Ask Dr. Etingin: Anticholinergic drugs; Alcohol and antibiotics; Symptoms of pancreatic cancer

I’m 75, and I take a medication called Detrol to help control urinary incontinence. I’ve been told that this medication can cause risky side effects in older adults. Is this true?

The drug you take is in a class called anticholinergics. These drugs work by blocking a brain chemical called acetylcholine, which plays a role in a range of body functions, including muscle contraction in the urinary tract, lungs, digestive tract, and other areas of the body. Some side effects associated with these medications include drowsiness, blurred vision, dry mouth, constipation, memory lapses, and confusion.

Some clinical studies have found an association between long-term use of anticholinergics and an increased risk of dementia in older adults. The American Geriatrics Society categorizes anticholinergic drugs as “high risk” for seniors and advises choosing a different type of medication for elderly adults whenever possible.

Other anticholinergic drugs include oxybutynin (Ditropan, Oxytrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare), and trospium (Sanctura). Other conditions that are sometimes treated with anticholinergic drugs include asthma, chronic obstructive pulmonary disease (COPD), symptoms of Parkinson’s disease, and diarrhea.

It’s a good idea to discuss this medication with your physician and ask if there are other treatments that might work for you. Some women are able to decrease or stop urine leakage by using strategies such as avoiding caffeine, artificial sweeteners, alcohol, and other foods and beverages that can irritate the bladder, limiting fluid consumption, and exercising the pelvic floor muscles. You may want to see a urologist who specializes in the treatment of urinary incontinence in women and can provide you with information about all of the treatment options that may be appropriate for you.

Will antibiotics still work if I drink alcohol while I’m taking them?

You don’t say which antibiotic you’ve been prescribed, but alcohol may influence the effectiveness of many of these medications. In addition, drinking alcohol while taking antibiotics can increase the chance of certain side effects, such as nausea, vomiting, rapid heartbeat, excessive sweating, flushing, drowsiness, and dizziness. Also, some antibiotics speed up digestion, and they may cause alcohol to enter your bloodstream more quickly.

In general, it’s best to avoid alcohol while taking antibiotics of any type. Be sure to check the label on your prescription to see if it provides instructions about alcohol use. For some antibiotics, it’s best to avoid alcohol for three days after you’ve finished taking it. Also, remember that any time you have questions about whether alcohol will interfere or interact with a medication, consult your pharmacist. He or she can also tell you if a newly prescribed drug may interact with any other medications you may be taking.

What are the symptoms of pancreatic cancer, and how common is it?

Symptoms of pancreatic cancer may include pain in the upper abdomen that radiates to your back, fatigue, loss of appetite or unexplained weight loss, jaundice (yellowing of the skin and eyes), and blood clots. However, symptoms often don’t occur until the disease is advanced, so it is rarely detected in its early stages.

An estimated 56,000 Americans are diagnosed with pancreatic cancer annually. The estimated five-year survival rate for patients with all stages of pancreatic cancer is 9 percent. Pancreatic cancer has a higher mortality rate than many other types of cancer; each year, about 45,000 people die from it.

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