suggestion from Beizer about helping your aging parents find the right medications: “Think about whether it’s time to look for a geriatrician who really focuses on care for older adults, particularly frail older adults with multiple problems.” That level of care can help your parents beyond this year’s allergy season.
For more information about medication safety for seniors, visit HealthinAging.org, the AGS site for caregivers and families.
Have allergy medicines exacerbated any of your conditions before? What was your experience like? We’d like to hear your stories in the comments below.