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Potentially Inappropriate Medications in Older Adults: Independent of Diagnoses or Conditions
2002 Beers Criteria — Medications with Severity Rating of “High”
Common Brand Name (generic name)
These drugs have potential for causing dependence, hypertension, angina and
myocardial infarction. In addition, Amphetamines have CNS stimulant adverse effects.
Potential for prostatic hypertrophy and cardiac problems.
Associated with QT interval problems and risk of provoking torsades de pointes. Lack
Of all antiarrhythmic drugs, this is the most potent negative inotrope and therefore
may induce heart failure in elderly patients. It is also strongly anticholinergic. Other
antiarrhythmic drugs should be used.
Long half-life of drug and risk of producing excessive CNS stimulation, sleep
disturbances, and increasing agitation. Safer alternatives exist.
Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the
antidepressant of choice for elderly patients.
These drugs have a long half-life in elderly patients (often several days), producing
prolonged sedation and increasing the risk of falls and fractures. Short and
intermediate acting benzodiazepines at appropriate lower dosages are preferred if a
Because of its strong anticholinergic and sedating properties, doxepin is rarely the
antidepressant of choice for elderly patients.
It has a prolonged half life in elderly patients and could cause prolonged
hypoglycemia. Additionally, it is the only oral hypoglycemic agent that causes SIADH.
One of the least effective antiemetic drugs, yet it can cause extrapyramidal adverse effects.
All nonprescription and many prescription antihistamines may have potent
Adalat/Procardia (nifedipine – short acting)
anticholinergic properties. Nonanticholinergic antihistamines are preferred in
elderly patients when treating allergic reactions. Benadryl:
May cause confusion and
sedation. Should not be used as a hypnotic and when used to treat emergency allergic
reactions, it should be used in the smallest possible dose.
Potential for hypotension and constipation.
May cause bradycardia and exacerbate depression in elderly patients.
Potential for renal impairment. Safer alternatives available.
Has been shown to be no better than aspirin in preventing clotting and may be
considerably more toxic. Safer more effective alternatives exist.
Greater potential for CNS and extrapyramidal adverse effects.
CNS and extrapyramidal adverse effects.
This is a highly addictive and sedating anxiolytic. Those using meprobamate for
prolonged periods may become addicted and may need to be withdrawn slowly.
All barbiturates (except phenobarbital) are highly addictive and cause more adverse
effects than most sedative or hypnotic drugs in elderly patients (except when used to
GI antispasmodic drugs are highly anticholinergic and have uncertain effectiveness.
These drugs should be avoided (especially for long-term use).
Because of increased sensitivity to benzodiazepines in elderly patients, smaller doses
may be effective as well as safer. Total daily doses should rarely exceed the suggested
Long-term use of stimulant laxatives may exacerbate bowel dysfunction (except in the
Potential for aspiration and adverse effects. Safer alternatives available.
Donnatal and others (belladona alkaloids)
Causes more sedation and anticholinergic adverse effects than safer alternatives.
Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly
patients, since these cause anticholinergic adverse effects, sedation, and weakness.
Additionally, their effectiveness at doses tolerated by the elderly patient is
Narcotic analgesic that causes more CNS adverse effects, including confusion and
hallucinations, more commonly than other narcotic drugs. Additionally it is a mixed
Ditropan (oxybutynin – regular release)
Not an effective oral analgesic in doses commonly used. May cause confusion and has
many disadvantages to other narcotic drugs.
Long-term use of full-dosage, longer half life, non-cox selective NSAIDs have the
potential to produce GI bleeding, renal failure, high blood pressure and heart failure.
Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most
Immediate and long-term use should be avoided in older persons, since a significant
number have asymptomatic GI pathologic conditions.
Concerns about cardiac effects. Safer alternatives available.
Adapted from Fick DM et al.,Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, Archives of Internal Medicine,
December 8/22, 2003, 163:2716-2724
Indocin and Indocin SR (indomethacin)
^ See the Reference Key for specific concerns Identified as one of the top 25 potentially inappropriate medications prescribed in Greater Genesee County as identified by
Please note that this list does not attempt to identify all potentially inappropriate medications, nor are these medications inappropriate in every older adult. The prescribing physician must determine the appropriateness of the medications chosen for patients.
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