Medications to Avoid in the Elderly

The American Geriatrics Society (AGS) just released their 2012 update to their Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (65+ years old).

Quick summary: Medications to Avoid in the Elderly

Drug	Rationale	Recommend	Quality of Evidence	Str of Rec
Nitrofurantoin	Pulmonary tox Alternatives Lack of efficacy <60 mL/min	Avoid long term suppression; avoid if CrCl <60 mL/min	Moderate	Strong
Antipsychotics (conventional or atypical)	Increase CVA and CV mortality in dementia	Avoid unless danger to self/others and non pharm has failed	Moderate	Strong
Insulin, sliding scale	Hypoglycemia risk	Avoid	Moderate	Strong
Chlorpropamide Glyburide	Hypoglycemia risk	Avoid	High	Strong
Benzodiazepines (Short and long acting)	Risk cognitive effects and injury (fall/MVA); rare use appropriate eg benzo withdrawal	Avoid for treatment of insomnia, agitation, or delirium	High	Strong
Megestrol	Minimal effect on weight; risk of thrombotic events and death	Avoid	Moderate	Strong
Metoclopramide	EPS and TD	Avoid, unless gastroparesis	Moderate	Strong
Non-COX NSAIDs, oral	GI bleeding; Protection w/ PPIs or misoprostol	Avoid chronic use	Moderate	Strong
Non-BZD Hypnotics      (“z” drugs like ambient, soma, sonata)	Risk cognitive effects and injury (fall/MVA); same ADE as benzo’s	Avoid chronic use, >90 days	Moderate	Strong
Estrogens with or w/o progestin	Carcinogenic potential, lack of efficacy in dementia/CV dz prevention	Avoid oral and topical patch. Topical cream safe and effective for vaginal symptoms	High	Strong
Muscle Relaxants	Ineffective at tolerated doses, antichol, falls	Avoid	Moderate	Strong

Full List - Worth Reviewing