First the bad news, because there doesn’t seem to be any good news concerning the subject I’m about to cover: I recently learned that anticholinergic drugs (these can help treat a variety of conditions, such as chronic obstructive pulmonary disease, incontinence, depression and high blood pressure) are associated with an increased risk of dementia in older people who have used them for longer than a few months. Vesicare is one of these drugs. I’ve been taking it for years for bladder issues.
One study says Vesicare increases risk only in those with diabetes (I don’t have that YET), while the rest don’t mention diabetes. No one is claiming that anticholinergic drugs actually cause dementia. And, the increased risk to individuals is small (I guess that’s a scrap of good news). It’s a risk to take them nonetheless, and Alzheimer’s petrifies me. It represents the majority of dementia cases, in case you didn’t already know!
I’m writing to tell you this news, in case you or someone you know is taking one or more of the culprit drugs. I was surprised that Dr. Alan Garely, the New York urogynecologist who prescribed the Vesicare, hadn’t notified me. I don’t see him often, but I’ve known him for years. I serendipitously Googled “Vesicare” last weekend and read about its link to dementia. A couple of studies are almost two years old, which alarmed me even more. How did I miss reading about them? Stress urinary incontinence is prevalent in US women: 30% to 40% have it in middle age, and 30% to 50% have it in older age. Did the media bury the stories? Why did The New York Times website report about the dementia risk at the end of June as if it was new news?
Coincidentally, I’d made an appointment weeks ago to see Dr. Garely because I needed him to refill my Vesicare prescription. I’d bring up the studies first thing, I thought.
“We have to change your Vesicare prescription,” he said, immediately after greeting me.
“Why didn’t you notify me earlier?”
“The American Urology Association, The American Urogynecology Society and the FDA haven’t issued any advisory for us to stop prescribing anticholinergics in patients who don’t already have cognitive impairment. All patients in the practice need to see me once a year and call in for a drug refill every six months. Since it’s not the current standard of care to stop anticholinergics with all patients, we decided that when patients call for a refill or show up for the yearly visit, we would switch them all off of anticholinergics. We are being proactive and not waiting for an ‘official’ warning.”
“The FDA doesn’t say to stop taking these drugs unless you already have cognitive impairment. Yet, the studies say they increase the risk of getting dementia in the first place. That makes no sense whatsoever.”
“I don’t agree with the ‘recommendations’, which is why I’m switching all patients off of these drugs.”
“So, now that I’ve been taking Vesicare for about 10 years, I definitely have an increased risk for dementia.”
“Cognitive decay secondary to anticholinergics (drug-induced dementia) is usually reversed once the drug is stopped. Patients will revert to baseline.”
“That’s encouraging. But can I try to stop taking drugs altogether?” I asked, after Dr. Garely told me he was writing a prescription for a different drug that might be more expensive, but didn’t have the dementia connection.
“Rather than stopping all medication cold, you should first take the new drug every other day and see how you do. If your bladder isn’t giving you issues on that schedule, see how it does if you stop taking the new drug entirely. There is no ‘one size fits all’ in medication dosing. I want to work with each patient to do what is best for her.”
I’ve reported about many drugs since launching FabOverFifty nine years ago, and each one can be a double-edged sword. They’re often essential to keeping us well, BUT the overwhelming majority of them have the potential to produce side effects. These can range from minor problems like a runny nose to mega problems, like increasing our risk for dementia. The alternative bladder drug Dr. Garely recommended could increase my risk for high blood pressure. My pressure has always been perfect, without medication. Do I risk raising it to take a drug that will reduce my bladder problems? I certainly don’t want dementia and I’m not too wild about hypertension, either.
“Hypertension on the new drug is low, but not zero. We’d check your blood pressure six weeks after starting the drug,” Dr. Garely told me. “If overactive bladder is affecting someone’s quality of life, the low risk of short-term hypertension can be outweighed by the therapeutic benefit of the drug. This is only something that each patient can determine for herself. Obviously, if the drug caused hypertension, we’d stop it.”
I’ve made my decision. If I don’t wait to urinate (that would be a good tagline for a bladder campaign), my bladder doesn’t become an issue. So I’m going to forego the new drug. High blood pressure can have far worse consequences than a little bladder leakage. If I did develop hypertension, it likely would be reversed once I stopped the new drug, Dr. Garely said, since it would be considered “drug-induced hypertension.” NOTE: Likely isn’t a strong enough word for me.
What would you do in my situation? Please make sure to research every drug you’re taking to see if the side effects outweigh the benefits or vice versa.
Dr. Alan D. Garely is Chair of Obstetrics and Gynecology & Director of Urogynecology and Pelvic Reconstructive Surgery at Mount Sinai South Nassau. He also is a professor at the School of Medicine at Mount Sinai.