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Potentially Inappropriate Medication Use in Older Adults Due to Drug-disease or Drug-syndrome Interactions
Latest Research
| Disease or Syndrome | Drug(s) | Rationale | Recommendations |
| Heart failure |
|
These drugs may increase the chance of fluid retention, and contribute to heart failure. | Avoid |
| Syncope or fainting | Acetylcholinesterase inhibitors
|
These drugs increase the chance of dizziness, fainting, and falling, and may cause a slowed heartbeat. | Avoid |
| Chronic seizures or epilepsy | Bupropion Chlorpromazine Clozapine Maprotiline Olanzapine Thioridazine Thiothixene Tramadol |
These medications may increase the frequency of seizures in some older adults. But they may be acceptable in older patients with well-controlled seizures and for whom other drugs have not been effective. | Avoid unless seizures are well controlled and other drugs do not work. |
| Delirium | All Tricyclic Antidepressants (TCAs) All Anticholinergic drugs Benzodiazepines Chlorpromazine Corticosteroids H2-receptor antagonist Meperidine Sedative hypnotics Thioridazine |
These medications can cause or worsen delirium in older people. Avoid these drugs in older adults with or at high risk of delirium. | Avoid |
| Dementia and cognitive/mental impairment | Anticholinergic drugs Benzodiazepines H2-receptor antagonists Zolpidem Antipsychotics-used regularly or as needed |
Avoid these drugs in adults with cognitive or "thinking" problems because these medications may make this worse. Antipsychotic drugs should not be prescribed for behavioral problems related to dementia unless non-drug or safer drug options are not working and a patient is a threat to himself or others. Antipsychotic drugs may increase the chance of stroke and death in people with dementia. | Avoid |
| A history of falls or fractures | Anticonvulsants Antipsychotics Benzodiazepines Nonbenzodiazepine hypnotics
|
These drugs can cause fainting and falls, and make it hard to coordinate movements. | Avoid unless safer medications are not available. Avoid anticonvulsant drugs in someone with a history of falls/fractures unless it is for seizures. |
| Insomnia | Oral decongestants
|
These drugs make insomnia worse. | Avoid |
| Parkinson's disease | All antipsychotics except quetiapine and clozapine Antiemetics
|
These drugs may worsen symptoms of Parkinson's disease and/or cause Parkinson's-like symptoms Quetiapine and clozapine appear to be less likely to worsen symptoms of Parkinson's disease than the other drugs listed here. | Avoid |
| Chronic constipation | Oral medications for urinary incontinence
|
The medications can worsen constipation and safer medications are available. | Avoid unless no other alternatives are available. |
| Repeated stomach or intestinal ulcersc | Aspirin at doses higher than 325 milligrams per day Non-COX-2 selective NSAIDs |
These drugs may make ulcers worse and increase the chance of new ulcers. | Avoid these drugs unless other medications are not effective and the patient can take an accompanying medication that can help prevent ulcers-such as a proton-pump inhibitor or misoprostol. |
| Poor kidney function | Nonsteroidal anti-inflammatory drugs Triamterene (alone or in combination with other medications) | These drugs may increase risks of potentially serious kidney damage. | Avoid |
| Urinary incontinence (accidental loss of urine) in women | Estrogen in pill or patch form (but not estrogen cream inserted into the vagina) | Estrogen in pill or patch form can make urinary incontinence worse in women. | Avoid in women. |
| Prostate enlargement or urinary problems in men | Ipratropium inhaler Tiotropium inhaler |
These medications may cause aggravated prostate problems and make urination more difficult. | Avoid in men. |
| Stress or mixed urinary incontinence (loss of urine when sneezing/coughing/bending over/with exercise) | Alpha-blockers
|
These may make bladder-control problems worse | Avoid in women. |