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Sedating antihistamine adverse effect — DGM MCQ

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ModeratePolypharmacySedating antihistamine adverse effectDGM

An 85-year-old man with dementia is reviewed after increased falls and daytime sleepiness. He was prescribed promethazine for itching at night. His medicines include donepezil, ramipril, atorvastatin, macrogol and promethazine. Which medication should be reviewed?

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Correct answer: C — Promethazine

Promethazine is sedating and anticholinergic, which can worsen cognition, urinary retention and falls in older adults. Donepezil can cause bradycardia, but the new sedating antihistamine is the clearest modifiable factor. First-generation antihistamines are common hidden contributors to geriatric syndromes.

Reference: BNF Prescribing in elderly; STOPP/START criteria v3