Learn More: Alternatives for Medications Listed in the AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

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Recently, the American Geriatrics Society (AGS) released the 2023 AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. For more than 20 years, the Beers Criteria® have been a valuable resource for healthcare providers about the safety of prescribing drugs for older people.

Your healthcare provider may choose to substitute alternatives in place of potentially inappropriate medications included in the AGS Beers Criteria®. Some of these alternatives are listed below and focuses on medications that are tracked in various quality measures, which are used by U.S. health plans to measure performance on important aspects of care.

Key Points

  • Never stop taking a medication without first talking to your healthcare provider, even if a medication you’re taking is listed on the AGS Beers Criteria®.
  • Know about the medications you are taking. Ask your clinician or pharmacist about the medications you are taking and their potential side effects. If you’re experiencing any symptoms, ask if they could be related to a medication you are taking or if it may be a sign of another problem. Use only trusted, reliable sources (such as MedlinePlus) to look up information.
  • Review your medications regularly. You should regularly review all of the medications you are taking with your clinicians and pharmacists. You should report any problems with your medications, including any side effects, questions you may have about them, or any problems with taking them as prescribed (such as cost). These reviews should occur at least once a year as well as any time a new medication is prescribed.
REMEMBER: Potentially inappropriate medications are just that — potentially inappropriate. The AGS Beers Criteria® and the list of alternatives are resources, not a replacement, for the expertise and knowledge of your healthcare provider. The AGS Health in Aging Foundation has developed this resource to help you talk to your healthcare provider about these possible alternatives to Beers Criteria® medications you’re taking.
For more information on potentially inappropriate medication use, please read the Ten Medications Older Adults Should Avoid or Use with Caution tip sheet.
Medication Class/Examples Possible Alternatives to Discuss with your Healthcare Provider
NOTE: This is only a partial list of medications. Medications listed in parentheses are examples of brand names of the generic medications listed.
First Generation Antihistamines 
(used for allergies)
  • chlorpheniramine (AllerChlor)
  • diphenhydramine (Benadryl)
  •  saline nasal rinse
  • steroid nasal sprays such as fluticasone (Flonase)
  •  Allergy products such as:
      - cetirizine (Zyrtec)
      - fexofenadine (Allegra)
      - loratadine (Claritin)
Tricyclic Antidepressants 
used for depression
  • amitriptyline (Elavil)
  • imipramine (Tofranil)
  •  selective serotonin reuptake inhibitors (SSRIs) such as:
      - citalopram (Celexa)
      - sertraline (Zoloft)
  • buproprion (historically known as Wellbutrin)
 Barbiturates
  • phenobarbital
  • other drugs ending in “barbital”
 For epilepsy, anticonvulsants such as:
  • lamotrigine (Lamictal)
  • levetiracetam (Keppra)
Sleeping Aids
  • zolpidem (Ambien)
  • zaleplon (Sonata)
  • eszopiclone (Lunesta)
 Ask your healthcare provider about other strategies to improve your sleep (without medications).
Pain Medication (NSAIDs)

People with chronic kidney disease or chronic renal failure should avoid all non-aspirin, nonsteroidal anti-inflammatory medications (NSAIDs).

  These alternatives listed are for moderate pain:
  • acetaminophen (Tylenol)
  • topical capsaicin products
  • lidocaine patches
  • serotonin–norepinephrine reuptake inhibitors (SNRIs) such as:
      - duloxetine (Cymbalta)
      - venlafaxine (Effexor) 
Benzodiazepines (often used to treat anxiety and sleep disorders as well as other conditions)

People with a history of falls should avoid benzodiazepines, such as:

  • alprazolam (Xanax)
  • lorazepam (Ativan)
  • diazepam (Valium)
  For moderate or severe anxiety:
  • selective serotonin reuptake inhibitors (SSRIs) such as:
     - citalopram (Celexa)
     - sertraline (Zoloft)

For sleep or anxiety:

  • Ask your healthcare provider about anxiety management techniques and other strategies to improve sleep.
 Hormone Therapy
  • Estrogen pills and patches
  For hot flashes and night sweats:
  • gabapentin (Neurontin)
  • serotonin–norepinephrine reuptake inhibitors (SNRIs)
  • selective serotonin reuptake inhibitors (SSRIs)

For vaginal dryness:

  • topical estrogen creams
Muscle Relaxants
  • cyclobenzaprine (Flexeril or Amrix or Fexmid)
  • methocarbamol (Robaxin)
  •  acetaminophen
  • NSAID pain medications such as ibuprofen or naproxen (Short-term use only. Be cautious about long-term use; avoid if you have heart failure of kidney disease.)
  • Stretching, heating and/or cooling, and physical therapy or therapeutic massage

 

 

 

Last updated May 2023

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