High Risk Medications for Patients Aged 65 & Older
Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.
Did you know that our bodies begin to respond differently to medications as we get older?
As we age, various changes occur throughout the body. For example, the liver or kidneys may not clear a medication from our system as efficiently as it once did. Likewise, receptors in the body may become more sensitive to certain drugs. These changes have the potential to make us more susceptible to serious and unwanted effects, such as: confusion, depression, falling, and other health consequences. A group of medical experts developed a list of drugs potentially inappropriate for patients aged 65 or older. This list is called the Beer’s Criteria. Some of the drugs are shown below, along with concerns and possible alternatives to these drugs.
Because the risks associated with these medications may outweigh the benefits, talk with your physician about some of the possible alternatives. However, do not stop taking them without first consulting with your doctor.
| Generic (Brand) Name | Concerns | Possible Alternatives |
| Propoxyphene (Darvocet, Darvon)
| Combination no better than acetaminophen (Tylenol) alone, less effective than ibuprofen (e.g. Motrin, Advil), and may cause narcotic adverse effects. FDA revised labeling includes: Black Box warning concerning risk of overdose, a warning of severe adverse reactions, occurring with concomitant use with CNS depressants (including alcohol), and precautions concerning additional susceptibility of this age group to CNS effects. | Mild Pain: acetaminophen (Tylenol), ibuprofen (e.g. Motrin, Advil) Moderate or servere pain: hydrocodone/acetaminophen, oxycodone/acetaminophen, oxycodone, fentanyl patch Note: Sudden discontinuation of chronic therapy can result in withdrawal symptoms. Gradual tapering is recommended. |
| Cyclobenzaprine (Flexeril) | Questionable efficacy at doses tolerated by this age group and efficacy past 2-3 weeks is not proven. Can cause sedation, weakness, confusion, drug mouth, urine retention and may increase the risk of falls in this age group. | Spasticity: baclofen (Lioresal), tizanidine (Zanaflex) |
| Hydroxyzine (Atarax, Vistaril) | Can cause sedation, confusion, dry mouth, urinary retention and may increase the risk of falls in this age group. | Allergic conditions: fexofenadine (Allegra), cetirizine (Zyrtec), loratidine (Claritin), desloratadine (Clarinex), azelastine (Astelin) Anxiety: citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor), buspirone (Buspar) |
| Promethazine (Phenergan) | Can cause sedation, confusion, dry mouth, urinary retention and may increase the risk of falls in this age group. | Allergic conditions: fexofenadine (Allegra), cetirizine (Zyrtec), loratidine (Claritin), desloratadine (Clarinex), azelastine (Astelin) Nausea: ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet) |
| Oral Estrogens (Premarin, Prempro) | Carcinogenic potential (breast, endometrial cancer), not cardioprotective in this age group. May increase the incidence of dementia in this age group. | Hot flashes: paroxetine (Paxil), gabapentin (Neurontin), venlafaxine (Effexor) Bone density: calcium, Vitamin D, alendronate (Fosamax), raloxifene (Evista) |
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