The Alarming Medication Side Effect No One Ever Told You About

Updated: Jun 18, 2020



Introduction


Have you ever heard of anticholinergic medications? Neither had I. But you’re about to.


When it comes to treating mental health issues, there are a whole range of options—like multiple generations of psych meds; an alphabet’s worth of therapies like CBT, EMDR, and ABA; electroconvulsive therapy; and newer treatments like transcranial magnetic stimulation and ketamine infusions, and of course what looks to be the promising treatment of psychedelics.


For me, I’ve had symptoms of depression that have gotten bad enough that I’ve been open to trying all sorts of things. I’ve tried CBT, DBT, and EMDR therapies. I also tried at least a dozen different psych meds before finding one that started actually helping. It still wasn’t as much of an improvement as I had hoped, though, and I eventually started doing electroconvulsive therapy (ECT) as well.


From what I’ve read, we don’t understand why ECT is effective for treating depression and other mental illness, but the research has consistently shown for decades that inducing a seizure under controlled conditions really does help symptoms. Even though it’s an effective treatment, ECT has negative connotations. I remember happening to see the “shock therapy” scene from One Flew Over the Cuckoo’s Nest being performed during an awards show on TV when I was in elementary school, and it was horrible enough that, even though I didn’t know what was going on, I never forgot it. It’s the main reason I want to quickly clarify some very significant differences with how electroconvulsive therapy is currently (no pun intended) quite different from how I think society often imagines it: First, that the treatment is consensual. Second, that it’s done under general anesthesia and that muscle relaxant medications are used, so it is not painful. Third, as I mentioned, the treatment can be very helpful, especially in individuals with severe mental illness that hasn’t responded to other treatments.  


Experiencing Cognitive Changes


Still, unfortunately, all these treatments don’t come without side effects. One medication I tried made me hungry all the time, others gave me constant stomach pain. I started noticing a more troubling pattern, though, starting a few years ago around the time I started doing ECT: cognitive changes. And not for the better.


When I started ECT, the doctors warned me it might affect my memory. I was desperate to feel better, though, so this didn’t bother me very much at the time.

I did experience memory loss with the treatment—which, I know now, is not fun, and, honestly, not something I’m totally sure I would choose again if I knew then what I do now. It’s also something I would encourage ECT candidates to not take lightly.

ECT treatment starts with an intensive round of several sessions a week over several weeks. This is when the memory loss occurred for me. After that initial round, maintenance treatments can be much more spread out. I currently go in about every six weeks. Once I got to this point, I noticed I wasn’t losing more memories (though, unfortunately, I also didn’t seem to gain any back).


Even though I wasn’t losing more memory, I felt my cognition was still being hampered. For the last several years, sometimes I feel foggy. The biggest cognitive change I notice, though, is that I frequently have a really hard time recalling words and terms for things. It can be things I was just talking about yesterday, too, or things I’ve spent the last month studying about in a class. I know people talk about this very thing as a side-effect of aging—but in my thirties? I don’t know if that’s quite when this becomes normal.


I’ve always assumed that these frustrating cognitive changes have been due to my maintenance ECT treatments. And they bother me. At one point, I started looking to see if there might be alternatives to continuing with ECT. I also consulted with the psychiatrist in charge of the treatments about what I could do about the cognition issues. He prescribed me Aricept, a medication used for Alzheimer’s disease and dementia, which I tried for a while but gave up when it didn’t seem to do anything. He also changed my schedule of anesthesia drugs when I go in for a treatment to include ketamine.


Just a couple of weeks ago, though, I heard some information that made me think ECT might not be the issue after all—it might be my psych meds.




Could it be the meds?


I recently posted about how I’ve been accepted to physician assistant school. One of the ways I’ve been trying to prepare is by listening to lots of medical podcasts. The other day, I had on the pharmacology podcast Real Life Pharmacology while I was at work. The topic? A tricyclic antidepressant called doxepin. I actually take a tricyclic antidepressant, desipramine, and because of this, I perked up at the topic. I thought most of the information I would hear in the podcast would sound familiar.


Tricyclic antidepressants are an older antidepressants, the model that came out before SSRIs like fluoxetine (Prozac). As the podcast episode explained, tricyclics are now used less for mood issues and more for indications like nerve pain and bladder spasms. Personally, though, they were the first class of antidepressants that actually helped me.


Anyway, the host of Real Life Pharmacology, Eric Christianson, PharmD, was going through different characteristics of the medication, along with a number of side effects. And then he mentioned: the medication is also “anticholinergic,” meaning it blocks the action of the neurotransmitter acetylcholine.


Anticholinergic effects, he went on to say, “can include memory problems [and] confusion.”


“What?” I thought. “What??

I started googling. I found a list titled “Anticholinergic cognitive burden scale” developed by Dr. Malaz Boustani from the Regenstrief Institute and the Indiana University Center for Aging Research, and published by Harvard Health Publishing In 2009. It listed my antidepressant, desipramine. Anticholinergic. I looked for quetiapine, a medication that’s helped me so much with sleep. It’s an antipsychotic medication I was prescribed off-label during a hospital stay and that I’ve taken for years. Also anticholinergic. The medication I take for anxiety? Phew, that, at least, was not on the list.


Talking to my pharmacist


A small, panicky fire started inside me. My first automatic response was to keep searching on Google, resulting in articles like “What are anticholinergic drugs and should you be worried about a link to dementia?” from USA Today before I stopped myself. I should really be consulting a provider, I thought, not just Doctor Google.


After work, I went straight to my pharmacy, a CVS, and asked to speak with the pharmacist. He came over after a few minutes. I don’t know his name—I’ll call him Dr. Drug. I tried to explain to Dr. Drug what I had been putting together—that I had been experiencing cognitive changes since starting ECT, but that I was wondering if it had more to do with my medication at this point. And that I was concerned about this. Very concerned.


Dr. Drug was skeptical, to say the least.


The CVS pharmacist frowned and looked up my chart. “Well, only one of these is anticholinergic,” he said.


“No.” I said. “Two are.” I pointed out quetiapine, but he didn’t seem to believe that it qualified. “I feel like it was a reliable source” I wanted to say. But I couldn’t recall where that list was published. (It was through Harvard.)


Dr. Drug frowned some more. “I really don’t think this would cause memory loss,” he said.


“Well, it’s not so much causing memory loss I’m worried about, it’s the overall cognitive changes I’ve been experiencing since that time,” I tried to explain to him.


“I think you’re fine.”


I left frustrated and angry. If there was nothing to worry about, why was I seeing articles about a connection between the medications and symptoms of dementia? And why did he only identify one of the two medications that Harvard Health article included as anticholinergic?


Also, why had no provider who had ever looked over my list of medications ever suggested that these prescriptions might be connected to this kind of problem? I did a mental tally of the providers who have reviewed my medications in the last few years: There’s the ECT psychiatrist I currently work with who I have talked to numerous times about cognitive changes, an anesthesiologist present for every ECT treatment (who have also been present during the previously mentioned conversations), a rotation of at least a half dozen other psychiatrists who in the past have administered ECT and who have asked me about side effects, the nurse practitioner I see for managing my psych meds, the psychiatrist who managed them before her, and my internist. Plus that pharmacist. And one before him who I asked to take a look at my meds once.


Seriously, at least twenty medical providers have gone over my list of medications and heard me express concern about my memory problems. Not a single one of them ever brought up that this class of medication that I was taking could perhaps be contributing.


I got even more angry a few days later. It was maybe 7:00 PM on a Saturday evening, and I got a phone call from the pharmacy. I ignored it, but then they called again. “Something must be going on,” I thought, and answered.


To my horror, it was Dr. Drug.


Dr. Drug explained why he was calling me at 7:00 PM on a Saturday evening. The pharmacy (a CVS) had sent me an email survey after my interaction with him earlier that week, and I had filled it out quite negatively after our frustrating exchange. Much to my dismay, I found out these results were far from anonymous. Instead, they sent my negative survey results directly to that pharmacist, with my personally identifying information, and told the pharmacist to call me directly and discuss them. Again, this was CVS Pharmacy. So all of you know. I recommend that you avoid CVS (if for no other reason than because if you purchase so much as a stick of gum there, you’ll leave with a six-foot receipt).


I tried to be polite to Dr. Drug. He wanted to know what other information he could give me that would help me be more satisfied. This conversation, however, went in the exact same circles the previous one had: Me explaining what I had been reading, pharmacist Dr. Drug telling me it wasn’t significant. I kept trying to say okay, thank you, and politely hang up, at which point the conversation got really interesting.


“Well, compared with other pharmacists I’ve worked with, I can tell you I’m really knowledgeable,” the CVS pharmacist started telling me. “If there were something going on here, I think I would know, and be able to help you with it. I really know a lot about medications.”


I hung up mad.


My guess for why no provider has ever suggested the medications I take with anticholinergic effects could have something to do with my negative cognitive changes is that it’s simply impossible for any one person to know every medication, their chemical properties, and their side effects and interactions. It would be impossible for them to do so. I understand that.


But do the providers understand that? That pharmacist sure didn’t. The guy made it clear he thought he knew everything…which is unsettling. If he could at least acknowledge the fact that his brain isn’t a computer, he’d be able to keep learning about the things he wasn’t as sure about. But if a person thinks they know everything…I don’t think they’ll ever try to look beyond their own limits, even if someone else’s health and wellbeing are on the line.

I was still left with the question of whether my medications are messing with my mental capacity. I decided that, instead of relying on one person’s limited knowledge to answer that question, I would look at the science and research for myself. I went home and started searching through PubMed and Google Scholar. Here’s what I found out.


Anticholinergic Medications and Cognition: What the research says


What medications are anticholinergic?


A variety of medications have anticholinergic properties. These medications tend to come from a few categories (though not all medications in these categories are anticholinergic): antihistamines, antipsychotics, tricyclic antidepressants, muscle relaxants, and medications for nerve pain, and medications for heart problems. As I mentioned, I used this source from Harvard Health Publishing to identify these medications. The source only includes their names; I wanted to know what each of them was, and spent some time looking them all up. I’ve included the list and some tidbits about what I learned below at the bottom of the post. I’ll include the caveat that this is definitely not any kind of comprehensive source, and that I’m no expert. If you want to know more, I’d encourage you to spend some time doing your own research from reliable sources, and to talk to your health care provider. Again, which I am not.


Does research show anticholinergic medications are associated with cognitive decline?


After the pharmacist encounters, I went home and started looking up research for myself to see what science had to say about anticholinergic medications being associated with cognitive decline. I think you’ll find these studies just as fascinating as I did.


“Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis” by Kimberly Ruxton, Richard J. Woodman, and Arduino A. Mangoni, British Journal of Clinical Pharmacology, 2 March 2015, volume 80, issue 4, pp. 921-926

This journal article was a systematic review of studies on this topic. What does this mean? Read one article, get the conclusions from many articles! I love systematic review and meta-analysis articles for this reason. (Spoiler: I’ve included a few!)


This article looked at 18 studies in total; of those, there were three studies with 8,845 participants that specifically looked at the medications and cognition. These participants were age 65 or older; the studies followed them for 4-10 years. The authors of the paper use the term “drugs with anticholinergic effects,” or DACEs, when talking about anticholinergic medications.


The data from those three studies was combined in this paper to get bigger, better data. And what did the researchers find out? I’ll quote the authors directly: “Exposure to DACEs as a class was associated with a 45% increase in the odds of cognitive impairment.”


I’m sorry, did you hear that, CVS pharmacist? ANTICHOLINERTIC MEDICATIONS WERE ASSOCIATED WITH A FORTY-FIVE PERCENT INCREASE IN THE ODDS OF COGNITIVE IMPAIRMENT. Wouldn’t you say that’s something to be aware of? I would.


Now, because these meta-analysis/systematic review studies that combine studies are so awesome, I have a few more for you:


“Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review” by Chris Fox et al, Age and Ageing, September 2014, volume 43, issue 5, pp. 604-615

This study took a look at 46 studies published since 2002, from which there were 60,944 participants. Of those 46 studies, there were 33 studies that looked at cognition. The paper said the participants of all these studies were “adults,” but didn’t give any more information about the ages of the participants.


And what did they find? First, some good news: The authors write that using anticholinergic medications was not associated with an increase in mild cognitive impairment (MCI). MCI is an official clinical term to describe when someone starts having memory problems. It’s also considered a precursor for dementia (which, by the way, is not a normal part of aging). So, breathe a sigh of relief there: these medications don’t give you Alzheimer’s disease or other dementias.


And then…the bad news. In the article, the authors tell us, “seventy-seven percent of included studies evaluating [anticholinergic use and] cognitive function reported a significant decline in cognitive ability with increasing anti-cholinergic load”—in other words, the studies showed taking these medications was associated with a decline in cognitive ability, and taking more of these medications was associated with more cognitive decline. Unfortunately, they don’t give us any numbers to describe the nature of this association. Still, the study definitely shows evidence for a relationship between anticholinergic medications and cognitive decline.


“The cognitive impact of anticholinergics: A clinical review” by Noll Campbell et al, Clinical Interventions in Aging, June 9 2009

One more systematic analysis for you. This one looked at studies from 1966-2008, so it’s a bit older. It includes 27 studies, with a total of 8,442 participants. The median age of the participants of each of the individual studies was listed: They fell from 40-88. Like the previous paper, this one doesn’t give us much in the way of statistics, but it states very clearly: “The finding of this systematic review indicates the burden of anticholinergic has consistently been shown to negatively associate with cognitive performance. All but two studies [of 27 that qualified for] this review support the association of anticholinergic use and worsening cognitive performance.”


One weak point of these studies is that their participants tend to be older adults. Still, I included them because they were very strong in other ways: The studies combine data from a ton of other studies, and have rather large sample sizes. Even though the participants tend to be older, the results of these studies are quite clear: There is an association between this list of common medications and cognitive decline.


I did work to find research on younger groups, though. There was hardly anything available, but I did find this study that matched my demographic: healthy young women.


“Effects of cholinergic blockage on language in healthy young women: Implications for the cholinergic hypothesis in dementia of the Alzheimer type” by D. Aarsland, J. P. Larsen, I. Reinvang, and A. M. Aasland, Brain, December 1994, volume 117, issue 6, pp. 1377-1384

This study involved 22 healthy women ages 20-40 years old (with an average age of 24.9). Each participant came to the lab for two sessions, one week apart, where they performed a whole bunch of assessments looking at reaction time, language, spelling, memory, and attention. The twist: On one visit, before the tests, they got a dose of an anticholinergic medication that doesn’t cross the blood-brain barrier (so, presumably can affect the body but not the brain). On the other visit, they got either a high or low dose of an anticholinergic medication that does cross the blood-brain barrier. As to which they received when? The participants didn’t know—nor did the people administering the tests.


The researchers tell us what happened next. When they added up the scores and looked at the numbers, they found some patterns.


First, they found the scores on some assessments didn’t change with the different drugs, specifically some of the reading and language tests (“tests assessing lexical strategies”—no, I don’t know what that means, either).


A lot of the test scores, though, did change based on which medication the participant had been given. When they were given a dose of the anticholinergic medication that crosses the blood-brain barrier (so, the one that can affect the brain), scores testing the following tended to be lower: word spelling, lexical decision, tachistoscopic reading (umm…which have something to do with words?), memory (I know what that is!), arousal (which was whether the participant felt awake and clear or groggy and foggy), and oral language (speaking?). Also, the authors write that with this medication, subjects experienced…”WORD-FINDING DIFFICULTIES.”


Word-finding difficulties: Exactly the thing I’ve struggled with the most.


What can we conclude from the research?


That last study, admittedly, was not the greatest: It was older, smaller, and only looked at the immediate, short-term effects of anticholinergics. Still, wouldn’t you know? It showed the same pattern that other much larger and longer-lasting studies showed: Even in healthy young women, anticholinergic medications were associated with cognitive decline. The overall trend of the research supports the fact that taking these meds and experiencing negative cognitive changes tend to go together.


And, maybe, that that CVS pharmacist didn’t know as much as he thought he did.


What next?


When I first started looking into these medications, my gut reaction was honestly to drop the two anticholinergic prescriptions I have immediately. Stop taking them cold-turkey. When I took a step back and looked at things logically, though, I knew that wouldn’t be a good idea. My prescriptions have been—are—an important component of surviving depression. And it wouldn’t be a good idea to just stop something that’s been helping (and possibly crash hard).


Still, discovering this information about anticholinergics and cognitive decline has lead me to started looking around at other options, in addition to reexamining what I currently do. For one thing, I figured out I’ve been on a extremely high dose of quetiapine, the anticholinergic I’m prescribed take off-label for sleep. I’ve tapered down to a lower dose, and started focusing a lot more on healthy sleep habits. Interestingly, even though I don’t always fall asleep as fast, I’m a lot less groggy in the morning. I’ve also started looking around for options to treat depression that I haven’t tried yet. One I’m seriously considering (and that I hope to write more about soon) is transcranial magnetic stimulation (which is now covered by health insurance, which wasn’t true the last time I looked into it!).


Also, I think I’m going to try to find a new pharmacy.


Though this has been really alarming, there’s also something exciting about all of this. First of all, knowledge is power. I feel like I should have been paying more attention all along to what I’m doing to my body in the name of treatment—and it’s encouraging to realize there is so much information out there to start doing better. It’s exciting to be learning more, to be seeing there are still options and possibilities. Those are actually some of the same reasons I love doing this blog, too. It gives me a reason to learn more and try more.


I’m looking forward to more learning and trying. And I’m looking forward to telling you what I find out.

Anticholinergic Medications


The following list comes from the article “Anticholinergic cognitive burden scale” from Dr. Malaz Boustani and colleagues. They’re listed by their generic name, with common brand names in parenthesis.


The authors divide these medications into three categories with a score of 1, 2, or 3, with three having the largest cognitive burden. They write the medications with a score of 1 have “no evidence of clinically relevant cognitive effects” (which is why I’ve included little information about these meds). They also explain a prescriber should add up the score of the medications a patient is taking, and if this equals a score of 3 or higher, they should consider how they might make changes to lower the score. (I hope it’s okay that I’ve put their list here–someone please tell me if I’m breaking copyright law.)


I’ve added to the list info from some quick googling, because I wanted a list that told me what the meds do, not just their names. Again, though, the disclaimer: I’m not an expert, and this isn’t a comprehensive source. You should not be basing medical decisions on this article. Do that with consulting with real professionals.


Score 3

  1. Amitriptyline (Elavil): A tricyclic antidepressant used to treat depression, insomnia, and nerve pain

  2. Amoxapine (Asendin): A tetracyclic antidepressant used to treat depression and nerve pain

  3. Benztropine (Cogentin): Blocks acetylcholine; reduces muscle stiffness and sweating, helps with walking in patients with Parkinson’s disease

  4. Carbinoxamine (Clistin, RyVent, Karbinal): An antihistamine, helps with allergic reactions

  5. Chlorpheniramine (an ingredient in many cough and cold medicines): An antihistamine, helps with allergies, hay fever, colds. Dries nasal mucosa. Doesn’t cause as much drowsiness as other antihistamines.

  6. Clemastine (Tavist, Dayhist): An antihistamine, can treat hay fever and allergy symptoms

  7. Clomipramine (Anafranil): A tricyclic antidepressant used to treat OCD, panic disorder, depression, and chronic pain

  8. Clozapine (Clozaril, Versacloz, FazaClo): An antipsychotic, used to treat schizophrenia and to reduce the risk of suicidal behavior

  9. Darifenacin (Enablex): A muscle relaxant and anti-spasmodic, used to treat overactive bladder

  10. Desipramine (Norpramine, Pertofrane): A tricyclic used to treat adult ADD/ADHD, trichotillomania, depression, and nerve pain

  11. Dicyclomine (Bentyl): A muscle relaxant and anti-spasmodic, used to treat IBS and cramping

  12. Dimenhydrinate (Dramamine, Gravol): Used to treat motion-sickness and nausea

  13. Diphenhydramine (an ingredient in many cough and cold medicines, Benadryl, Nytol, Banophen): An antihistamine. Topically, it can treat itching from insect bites, minor wounds, poison ivy, poison oak, and poison sumac. Orally, can treat allergies, hay fever, cold symptoms, and insomnia. When injected, can treat motion sickness and symptoms of Parkinson’s disease.

  14. Doxepin (Sinequan, Zonalon, Silenor, Prudoxin): A tricyclic; can treat nerve pain; can help with sleep, anxiety, and depression

  15. Flavoxate (Urispas): A muscle relaxant, can treat bladder spasms and painful urination, and help with frequent urination

  16. Hydroxyzine (Atarax, Vistaril): An antihistamine, treats nausea, vomiting, allergies, rash, hives, and itching

  17. Imipramine (Janimine, Tofranil): A tricyclic, can treat nerve pain, depression, and bed-wetting

  18. Meclizine (Antivert): An antihistamine, can treat motion sickness, nausea, vomiting, vertigo

  19. Nortriptyline (Pamelor): Tricyclic, treats depression, peripheral neuropathy, TMJ pain

  20. Olanzapine (Zyprexa): An antipsychotic. Can treat schizophrenia, psychosis, bipolar disorder

  21. Orphenadrine (Disipal, Norflex): A muscle relaxant, can help relieve pain from sprains and other injuries

  22. Oxybutynin (Ditropan, Oxytrol): A muscle relaxant and anti-spasmodic, treats overactive bladder

  23. Paroxetine (Paxil, Brisdelle): A SSRI antidepressant, can treat depression, social anxiety, OCD, PTSD, PMS, and post-partum depression

  24. Perphenazine (Trilafon): An antipsychotic, can treat schizophrenia, nausea, vomiting, Tourette’s syndrome

  25. Procyclidine (Kemadrin): Treats Parkinson’s disease, as well as involuntary movements caused by other medications (drug-induced parkinsonism, akathisia, dystonia)

  26. Promethazine (Phenergan, Zipan, Phenadoz, Promethegan): An antihistamine, can treat allergies and motion sickness, helps control pain, nausea, and vomiting, and is used as a sedative before and after medical procedures and surgeries

  27. Quetiapine (Seroquel): An antipsychotic, treats psychosis, schizophrenia, bipolar disorder, and aggressiveness in dementia

  28. Scopolamine (Hyoscine): Treats motion sickness and nausea, reduces saliva secretions

  29. Tolterodine (Detrol): A bladder relaxant, reduces bladder spasms

  30. Trifluoperazine (Stelazine): An antipsychotic, treats psychotic disorders, anxiety, and nausea and vomiting from chemotherapy

  31. Trihexyphenidryl (Artane, Tremin): Treats Parkinson’s symptoms including tremor and slurred speech; relaxes muscle and nerve impulses

  32. Trimipramine (Surmontil): A tricyclic antidepressant, treats depression, nerve pain, insomnia, anxiety. A weak antipsychotic.

Score 2

  1. Amantadine (Symadine): An antiviral, treats and prevents flu symptoms, treats Parkinson’s and Parkinson-like symptoms

  2. Belladone alkaloids: Treats IBS, intestinal ulcers

  3. Carbamazepine (Carbatrol, Tenl, Tegretol, Equetero, Eqitol): An anticonvulsant, treats seizures, nerve pain, and bipolar disorder

  4. Cyclobenzaprine (Amrix, Fexmid): A muscle relaxant, can treat pain and stiffness associated with muscle spasms

  5. Cyproheptadine (Periactin): An antihistamine, treats hives, itching, runny nose and eyes

  6. Loxapine (Adasuve, Loxitane): An antipsychotic, treats schizophrenia

  7. Meperidine (Demerol): A narcotic, treats pain. A controlled substance.

  8. Methotrimeprazine/levomepromazine (Levoprome, Nozinan, Detenler, Hirnamin, Neurocil): Treats pain and nausea, is a low-potency antipsychotic, often used in palliative care

  9. Molindone (Moban): An antipsychotic, treats psychosis and schizophrenia

  10. Oxcarbazepine (Trileptal): An anticonvulsant, treats epileptic seizures

  11. Pimozide (Orap): An antipsychotic, used to treat tics associated with Tourette syndrome

Score 1

  1. Alprazolam (Xanax): A benzodiazepine

  2. Atenolol (Tenormin): A beta blocker

  3. Brompheniramine maleat (Veltane): An antihistamine

  4. Bupropion hydrochloride (Wellbutrin, Zyban): An atypical antidepressant

  5. Captopril (Capoten): An ACE inhibitor

  6. Chlorthalidone (Thalitone): A diuretic and antihypertensive

  7. Cimetidine hydrochloride (Tagamet): Treats stomach ulcers and acid reflux

  8. Clorazepate (Tranxene): A benzodiazepine

  9. Codeine: A narcotic

  10. Colchicine (Colcrys): An anti-inflammatory

  11. Diazepam (Valium): A benzodiazepine

  12. Digoxin (Lanoxin): Treats high blood pressure, heart failure, and heart rhythm problems

  13. Dipyridamole (Persantine): A vasodilator and blood thinner

  14. Disopyramide phosphate (Norpace): An anti-arrhythmic

  15. Fentanyl: An opiate

  16. Isosorbide (Ismotic): Treats chest pain, heart failure, and esophageal spasms

  17. Loperamide (Imodium): Treats diarrhea

  18. Metoprolol (Lopressor, Toprol-X): A beta blocker

  19. Nifedipine (Adalat, Procardia): A calcium channel blocker, treats high blood pressure

  20. Prednisone: A corticosteroid

  21. Qulnidine (Duraquin, Quinora): An antiarrhythmic, also treats malaria

  22. Risperidone (Risperdal): An antipsychotic

  23. Theophylline: Opens the airways of the lungs

  24. Trazodone (Desyrel, Trilodine): An SSRI antidepressant and sedative

  25. Triamterene (Dyrenium): A water pill diuretic


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