A quarter of a century ago, Dr. Mark Beers’ research team published the first list of drugs to avoid in elderly patients. The list was subsequently called the Beers Criteria.
| Drugs | Rationale and recommendations |
| Non-selective cyclooxygenase NSAIDs for oral use | Increased risk of gastrointestinal bleeding or peptic ulcer disease in high-risk groups. Use of a proton pump inhibitor or misoprostol reduces but does not eliminate the risk. Upper gastrointestinal ulcers, major bleeding or perforation caused by NSAIDs occur in about 1% of patients treated for 3-6 months and in about 2-4% of patients treated for 1 year. |
| Indomethacin | More often than other NSAIDs have adverse effects on the CNS. Of all NSAIDs indomethacin has the most adverse effects. |
| First-generation antihistamines | High anticholinergic potential. Development of tolerance, especially when used as a sleeping pill.Decreased clearance with age. Risk of confusion, dry mouth, constipation and other anticholinergic effects or toxicity. Use of diphenhydramine in acute severe allergic reactions is acceptable |
| Spasmolytics (atropine (except ophthalmic), belladonna alkaloids, scopolamine, etc.). | High anticholinergic potential.Uncertain efficacy. |
| Ticlopidine | More effective and safer alternatives are available. |
| Nitrofurantoin | Pulmonary toxicity, hepatotoxicity and peripheral neuropathy are possible, especially with prolonged use. Safer alternatives are available |
| Peripheral alpha-1 blockers (doxazosin, terazosin) | High risk of orthostatic hypotension. Not recommended as a routine treatment for hypertension. Alternative agents have a better risk-benefit profile |
| Central alpha-blockers (clonidine, guanfacine, methyldopa, reserpine (> 0.1 mg/day)) | High risk of adverse effects on the CNS. May cause bradycardia and orthostatic hypotension. Not recommended as a routine treatment for hypertension |
| Dronedaron | More severe outcomes have been reported in patients with persistent atrial fibrillation, severe or recently decompensated heart failure. |
| Digoxin | Use as first-line treatment for atrial fibrillation or heart failure may be associated with increased mortality.Higher doses are not associated with additional benefit and may increase the risk of toxicity.Decreased renal clearance of digoxin may result in an increased risk of toxic effects. |
| Amiodarone | Has greater toxicity than other antiarrhythmic drugs used in atrial fibrillation. |
| Skeletal muscle relaxants. | Most myorelaxants are poorly tolerated by the elderly, as they have anticholinergic side effects, sedation, and increase the risk of fractures. Efficacy at doses tolerated by the elderly is questionable. |
| Desmopressin | High risk of hyponatremia. There are safer alternative therapies available. |
| Proton pump inhibitors | Risk of Clostridium difficile infection and loss of bone mass and fractures.Avoid scheduled administration for >8 weeks. |
| Metoclopramide | May cause extrapyramidal effects, including tardive dyskinesia; risk may be higher in debilitated elderly. Avoid except in cases of gastroparesis. |
| Estrogens with or without progestins | Evidence of carcinogenic potential (breast and endometrial cancer). Lack of cardioprotective effects and cognitive protection in elderly women.Acceptable use of vaginal cream or tablets |
| Testosterone | Possible heart problems. Contraindicated in men with prostate cancer |
| Trihexyphenidyl | Better alternatives are available. |
| Isoxuprine | Lack of efficiency |
| Benzodiazepines | Elderly people have increased sensitivity to benzodiazepines and reduced metabolism of long-acting preparations. Increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in the elderly. May be appropriate for seizure disorders, rapid eye movement sleep disorders, benzodiazepines, ethanol withdrawal, severe generalized anxiety disorder. |
| Zaleplon | Benzodiazepine receptor agonists have side effects similar to those of benzodiazepines in the elderly. Minimal improvement in sleep latency and duration. |
| Barbiturates | High physical dependence. High risk of overdose. |
| First (conventional) and second (atypical) generation antipsychotics | Increased risk of impaired cerebral circulation (stroke) and higher rate of cognitive decline and mortality in people with dementia. Avoid except for schizophrenia, bipolar disorder or short-term use as an antiemetic during chemotherapy. |
| Antidepressants (amitriptyline, clomipramine, imipramine, paroxetine, doxepin> 6 mg/day) | High anticholinergic potential.Sedative effect, increased risk of orthostatic hypotension. |
0.0 out of 5 stars (based on 0 reviews)
