Dangerous Medications For Seniors, Are Yours On The List?

Beers Criteria List

Every few years the American Geriatrics Society publishes a list of what they term to be "potentially inappropriate medication for use in older adults." It's called the Beers Criteria® and it's widely used by geriatricians, pharmacists, researchers and other health practitioners. Unfortunately it's not as widely known or used by consumers.

We think it's a fantastic reference guide for the general population. We don't recommend you use the information to override a prescription your doctor has made for you. Rather, we suggest it be used as a resource to ask your doctor why the decision was made and if the decision remains appropriate.

The Beers Criteria® includes 30 classes of medications to be avoided in older adults and 40 medications or medication classes that should be avoided or used with caution by certain older adults with certain ailments. It also covers medication combinations that should be avoided and medications that should be avoided for those with kidney issues. You can get the entire list here.

We're going to focus on some of the more widely prescribed medications that are found on the Beers Criteria® list, the concerns with those medications and some of the alternatives you can explore to give you the same benefits without the risk. Please remember, there are exceptions to every rule and there may be appropriate reasons to be taking some of the medications even if its recommended most people avoid them. This is meant as a guide to discuss your medication regimen with your doctor.

Class of Drugs Listed as InappropriateMedications Listed as InappropriateSample Brand NamesConcernAlternatives

Antihistamines (anti-allergy medication)

Brompheniramine
Carbinoxamine
Chlopheniramine
Clemastine
Cyproheptadine
Dexbrompheniramine
Dexchlorpheniramine
Dimenhydrinate
Diphenhydramine (oral)
Doxylamine
Hydroxyzine
Meclizine
Promethazine
Pyrilamine
Triprolidine

Benadryl

AllerChlor

Clearance reduced with advanced age, risk of confusion, dry mouth, constipation

Saline nasal rinse

Steroid nasal sprays such as fluticasone (Flonase)

Allergy products such as:
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratadine (Claritin)

Anti-anxiety
Sleeping aids
(Benzodiazepines)

Alprazolam
Estazolam
Lorazepam
Oxazepam
Temazepam
Triazolam
Chloradiazepoxide
Clonazepam
Clorazepate
Diazepam
Flurazepam
Quazepam

Xanax

Ativan

Valium

Risk of cognitive impairment, delirium, falls, fractures and motor vehicle crashes in older adults

For anxiety:

Buspar
Celexa
Zoloft

For sleep:
Ask your doctor about non-medication sleep hygiene techniques

Sleeping Aids

Eszopiclone
Zaleplon
Zolpidem

Ambien

Sonata

Lunesta

Risk of delirium, falls, fractures, increased emergency room visits, hospitalizations, motor vehicle crashesAsk your doctor about non-medication sleep hygiene techniques

Antipsychotics

First (conventional) generation
Second (atypical) generation
Increased risk of stroke, and greater rates of cognitive decline and mortality in people with dementia.

For delirium - antipsychotics (e.g., haloperidol, quetiapine), short term, restricted use.


For schizophrenia—nonanticholinergic agents may be acceptable (not chlorpromazine, loxapine, olanzapine, perphenazine, trifluoperazine, thioridazine).


For behavioral complications of dementianonanticholinergic agent (e.g., risperidone, quetiapine), short term, resitricted use.

Pain Medications (NSAIDs)Aspirin >325 mg/day
Diclofenac
Diflunisal
Etodolac
Fenoprofen
Ibuprofen
Ketoprofen

Meclofenamate
Mefenamic acid
Meloxicam
Nabumetone
Naproxen
Oxaprozin

Piroxicam
Sulindac
Tolmetin

Motrin

Advil

Aleve

Anaprox

DS

Naprosyn

Daypro

Feldene

Cambia

Cataflam

Voltaren

Zipsor

Zorvolex

Increased risk of gastrointestinal bleeding or peptic ulcer disease. Can also increase blood pressure and induce kidney injury. Risks can be associated with duration and dosage.

Tylenol

Topical capsaicin products

Lidocaine

Serotonin

AntidepressantsAmitriptyline
Amoxapine
Clomipramine
Desipramine
Dozepin<6mg/day
Imipramine
Nortriptyline
Paroxeline
Protriptyline
Trimipramine

Elavil

Tofranil

Highly anticholinergic, sedating and cause orthostatic hypotension

Celexa

Zoloft

Buproprion

Barbituates

Amobarbital
Butabarbital
Butalbital
Mephobarbital
Pentobarbital
Phenobarbital
Secobarbital

High rate of addiction, tolerance and greater risk of overdose at low dosages

Lamictal

Keppra

 

How To Use The Beers Criteria®

With over 90% of adults over the age of 65 taking at least one medication and 40% taking at least five medications, prescriptions and over the counter drugs are a common part of most seniors' lives. The Beers Criteria® list of potentially inappropriate medications for older adults is a great tool to make you a better informed patient. But it should never be used in isolation to make a decision on your own without first consulting your doctor. It's a starting point to begin a conversation with your doctors that ensures you get the best medical outcome with the least amount of risk.

It's important to remember that the Beers Criteria does not address all medication risks. It does not necessarily identify all inappropriate medications, over-prescribing, or the under use of certain helpful medications. It does not address medication adherence or medication compliance. Moreover, despite being inappropriate for most people, some medications may be the best alternative in some situations for some people. Lastly, the Beers Criteria list does not apply to seniors in hospice or palliative care.