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Medications and the Elderly

Updated Beers List: Drugs to Avoid in Older Adults

Drug–drug interactions can have potentially life-threatening consequences in older adults, who often take several drugs at once for multiple diseases. Elderly patients are more susceptible to drug interactions than younger patients because of the physiologic changes associated with aging and the sheer number of drugs older patients are taking.

Drugs to avoid in patients =65 years:

Analgesic/anti-inflammatory

• Indomethacin (Indocin)
• Ketorolac  (Tordal)
• Long-term use of full-dose, longer half-life, non–COX-selective NSAIDs: naproxen, oxaprozin, and piroxicam
• Meperidine (Demoral)
• Pentazocine (Talwin)
• Propoxyphene and propoxyphene combination products (Darvon, Darvocet N-100)

Cardiovascular

• Amiodarone (Cordarone)
• Clonidine (Catapress)
• Digoxin (Lanoxin, Digatek, Digitalis)
• Disopyramide  (Norpace)
• Doxazosin  (Cardura)
• Guanadrel (Hylorel)
• Methyldopa and methyldopa-hydrochlorothiazide (Aldomet)
• Reserpine, >0.25 mg (Harmonyl)
• Short-acting dipyridamole (Persantine)
• Short-acting nifedipine (Adalat, Procardia)
• Ticlopidine (Ticlid)

Diabetic agents

• Chlorpropamide (Diabinese)

Gastrointestinal

• Cimetidine (Tagamet)
• Gastrointestinal antispasmodic drugs: dicyclomine (Bently), hyoscyamine (Levsin), propantheline Pro-Banthine), belladonna alkaloids, and clindinium-chlordiazepoxide
• Long–term use of stimulant laxatives: bisacodyl, cascara sagrada, Neoloid, except when used with opiate analgesic
• Mineral oil
• Trimethobenzamide (Tigan)

Muscle relaxants

• Ditropan XL
• Muscle relaxants, antispasmodics: methocarbamol (Robaxin), carisoprodol (Soma), chlorzoxazone (Parafon Forte), metaxalone (Skelaxin), cyclobenzaprine (Flexeril), oxybutynin (Ditropan XL)
• Orphenadrine (Norflex)

Psychotropics

• Amitriptyline, chlordiazepoxide-amitriptyline, perphenazine-amitriptyline (Elavil)
• Amphetamines, anorexic agents
• Barbiturates (except phenobarbital), except for seizures control
• Benzodiazepines (short-acting): doses >3 mg lorazepam (Ativan); >60 mg oxazepam (Serax); >2 mg alprazolam (Xanax); >15 mg temazepam (Restoril); >0.25 mg triazolam (Halcion)
• Benzodiazepines (long-acting): chlordiazepoxide (Librium), chlordiazepoxide-amitriptyline,
• clidinium-chlordiazepoxide (Librax), diazepam (Valium), quazepam (Doral, Dormalin), halazepam (Paxipam), chlorazepate (Tranxene)
• Doxepin (Sinequan)
• Ergot mesyloids, cyclandelate (Cyclospasmol)
• Fluoxetine, daily dose (Prozac)
• Flurazepam  (Dalmane)
• Guanethidine (Ismelin)
• Meprobamate  (Miltown)
• Mesoridazine  (Serentil)
• Thioridazine (Mellaril)

Respiratory

• Anticholinergics, antihistamines: chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril)
• cyproheptadine (Periactin), promethazine (Phenergan), tripelennamine (PBZ, PBZ-SR), dexchlorpheniramine (Polaramine)
• Diphenhydramine (Benadryl)