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Microsoft word - potentially inappropriate medications in the elderly 07_08.doc

Potentially Inappropriate Medications in the Elderly
Medications with Severity Rating of High1,2
Medication
Prescribing Concern2
Possible Alternatives
Amitriptyline (Elavil®)
• Has strong anticholinergic and sedating Consider an antidepressant agent with less sedation and Amitriptyline/ chlordiazepoxide
fewer anticholinergic effects (Pamelor® (g), Norpramin® (g), (Limbitrol®, Limbitrol DS®)
• Rarely the antidepressant of choice in elderly • Cause more side effects than most other Avoid use in the elderly, except when used to control Barbiturates (except phenobarbital)
sedative or hypnotic drugs in the elderly • These anti-anxiety agents have a long half-life in If a benzodiazepine is necessary, consider a smaller dose of Chlordiazepoxide (Librium®)
a short or intermediate-acting agent (Ativan® <3mg (g), Diazepam (Valium®)
• May cause prolonged sedation and increase the Serax® <60mg (g), Xanax® <2mg (g), Restoril® <15mg (g), • Has a prolonged half-life in the elderly • Can cause prolonged and serious hypoglycemia Consider a second generation sulfonylurea (Glucotrol® (g), Chlorpropamide (Diabinese®)
• May also cause syndrome of inappropriate secretion of antidiuretic hormone (SIADH) • Gastrointestinal antispasmodic agents are highly Dicyclomine (Bentyl®)
Hyosycamine (Levsin®, Levsinex®)
• Generally produce substantial toxic effects in the Avoid gastrointestinal antispasmodics in the elderly, Belladonna alkaloids (Donnatal®)
Clidinium-chlordiazepoxide (Librax®)
• Effectiveness at doses tolerated by the elderly is Use the smallest dose possible if the use of Benadryl® is Diphenhydramine (Benadryl®)
• The most potent negative inotrope of all the When appropriate, other antiarrhythmic drugs should be Disopyramide (Norpace®, Norpace CR®)
• May induce heart failure in the elderly • Has strong anticholinergic and sedating Consider an antidepressant with less sedation and fewer Doxepin (Sinequan®)
anticholinergic effects (Pamelor® (g), Norpramin® (g), • Rarely the antidepressant of choice in the elderly Celexa® (g), Lexapro®3). Medication
Prescribing Concern2
Possible Alternatives
Consider safer alternatives (Celexa (g)®, Lexapro®3, Fluoxetine (Prozac®) daily
• May produce excessive CNS stimulation, sleep • Has an extremely long half-life in the elderly If a benzodiazepine is necessary, consider a medium- or Flurazepam (Dalmane®)
short-acting benzodiazepine (Restoril® <15mg (g), Halcion® May cause prolonged sedation and increase the • Causes the most CNS adverse events of all the Indomethacin (Indocin®, Indocin SR®)
available nonsteroidal anti-inflammatory agents Avoid use in the elderly, safer alternatives exist. • May cause renal failure and/or hypertension • May cause confusion Meperidine (Demerol®)
• Not an effective oral analgesic in doses Avoid use in the elderly, morphine is the preferred agent. Meprobamate (Equanil®, Miltown®)
• If used for prolonged periods of time, the drug Methocarbamol (Robaxin®)
Chlorzoxazone (Parafon Forte DSC)

• Most muscle relaxants and antispasmodics are Orphenadrine (Norflex)
Avoid use of any skeletal muscle relaxants in the elderly. Carisoprodol (Soma®)
• Can cause anticholinergic adverse events, Metaxalone (Skelaxin®)
Cyclobenzaprine (Flexeril®)
• May cause bradycardia and exacerbate Consider an alternative treatment for hypertension (a Methyldopa (Aldomet®, Aldoril®)
• Causes a higher incidence of confusion, Pentazocine (Talwin compound®,
Consider other moderate pain relievers (acetaminophen or hallucinations and other CNS side effects than Talacen®, Talwin NX®)
• Offers few analgesic advantages over Propoxyphene (Darvon®)
Consider other moderate pain relievers (acetaminophen or Propoxyphene/acetaminophen
• May cause prolonged sedation and increase the (Darvocet®)
Consider alternative antiplatelet agents (aspirin, or Plavix® if Ticlopidine (Ticlid®)
• Not much better than aspirin in clot prevention • Least effective of all antiemetic drugs Consider safer alternatives (Compazine® <10mg (g), Trimethobenzamide (Tigan®)
• Causes the most extrapyramidal side effects of 1 Potentially Inappropriate Medications in the Elderly- alternative medications. Approved by BCBSM/BCN Pharmacy and Therapeutics Committee April 15, 2004. 3 BCN requires step therapy for use of Lexapro.

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