GERIATRIC MEDICINE

Ten Medications Older Adults Should Avoid or Use With Caution

April 13, 2017
Authors: 

American Geriatrics Society (AGS) Foundation for Health in Aging

Ten Medications Older Adults Should Avoid or Use With Caution
(Courtesy of the AGS Foundation for Health in Aging)

Because older adults often have long-term health conditions that require treatment with multiple medications, there is a greater chance of experiencing unwanted drug side effects. Older people can also be more sensitive to certain medications.

To help you make better-informed decisions about your medications, and to lower your chances of overmedication and serious drug reactions, the American Geriatrics Society’s Health in Aging Foundation recommends that older people be cautious about using the following types of medications, including some that can be purchased without a prescription (over-the-counter).

➡ If you are taking any of these medications, talk to your healthcare provider or pharmacist.

➡ Do not stop taking any medication without first talking to your healthcare provider.

MEDICATIONS

USE WITH CAUTION
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
Used to reduce pain and inflammation.

AVOID regular, long-term use of NSAIDs:

  • When good alternatives are not available and NSAIDs are necessary, use a proton pump inhibitor such as omeprazole (Prilosec) or misoprostol (Cytotec) to reduce bleeding risk.
  • Use special caution if you are at higher risk of developing bleeding stomach ulcers. Those at higher risk include people more than 75 years old, people taking oral steroids, and people taking a blood-thinning medication such as apixaban (Eliquis), aspirin, clopidogrel (Plavix), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), or warfarin (Coumadin).
  • Also use special caution if you have kidney problems or heart failure.

Reasons: NSAIDs can increase the risk of bleeding stomach ulcers. They can also increase blood pressure, affect your kidneys, and make heart failure worse.

 

USE WITH CAUTION
Digoxin (Lanoxin):
Used to treat heart failure and irregular heartbeats.

  • For most older adults, other medications are safer and more effective.
  • Avoid doses higher than 0.125 mg per day. Higher doses increase toxicity and provide little additional benefit.
  • Be particularly careful if you have moderate or severe kidney problems.

Reasons: It can be toxic in older adults and people whose kidneys do not work well.

 

AVOID
Certain Diabetes Drugs

  • Glyburide (Diabeta, Micronase) and chlorpropamide (Diabinese)

Reasons: They can cause dangerously low blood sugar.

 

AVOID
Muscle Relaxants

  • Such as cyclobenzaprine (Flexeril), methocarbamol (Robaxin), carisoprodol (Soma), and similar medications.

Reasons: They can leave you feeling groggy and confused, increase your risk of falls, and cause constipation, dry mouth, and problems urinating. Plus, there is little evidence that they work well.

 

AVOID
Certain Medications used for Anxiety and/or Insomnia

  • Benzodiazepines, such as diazepam (Valium), alprazolam (Xanax), and chlordiazepoxide (Librium)
  • Sleeping pills such as zaleplon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta)

Reasons: They can increase your risk of falls, as well as cause confusion. Because it takes your body a long time to get rid of these drugs, these effects can carry into the day after you take the medication.

 

AVOID
Certain Anticholinergic Drugs

  • Antidepressants amitriptyline (Elavil) and imipramine (Tofranil)
  • Anti-Parkinson drug trihexyphenidyl (Artane)
  • Irritable bowel syndrome drug dicyclomine (Bentyl)

Reasons: They can cause confusion, constipation, dry mouth, blurry vision, and problems urinating (in men).

 

AVOID
The Pain Reliever merperidine (Demerol)

Reasons: It can increase the risk of seizures and can cause confusion.

 

AVOID
Certain Over-the-Counter (OTC) Products

  • AVOID products that contain the antihistamines diphenhydramine (Benadryl) and chlorpheniramine (AllerChlor, Chlor-Trimeton). These medications are often included in OTC remedies for coughs, colds, and allergies.
  • AVOID OTC sleep products, like Tylenol PM, which contain antihistamines such as diphenhydramine.

Reasons: Although these medications are sold without a prescription, they are not riskfree. They can cause confusion, blurred vision, constipation, problems urinating, and dry mouth.

 

AVOID
Estrogen Pills and Patches

  • Typically prescribed for hot flashes and other menopause-related symptoms.

Reasons: They can increase your risk of breast cancer, blood clots, and possibly dementia.

 

*If you are NOT being treated for psychosis,
AVOID using Antipsychotics

  • Such as haloperidol (Haldol), risperidone (Risperdal), or quetiapine (Seroquel). These medications are commonly used to treat behavioral problems in older adults with dementia.

Reasons: They can increase the risk of stroke or even death in older adults with dementia. They can also cause tremors and other side effects, as well as increase your risk of falls.

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This AGS Tipsheet and other tools like it can be found on the AGS-sponsored website http://www.healthinaging.org/ along with many other helpful tools for clinicians.

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DISCLAIMER: This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other healthcare provider. Always consult your healthcare provider about your medications, symptoms, and health problems. Sept 2015. ©2015 Health in Aging Foundation. All rights reserved. This material may not be reproduced, displayed, modified, or distributed without the express prior written permission of the copyright holder. For permission, contact info@healthinaging.org.

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