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Potentially Inappropriate Medication Use in Older Adults
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| Drugs and Categories of Drugs | Why these drugs may be inappropriate for older adults |
Recommendations |
| Anticholinergic drugs-these drugs can cause side effects such as confusion, hallucinations, sleepiness, blurred vision, difficulty urinating, dry mouth and constipation in older adults. | ||
Antihistamines-drugs that are typically prescribed for allergies, hives and eczema:
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These drugs cause many side effects in older adults, including confusion, drowsiness, blurred vision, difficulty urinating, dry mouth and constipation. Safer medications are available. | Avoid Use of diphenhydramine in special situations-such as for treating severe allergic reactions-may be appropriate. |
Antiparkinsonian drugs prescribed for Parkinson's disease and other health problems:
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There are other medications that are usually more effective for Parkinson's disease and related disorders than these. The drugs should not be used for other conditions, like treating side effects of other medications (for example the movement side effects of antipsychotic medications). | Avoid |
Antispasmodic medications prescribed trelieve cramps or spasms:
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It's is not clear whether these drugs are effective, but they have side effects. | Avoid except if used in short-term "comfort care." |
| Antithrombotics-these are medications tprevent or dissolve blood clots that can form inside blood vessels. These blood clots can be life-threatening. | ||
| The short-acting form of Dipyridamole that is taken by mouth | This form may make your blood pressure drop when you stand up. This can make you dizzy and may lead tdangerous falls. More effective alternatives are available. The form of dipyridamole that is injected, however, can be used during a heart "stress test." | Avoid |
| Ticlopidine | Safer, effective alternatives tthis drug are available. | Avoid |
| Anti-infective drugs-such as antibiotics and antiviral drugs. | ||
| Nitrofurantoin, an antibacterial drug prescribed for urinary tract infections | This drug may cause side effects that affect the lungs. Safer medications are available. | Avoid long-term use and in patients with certain kidney problems. |
| Cardiovascular drugs-for disorders that affect the heart and blood vessels. | ||
Alpha1 blockers-drugs for the prostate but alsprescribed for high blood pressure.
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These drugs can cause a drop in blood pressure and dizziness when you stand up. This can lead tfalls. Alternative treatments provide better results with lower risks. | Avoid using for high blood pressure. |
Medications, called Alpha agonists, which are prescribed for high blood pressure.
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These drugs may cause a slow heartbeat and dizziness. They are not recommended for routine treatment of high blood pressure. | Clonidine should not be a first-choice treatment for high blood pressure. The other drugs on the list should be avoided. |
Antiarrhythmic drugs prescribed for atrial fibrillation (irregular heart beat). (Class Ia, Ic, III)
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Other treatments may provide better results, or cause fewer side effects, or both. Amiodarone may contribute tthyroid, lung and heart problems. | These drugs should not be the first choice for treating atrial fibrillation. |
| Disopyramide | Disopyramide may increase risks of heart failure in older adults and may cause confusion, blurred vision, difficulty urinating, dry mouth and constipation. Safer medications are available. | Avoid |
| Dronedarone | There are other drugs that provide better results in patients with atrial fibrillation (irregular heartbeat) or heart failure. | Avoid in some patients with atrial fibrillation or heart failure. |
| Digoxin at doses higher than 0.125 milligrams per day | In older patients with heart failure, higher doses appear toffer nadditional benefit and may increase risks of dangerous side effects. Older patients with kidney problems are at particular risk of side effects. | Avoid |
| Nifedipine, immediate release | This drug may lower blood pressure and could cause other heart problems. | Avoid |
| Spironolactone at doses higher than 25 milligrams daily | In people with heart failure, higher doses may boost risks of high potassium. | Avoid higher doses in patients with heart failure or lower kidney function. |
| Drugs affecting the brain and spinal cord | ||
Tertiary Tricyclic Antidepressants, alone or in combination:
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Potential side effects include: confusion, drowsiness, blurred vision, difficulty urinating, dry mouth and constipation in older adults. They can alscause a drop in blood pressure and dizziness when you stand up. Safer medications are available. | Avoid |
| All antipsychotic drugs | These drugs may increase risks of confusion, sleepiness, blurred vision, difficulty urinating, dry mouth, constipation, stroke, and death in people with dementia. | Avoid using these drugs ttreat behavioral problems in older people with memory disorders unless non-drug options haven't worked and the patient is a threat thimself or herself or others. |
| Thioridazine Mesoridazine |
These drugs may cause confusion, sleepiness, blurred vision, difficulty urinating, dry mouth and constipation. They may alsincrease risks of dangerous changes in heartbeat. | Avoid |
Barbiturates
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These medications can be addictive. Over time, they get less effective in helping older adults sleep. They are more likely tcause overdoses at lower doses than alternative drugs. | Avoid |
| Benzodiazepines Short- and intermediate-acting:
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Older adults are especially sensitive tthese medications. These drugs may increase risks of mental decline, delirium, falls, fractures, and car accidents in older adults. Despite these risks, they may be appropriate, in certain cases, for treating seizures, certain sleep disorders, anxiety disorders, withdrawal from benzodiazepine drugs and alcohol, and end-of-life care. | Avoid benzodiazepines (all types) when treating insomnia, agitation, or delirium (serious confusion that may have lasting effects). |
| Chloral hydrate | Not effective long-term, with high risk of overdose. | Avoid |
| Meprobamate | This medication makes older adults sleepy and can be addictive. | Avoid |
Nonbenzodiazepine hypnotics
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These medications may not significantly improve sleep and can cause many serious side effects, including confusion, falls, and bone fractures. | Avoid ongoing use of these drugs (over 90 days). |
| Ergot mesylates Isoxsuprine | These medications are not very effective. | Avoid |
| Drugs and treatments for conditions affecting the glands that produce and secrete hormones, such as androgens ("male hormones") and estrogen and progestins ("female hormones") | ||
Androgens
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These drugs may worsen heart problems and cause other side effects. They shouldn't be prescribed for men with prostate cancer. | Avoid using in men with prostate cancer. In other men, prescribe only for moderate to severe declines in natural testosterone production. |
| Desiccated thyroid | Desiccated thyroid may not be appropriate for patients with a history of heart problems. Safer medications are available. | Avoid |
| Estrogens with or without progestins | These hormones may increase risks of breast cancer and cancer of the lining of the uterus. They don't appear to help protect women from heart disease or loss of cognitive (thinking) ability in later life. Estrogen cream inserted into the vagina does help vaginal dryness and is safe in women with breast cancer, especially if low doses are used. | Avoid pills and skin patches. Vaginal creams can be used at low doses to relieve pain during sex, and help prevent urinary tract infections, and related vaginal problems. |
| Growth hormone | Growth hormone has many side effects, including joint pain, swelling, enlargement of breast tissue in men, and carpal tunnel syndrome. It may also increase the chance of getting diabetes. | Avoid, except in patients who have had their pituitary gland removed for medical reasons. |
| Insulin, sliding scale | This way of dosing insulin is not very effective and can increase the chance of low blood sugar. | Avoid |
| Megestrol | This drug, prescribed to increase appetite, is not very effective, and may increase the chance of blood clots and, possibly, death. | Avoid |
Sulfonylureas, long-duration
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Both medications can cause dangerous low blood sugar and other side effects in older adults. Safer medications are available. | Avoid |
| Medications for gastrointestinal problems | ||
| Metoclopramide | This medication may cause shakiness, sleepiness, and uncontrollable abnormal body movements. Frail older adults may be even more likely to get these effects. | Avoid, except for gastroparesis, a condition that reduces the ability of the stomach to empty its contents. |
| Mineral oil, taken by mouth | When swallowed, mineral oil may be accidentally inhaled and, as a result, can cause pneumonia. Safer medications are available. | Avoid |
| Trimethobenzamide | Not very effective for treating vomiting. This medication can cause side effects such as shakiness, sleepiness, and abnormal body movements. | Avoid |
| Pain Medications | ||
| Meperidine | This is not a very effective pain reliever and may seizures. Safer medications are available. | Avoid |