“Potentially inappropriate medication use is not a rare event in elderly patients and is associated with higher risk of hospitalization in this age group. In order to reduce the possibility of prescribing inappropriate medications, and therefore to reduce the consequent risk of hospitalization, more attention should be paid when prescribing drugs.”
Lin, His-Yen, Chi-Chow Liao, Shou-Hsia Cheng, Pa-Chen Wang, and Ya-Send Hsueh. "Association of Potentially Inappropriate Medication Use with Adverse Outcomes in Ambulatory Elderly Patients with Chronic Diseases," Drugs Aging 25(1) (2008): 49-59, p.50.
“Medicines that are potentially inappropriate in older people … either have no clear evidence-based indication, carry a substantially higher risk of adverse side-effects compared to younger people or are not cost-effective. Inappropriate prescribing in the elderly population is now considered a major public health issue, given its direct linkage to substantial morbidity, mortality and wastage of health resources that result from adverse drug reactions.”
O’Mahony, Denis, and Paul Francis Gallagher. “Commentary: Inappropriate Prescribing in the Older Population: Need for New Criteria,” Age and Ageing 37 (2008): 138-141.
There are many reasons why drugs are metabolized differently in the elderly. Less lean body mass, less body water, and decreasing function of the liver and kidney are a few of the reasons.
It’s probably a good idea to see if you or your family members 65 or older are on any of these medications, and then talk to your doctor to see why, and if you should stop taking them, or possibly change to a related but safer medication. Don’t do this on your own—be sure to let your doctor do this! (But your doctor will probably appreciate your bringing in this list so he can look over it; or he should appreciate you calling him if you find one of your drugs on this list.)
On the other hand, this is a “general” list, so if your doctor says you’re on the right medicine, then follow his advice. It often really has to do with the potentially stronger side effects that are seen in the elderly, versus the therapeutic benefits of the medicine itself.
Some of the side effects we’re trying to avoid are: sedation, confusion, hallucinations, weakness, over-sedation causing falls and fractures, heart failure, blood pressure drop upon standing (causing falls and fainting spells), slow heart beat, depression, impotence, hypoglycemia, constipation, high blood pressure, kidney failure, angina, heart attacks, sleep disturbances, agitation, and decrease in kidney function.
2002 Criteria for Potentially Inappropriate Medication Use in Older Adults
The following alphabetical list has been interpreted from “Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults,” by Donna M. Fick, James W. Cooper, William E. Wade, Jennifer L. Waller, Ross Maclean, and Mark H. Beer, Archives of Internal Medicine 163 (2003): 2716-2724.
- Adalat – See nifedipine.
- Aldomet – See methyldopa.
- Aldoril – See methyldopa.
- Aleve – See NSAIDs.
- Alprazolam – See benzodiazepines that are short-acting.
- Amiodarone (Cordarone) – Adverse outcomes of high severity.
- Amitriptyline (Elavil), chlordiazepoxide-amitriptyline (Limbitrol), and perphenazine-amitriptyline (Triavil) – Adverse outcomes of high severity.
- Amphetamines and anorexic agents (except for methylphenidate hydrochloride) – Adverse outcomes of high severity.
- Anaprox – See NSAIDs.
- Android – See methyltestosterone.
- Anorexic agents (drugs to decrease appetite) – Adverse outcomes of high severity.
- Anticholinergics and antihistamines: chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril and Atarax), cyproheptadine (Periactin), promethazine (Phenergan), tripelennamine, dexchlorpheniramine (Polaramine) – Adverse outcomes of high severity.
- Atarax – See anticholinergics and antihistamines.
- Ativan – See benzodiazepines that are short-acting.
- Barbituates – See barbiturates.
- Barbiturates (all except Phenobarbital) except when they are used to control seizures – Adverse outcomes of high severity.
- Belladonna alkaloids – See gastrointestinal antispasmodic drugs.
- Benadryl – See diphenhydramine; and see anticholinergics and antihistamines.
- Bentyl – See gastrointestinal antispasmodic drugs.
- Benzodiazepeines that are long-acting: chlordiazepoxide (Librium), chlordiazepoxide-amitriptyline (Limbitrol), clidinium-chlordiazepoxide (Librax), diazepam (Valium), quazepam (Doral), halazepam (Paxipam), and chlorazepate (Tranxene) – Adverse outcomes of high severity.
- Benzodiazepines that are short-acting: doses greater than lorazepam (Ativan), 3 mg; oxazepam (Serax), 60 mg; alprazolam (Xanax), 2 mg; temazepam (Restoril), 15 mg; and triazolam (Halcion), 0.25 mg. – Adverse outcomes of high severity.
- Bisacodyl – See laxatives.
- Cardura – See doxazosin.
- Carisoprodol – See muscle relaxants and antispasmodics.
- Cascara sagrada – See laxatives.
- Catapres – See clonidine.
- Chlor-Trimeton – See anticholinergics and antihistamines.
- Chlorazepate – See benzodiazepines that are long-acting.
- Chlordiazepoxide – See benzodiazepines that are long-acting.
- Chlordiazepoxide-amitriptyline (Limbitrol) – See amitriptyline; and see benzodiazepines that are long-acting.
- Chlorpheniramine – See anticholinergics and antihistamines.
- Chlorpropamide (Diabinese) – Adverse outcomes of high severity.
- Chlorzoxazone – See muscle relaxants and antispasmodics.
- Cimetidine (Tagamet) – Adverse outcomes of low severity.
- Clidinium-chlordiazepoxide – See benzodiazepines that are long-acting; and see gastrointestinal antispasmodic drugs.
- Clonidine (Catapres) – Adverse outcomes of low severity.
- Cordarone – See amiodarone.
- Cyclandelate (Cyclospasmol) – Adverse outcomes of low severity (drug has not proved useful); also see ergot mesyloids.
- Cyclobenzaprine – See muscle relaxants and antispasmodics.
- Cyclospasmol – See cyclandelate; also see ergot mesyloids.
- Cyproheptadine – See anticholinergics and antihistamines.
- Dalmane – See flurazepam.
- Darvocett-N – See propoxyphene.
- Darvon – See propoxyphene.
- Darvon with ASA – See propoxyphene.
- Darvon-N – See propoxyphene.
- Daypro – See NSAIDs.
- Demerol – See meperidine.
- Dexchlorpheniramine – See anticholinergics and antihistamines.
- Diabinese – See chlorpropamide.
- Diazepam – See benzodiazepines that are long-acting.
- Dicyclomine – See gastrointestinal antispasmodic drugs.
- Digoxin (Lanoxin) should not exceed >0.125 mg per day except when treating atrial arrhythmias. – Adverse outcomes of low severity.
- Diphenhydramine (Benadryl) – Adverse outcomes of high severity; and see anticholinergics and antihistamines.
- Dipyridamole that is short-acting (Persantine) (Do not consider the long-acting dipyridamole, which has better properties than the short-acting in older adults, except with artificial heart valves.) – Adverse outcomes of low severity.
- Disopyramide (Norpace and Norpace CR) – Adverse outcomes of high severity.
- Ditropan – See muscle relaxants and antispasmodics.
- Donnatal – See gastrointestinal antispasmodic drugs.
- Doral – See benzodiazepines that are long-acting.
- Doxazosin (Cardura) – Adverse outcomes of low severity.
- Doxepin (Sinequan) – Adverse outcomes of high severity.
- Dulcolax – See laxatives.
- Edecrin – See ethacrynic acid.
- Elavil – See amitriptyline.
- Equanil – See meprobamate.
- Ergot mesyloids (Hydergine) and cyclandelate (Cyclospasmol) – Adverse outcomes of low severity.
- Estrogens alone (in pill form) – Adverse outcomes of low severity.
- Ethacrynic acid (Edecrin) – Adverse outcomes of low severity.
- Feldene – See NSAIDs.
- Ferrous sulfate >325 mg per day – Adverse outcomes of low severity.
- Flexeril – See muscle relaxants and antispasmodics.
- Fluoxetine (Prozac) used daily – Adverse outcomes of high severity.
- Flurazepam (Dalmane) – Adverse outcomes of high severity.
- Gastrointestinal antispasmodic drugs: dicyclomine (Bentyl), hyoscyamine (Levsin and Levsinex), propantheline (Pro-Banthine), belladonna alkaloids (Donnatal and others), and clidinium-chlordiazepoxide (Librax) – Adverse outcomes of high severity.
- Guanadrel (Hylorel) – Adverse outcomes of high severity.
- Guanethidine (Ismelin) – Adverse outcomes of high severity.
- Halazapam – See benzodiazepines that are long-acting.
- Halcion – See benzodiazepines that are short-acting.
- Hydergine – See ergot mesyloids.
- Hydroxyzine – See anticholinergics and antihistamines.
- Hylorel – See guanadrel.
- Hyoscyamine – See gastrointestinal antispasmodic drugs.
- Indocin – See indomethacin.
- Indocin SR – See indomethacin.
- Indomethacin (Indocin and Indocin SR) - Adverse outcomes of high severity.
- Ismelin – See guanethidine.
- Isoxsuprine (Vasodilan) – Adverse outcomes of low severity (drug has not shown to be useful).
- Ketoralac (Toradol) – Adverse outcomes of high severity.
- Lanoxin – See digoxin.
- Laxatives – the long-term use of stimulant laxatives: bisacodyl (Dulcolax), cascara sagrada, and Neoloid except in the presence of opiate analgesic use. – Adverse outcomes of high severity.
- Levsin – See gastrointestinal antispasmodic drugs.
- Levsinex – See gastrointestinal antispasmodic drugs.
- Librax – See benzodiazepines that are long-acting; and see gastrointestinal antispasmodic drugs.
- Librium – See benzodiazepines that are long-acting.
- Limbitrol – See amitriptyline; and see benzodiazepines that are long-acting.
- Lorazepam – See benzodiazepines that are short-acting.
- Macrodantin – See nitrofurantoin.
- Mellaril – See thioridazine.
- Meperidine (Demerol) – Adverse outcomes of high severity.
- Meprobamate – Adverse outcomes of high severity.
- Mesoridazine (Serentil) – Adverse outcomes of high severity.
- Metaxalone – See muscle relaxants and antispasmodics.
- Methocarbamol – See muscle relaxants and antispasmodics.
- Methyldopa (Aldomet) and methyldopa-hydrochlorothiazide (Aldoril) – Adverse outcomes of high severity.
- Methyldopa-hydrochlorothiazide – See methyldopa.
- Methyltestosterone (Android, Virilon, and Testrad) – Adverse outcomes of high severity.
- Miltown – See meprobamate.
- Mineral oil – Adverse outcomes of high severity.
- Muscle relaxants and antispasmodics: methocarbamol (Robaxin), carisoprodol (Soma), chlorzoxazone (Paraflex), metaxalone (Skelaxin), cyclobenzaprine (Flexeril), and oxybutynin (Ditropan). Do not consider the extended-release Ditropan XL. – Adverse outcomes of high severity.
- Naprosyn – See NSAIDs.
- Naproxen – See NSAIDs.
- Neoloid – See laxatives.
- Nifedipine, in the short-acting form (short-acting forms of Procardia and Adalat) – Adverse outcomes of high severity.
- Nitrofurantoin (Macrodantin) – Adverse outcomes of high severity.
- Norflex – See orphenadrine.
- Norpace – See disopyramide.
- Norpace CR – See disopyramide.
- NSAIDs – the long-term use of full-dosage, longer half-life, non-COX-selective NSAIDs: naproxen (Naprosyn, Anaprox, and Aleve), oxaprozin (Daypro), and piroxicam (Feldene). – Adverse outcomes of high severity.
- Orphenadrine (Norflex) – Adverse outcomes of high severity.
- Oxaprozin – See NSAIDs.
- Oxazepam – See benzodiazepines that are short-acting.
- Oxybutynin – See muscle relaxants and antispasmodics.
- Paraflex – See muscle relaxants and antispasmodics.
- Paxipam – See benzodiazepines that are long-acting.
- Pentazocine (Talwin) - Adverse outcomes of high severity.
- Periactin – See anticholinergics and antihistamines.
- Perphenazine-amitriptyline (Triavil) – See amitriptyline.
- Persantine – See dipyridamole.
- Phenergan – See anticholinergics and antihistamines.
- Piroxicam – See NSAIDs.
- Polaramine – See anticholinergics and antihistamines.
- Pro-Banthine – See gastrointestinal antispasmodic drugs.
- Procardia – See nifedipine.
- Promethazine – See anticholinergics and antihistamines.
- Propantheline – See gastrointestinal antispasmodic drugs.
- Propoxyphene (Darvon) and combination products (Darvon with ASA, Darvon-N, and Darvocet-N) - Adverse outcomes of low severity.
- Prozac – See fluoxetine.
- Quazepam – See benzodiazepines that are long-acting.
- Reserpine at doses >0.25 mg. – Adverse outcomes of low severity.
- Restoril – See benzodiazepines that are short-acting.
- Robaxin – See muscle relaxants and antispasmodics.
- Serax – See benzodiazepines that are short-acting.
- Serentil – See mesoridazine.
- Sinequan – See doxepin.
- Skelaxin – See muscle relaxants and antispasmodics.
- Soma – See muscle relaxants and antispasmodics.
- Tagamet – See cimetidine.
- Talwin – See pentazocine
- Temazepam – See benzodiazepines that are short-acting.
- Testosterone – See methyltestosterone.
- Testrad – See methyltestosterone.
- Thioridazine (Mellaril) – Adverse outcomes of high severity.
- Thyroid, dessicated – Adverse outcomes of high severity.
- Ticlid – See ticlopidine.
- Ticlopidine (Ticlid) – Adverse outcomes of high severity.
- Tigan – See trimethobenzamide.
- Toradol – See ketorolac.
- Tranxene – See benzodiazepines that are long-acting.
- Triavil – See amitriptyline.
- Triazolam – See benzodiazepines that are short-acting.
- Trimethobenzamide (Tigan) – Adverse outcomes of high severity.
- Tripelennamine – See anticholinergics and antihistamines.
- Valium – See benzodiazepines that are long-acting.
- Vasodilan – See isoxsuprine.
- Virilon – See methyltestosterone.
- Vistaril – See anticholinergics and antihistamines.
- Xanax – See benzodiazepines that are short-acting.
