Key Points
Potentially inappropriate drugs in pts ≥65 yo known to have a specific condition or dz. Avoid use unless otherwise marked; for tx alternatives, refer to Beers Criteria: Medication Alternatives Dependent on Condition/Dz. C = caution advised, D = decrease dose.
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levetiracetam [D] may increase risk of CNS ADRs
gabapentin [D] may increase risk of CNS ADRs pregabalin [D] may increase risk of CNS ADRs
cimetidine [D] May increase risk of mental state change famotidine [D] May increase risk of mental state change nizatidine [D] May increase risk of mental state change ranitidine [D] May increase risk of mental state change
edoxaban [D] may increase risk of bleeding rivaroxaban [D] may increase risk of bleeding
amiloride may increase risk of hyponatremia, hyperkalemia apixaban may increase risk of bleeding colchicine [D] may increase risk of GI, neuromuscular, bone marrow toxicity dabigatran etexilate [C] may increase risk of bleeding duloxetine may increase risk of GI ADRs edoxaban may increase risk of bleeding enoxaparin [D] may increase risk of bleeding fondaparinux may increase risk of bleeding nitrofurantoin may increase risk of pulmonary toxicity, hepatoxicity, peripheral neuropathy NSAIDs (oral or parneteral) may increase risk of nephrotoxicity probenecid may decrease effectiveness rivaroxaban may increase risk of bleeding spironolactone may increase risk of hyperkalemia tramadol extended-release may increase risk of CNS ADRs tramadol immediate-release [D] may increase risk of CNS ADRs triamterene may increase risk of hyponatremia, hyperkalemia
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May induce/exacerbate delirium: - anticholinergics
- antipsychotics
- benzodiazepines
- chlorpromazine
- corticosteroids (oral or parenteral)
- H2 blockers
- meperidine
- sedative hypnotics
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Dementia and Cognitive Impairment
May increase risk of CNS ADRs - anticholinergics
- antipsychotics
- benzodiazepines
- H2 blockers
- Non-benzodiazepine hypnotics
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May produce ataxia, impaired psychomotor fxn, syncope, additional falls; avoid opioid use, excluding tx for recent fracture or joint replacement - anticonvulsants
- antipsychotics
- benzodiazepines
- hypnotics
- opioids
- SSRIs
- TCAs
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May exacerbate existing or produce new/additional ulcers: - aspirin (>325 mg/day)
- NSAIDs (excluding COX-2 inhibitors)
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May promote fluid retention, exacerbate heart failure: - calcium channel blockers
- non-dihydropyridine (reduced ejection fraction heart failure use)
- cilostazol
- dronedarone (severe or recently decompensated heart failure use)
- NSAIDs
- thiazolidinediones
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May exacerbate/cause SIADH - antipsychotics [C]
- carbamazepine [C]
- carboplatin [C]
- cisplatin [C]
- cyclophosphamide [C]
- diuretics [C]
- mirtazapine [C]
- oxcarbazepine [C]
- SNRIs [C]
- SSRIs [C]
- TCAs [C]
- vincristine [C]
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May induce CNS stimulant effects - decongestants (oral)
- methylxanthines
- stimulants
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May worsen Parkinson sx: - antipsychotics (except aripiprazole, clozapine, quetiapine)
- metoclopramide
- prochlorperazine
- promethazine
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May lower seizure threshold: - brupropion
- chlorpromazine
- clozapine
- maprotiline
- olanzapine
- thioridazine
- thiothixene
- tramadol
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May increase risk of orthostatic hypotension, bradycardia - alpha-1 blockers
- cholinesterase inhibitors
- chlorpromazine
- olanzapine
- tertiary TCAs
- thioridazine
- vasodilators [C]
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Urinary Incontinence, Women
May aggravate incontinence; may use vaginal estrogen - alpha-1 blockers
- estrogens (systemic)
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Urinary Tract Sx, Lower/BPH
May decrease urine flow leading to urinary retention - anticholinergics (except antimuscarinics)
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J Am Geriatr Soc. 2015;63:2227
Epocrates Guideline Synopsis Last Update:
Mar 7, 2019
Source:
AGS
- American Geriatrics Society
Beers Special Note
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[C]
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caution advised
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[D]
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decrease dose
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