Ten Medications Older Adults Should Avoid or Use with Caution

Older adults tend to accumulate what I call the three “Ds”: Diseases, Doctors, and Drugs.  Multiple chronic diseases such as heart failure, high blood pressure, and diabetes are common in older adults.   Also, the management of more severe disease is often referred to a specialist physician.  Therefore it is not uncommon for patients with multiple diseases to see multiple specialists.  Finally, clinical guidelines for many chronic diseases suggest the use of multiple medications to control symptoms and prevent disease progression.

Unfortunately, the use of multiple medications (known as polypharmacy) can lead to dangerous drug interactions and an increased risk of adverse drug events.  Older adults are more sensitive to what is often referred to as drug-induced disease and drug-induced disease is a major contributor to negative clinical outcomes and increased health care costs.

The American Geriatrics Society Foundation for Health in Aging has issued a list of Ten Medications Older Adults Should Avoid or use with Caution.  This list includes:

1. AVOID long-acting Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as indomethacin used to reduce pain and inflammation typically from arthritis.  Safer alternative include shorter-acting drugs such as ibuprofen or naproxyn.  However any of these drugs can increase the risk of gastric ulcers and bleeding especially if combined with drugs used to prevent clots such as aspirin, clopidogrel (Plavix), and warfarin (Coumadin).
2. AVOID digoxin (Lanoxin) used to treat heart failure in doses greater than 0.125mg daily
3. AVOID longer-acting diabetes drugs such as glyburide (Micronase, Diabeta) and chlorpropamide (Diabinese).
4. AVOID muscle relaxants such as cyclobenzparine (Flexeril), methocarbamol (Robaxin), and carisprodol (Soma).  These drugs can increase the risk of falls, confusion, constipation, and dry mouth.  Also, there is little evidence that they are effective.
5. AVOID certain medications for anxiety and insomnia.  These include benzodiazepines used for anxiety such as diazepam (Valium), alprazolam (Xanax), and chlordiazepoxide (Librium) and sleeping pills such as zaleplon (Sonata) and zolpidem (Ambien).  These drugs greatly increase the risk of falling and confusion and their effects tend to last longer in older adults
6. AVOID certain anticholinergic drugs including
   1. Antidepressants: amitriptyline (Elavil) and imipramine (Tofranil)
   2. Trihexyphenidyl (Artane) used to treat Parkinson’s Disease
   3. Dicyclomine (Bentyl) used to treat irritable bowel syndrome
   4. Oxybutynin (Ditropan) used to treat overactive bladder (OAB)
7. AVOID the pain reliever meperidine (Demerol) which can increase the risk for seizures and confusion and these effects tend to last much longer in older adults
8. AVOID Certain Over-the-Counter (OTC) medications including antihistamines such as diphenhydramine (Benadryl, Tylenol PM) and chlorpheniramine (Chlor-Trimeton).  These drugs can cause drug mouth, constipation, confusion, falls, and urinary retention (especially in men with prostate enlargement)
9. AVOID Antipsychotic Drugs such as risperidone (Risperdal), olanzapine (Zyprexa), haloperidol (Haldol), and quetipine (Seroquel) unless you are being treated for psychosis.  These drugs can increase the risk of tremors, falls, stroke and death.
10. AVOID estrogen pills and patches.  These are typically prescribed for hot flashes and can increase the risk for breast cancer, blood clots, and even dementia

Source:   American Geriatrics Society Foundation   healthinaging.org