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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