Potentially Harmful Drugs in the Elderly: Beers List and More
[Pages:12]Detail-Document #230907
-This Detail-Document accompanies the related article published in-
PHARMACIST'S LETTER / PRESCRIBER'S LETTER
September 2007 ~ Volume 23 ~ Number 230907
Potentially Harmful Drugs in the Elderly: Beers List and More
(B=Beers list drug; C=Canadian list drug)
Drug
Concern
Alternative Treatment
Analgesics
Ketorolac (Toradol) GI bleeding.5
Mild pain: APAP, short-acting NSAID (e.g.,
(B); long-term use (C) Meperidinea (Demerol) (B); longterm use (C)
Pentazocine (Talwin) (B); long-term use (C)
Not effective at commonly used oral doses; confusion, falls, factures, dependency, withdrawal5,15
More CNS effects (e.g., confusion,
ibuprofen)
Moderate or severe pain: morphine, hydrocodone/APAP (Vicodin, etc), oxycodone (OxyContin, etc), oxycodone/APAP (Percocet, etc), fentanyl patch (Duragesic)19
Topicals (neuropathic pain, arthritis): lidocaine (Lidoderm), capsaicin (Zostrix, etc)
hallucinations) than
other opioids; ceiling to analgesic effect5
Propoxyphene (e.g., No better than
Darvon, etc) (B)
acetaminophen, but has narcotic AE5
Antidepressants
Amitriptyline (Elavil) (B, C), doxepin (Sinequan, etc) (B), imipramine (Tofranil)(C)
Anticholinergic AE, sedation, urinary retention or incontinence, constipation, arrhythmias, falls5,15
Tricyclic without active metabolites (Nortriptyline [Pamelor], desipramine [Norpramin])15 Trazodone (for insomnia)19 SSRI15 Bupropion (Wellbutrin) (for cardiac patient)19 Mirtazapine (Remeron) (for insomnia or anorexia)19
Neuropathic pain: topicals (lidocaine [Lidoderm],
Bupropion (Wellbutrin), seizure disorder (B)
May cause seizure5
capsaicin [Zostrix, etc])
Tricyclic without active metabolites (Nortriptyline [Pamelor], desipramine [Norpramin])15 Trazodone (for insomnia)19 SSRI15 Mirtazapine (Remeron) (for insomnia or anorexia)19
Fluoxetine (Prozac) Long half-life;
SSRI with shorter half-life (e.g., escitalopram
used daily (B) Tricyclic for
agitation, insomnia, anorexia5
Fall risk; urinary
[Lexapro], sertraline [Zoloft]) SSRI, with blood pressure monitoring15
depression in patient retention; worsening
with postural hypotension, BPH,
glaucoma, heart block15
glaucoma, heart block
(C)
More. . .
Copyright ? 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
~
(Detail-Document #230907: Page 2 of 12)
Drug
Concern
Alternative Treatment
Antidepressants, cont.
Tricyclic in patient with stress
Urinary retention or incontinence5
Antidepressant with little anticholinergic or alphablocking effect (e.g., citalopram [Celexa]), bupropion
incontinence or
[Wellbutrin])
bladder outflow
obstruction (B)
SSRIs in patient with SIADH (B)
May cause or worsen SIADH5
Tricyclic without active metabolites (Nortriptyline [Pamelor], desipramine [Norpramin])15 Trazodone (for insomnia)19 Bupropion (Wellbutrin) (for cardiac patient)19
Mirtazapine (Remeron) (for insomnia or weight loss)19
SSRI in patient on MAOI (C)
Enhanced SSRI side Avoid combination. If switching from MAOI to
effects15
another antidepressant, ensure a 14-day washout. If
switching from another antidepressant to an MAOI,
minimum washout is 2 weeks for drug without long
half-life and 5 weeks for drug with long half-life (e.g., fluoxetine).30
Antihistamines
Antihistamines, anticholinergic Anticholinergic AE, Cetirizine (Zyrtec), fexofenadine (Allegra),
(B): Chlorpheniramine (ChlorTrimeton, etc),
urine retention, confusion, sedation5
loratadine (Claritin), desloratadine
(Clarinex), levocetirizine (Xyzal), low-dose diphenhydramine19,26
Cyproheptadine (Periactin),
Dexchlorpheniramine
(Polaramine),
Diphenhydramine (Benadryl,
etc), Hydroxyzine (Vistaril,
Atarax),
Promethazine (Phenergan, etc)
Antihypertensives
Alpha-blockers
Hypotension, dry mouth,
(doxazosin [Cardura], incontinence5
Thiazide, ACE inhibitor, beta-blocker, calcium channel blocker22
prazosin [Minipress],
terazosin [Hytrin])(B)
Clonidine (Catapres) Orthostatic hypotension, CNS Thiazide, ACE inhibitor, beta-blocker,
(B)
AE5
calcium channel blocker22
Ethacrynic acid (Edecrin) (B)
Hypotension; fluid, electrolyte Furosemide (Lasix), bumetanide (Bumex) imbalances5
Guanethidine (B)
Methyldopa (Aldomet) (B) Nifedipine, short-
Orthostatic hypotension, depression5 Bradycardia; depression5
Hypotension, constipation5
Thiazide, ACE inhibitor, beta-blocker, calcium channel blocker22
Thiazide, ACE inhibitor, beta-blocker, calcium channel blocker22
Another calcium channel blocker or long-
acting (Procardia,
acting nifedipine
Adalat) (B)
More. . .
Copyright ? 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ P.O. Box 8190, Stockton, CA 95208
Phone: 209-472-2240 ~ Fax: 209-472-2249 ~
Drug
Concern
Antihypertensives, cont.
Reserpine >0.25mg Depression, impotence,
(B, C)
sedation, orthostatic
hypotension, extrapyramidal effects5,15
(Detail-Document #230907: Page 3 of 12)
Alternative Treatment
Thiazide, ACE inhibitor, beta-blocker, calcium channel blocker22
Thiazide in patient with gout (C)
May precipitate gout attack15
ACE inhibitor, beta-blocker, calcium channel blocker22
Antiplatelet Drugs Dipyridamole, shortacting (Persantine) (B); for dementia or stroke (C)
Ineffective for stroke
prevention &
dementia; orthostatic hypotension5,15
For stroke prevention: low-dose aspirin, clopidogrel (Plavix), aspirin/dipyridamole (Aggrenox)19
Ticlopidine (Ticlid) (B)
Antipsychotics Mesoridazine (Serentil) (B), Thioridazine (Mellaril) (B)
Chlorpromazine (Thorazine) in patient with history of postural hypotension (C) Clozapine (Clozaril) in patient with seizures (B)
Olanzapine (Zyprexa), obesity (B)
Thiothixene (Navane), in patient with seizure disorder (B)
Not more effective Low dose aspirin, clopidogrel (Plavix), than aspirin, but more aspirin/dipyridamole (Aggrenox)19 toxic5
CNS AE, seizures, extrapyramidal effects5
Fall risk15
Risperidone (Risperdal)*, haloperidol (Haldol)26
*Atypicals associated with increased mortality when used to treat behavioral problems in elderly with dementia31 Haloperidol, with blood pressure monitoring15
Lower seizure threshold5
Increased appetite, weight gain
Lower seizure threshold5
Risperidone (Risperdal)*, haloperidol (Haldol)26
*Atypicals associated with increased mortality when used to treat behavioral problems in elderly with dementia31 Risperidone (Risperdal)*, haloperidol (Haldol)26
*Atypicals associated with increased mortality when used to treat behavioral problems in elderly with dementia31 Risperidone (Risperdal)*, haloperidol (Haldol)26
*Atypicals associated with increased mortality when used to treat behavioral problems in elderly with dementia31
More. . .
Copyright ? 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ P.O. Box 8190, Stockton, CA 95208
Phone: 209-472-2240 ~ Fax: 209-472-2249 ~
(Detail-Document #230907: Page 4 of 12)
Drug
Anxiolytics Long-acting benzodiazepines (B, C): clorazepate (Tranxene, etc), chlordiazepoxide (Librium), diazepam (Valium), quazepam (Doral)
Short-acting benzodiazepines, daily doses greater than (B): alprazolam (Xanax) 2 mg, lorazepam (Ativan) 3 mg, oxazepam (Serax) 60 mg Meprobamate (Miltown) (B)
Concern
Alternative Treatment
Dependence, depression, prolonged sedation, confusion, falls, fractures, respiratory depression in COPD, incontinence5,15
For anxiety: shorter acting benzodiazepines (appropriately dosed) (alprazolam [Xanax],lorazepam [Ativan], oxazepam [Serax]; buspirone (Buspar)15,19
For sleep: nondrug therapy (See our DetailDocument #211015 [U.S.]/#210918 [Canada]); temazepam (Restoril) 7.5 mg*, zolpidem (Ambien) 5 mg*, Ambien CR 6.25 mg, zaleplon (Sonata) 5 mg*, ramelteon (Rozerem) 8 mg, eszopiclone (Lunesta) 1 mg* for difficulty falling asleep, 2 mg for difficulty staying asleep15,19,32 *Initial dose
Falls5
For anxiety: shorter acting benzodiazepines
(appropriately dosed) (alprazolam
[Xanax],lorazepam [Ativan], oxazepam [Serax]; buspirone (Buspar)15,19
Dependence, sedation5
For sleep: nondrug therapy (See our DetailDocument #211015 [U.S.]/#210918 [Canada]); temazepam (Restoril) 7.5 mg*, zolpidem (Ambien) 5 mg*, Ambien CR 6.25 mg, zaleplon (Sonata) 5 mg*, ramelteon (Rozerem) 8 mg, eszopiclone (Lunesta) 1 mg* for difficulty falling asleep, 2 mg for difficulty staying asleep15,19,32 *Initial dose
Cardiac Drugs Amiodarone (Cordarone, Pacerone) (B)
Beta-blockers in patient with asthma, COPD, or Raynaud's disease (C)15 Calcium channel blocker in patient with systolic heart failure (C) or chronic constipation (B, C) Digoxin (Lanoxin) doses >0.125 mg/d except for atrial arrhythmias (B) Disopyramide (Norpace) (B, C)
QT prolongation, torsades de pointes, lack of efficacy in elderly5 Worsening disease15
Worsening heart failure; constipation5,15
Toxicity due to reduced renal clearance5
Negative inotrope; anticholinergic; sudden death5,15
Depends on type of arrhythmia; flecainide (Tambocor), sotalol (Betapace), beta-blocker, dofetilide (Tikosyn)27 Alternate antihypertensive; nitrate or calcium channel blocker15
Diuretic, ACE inhibitor, appropriately titrated betablocker15
Dose reduction, with monitoring19
Depends on type of arrhythmia; for atrial fibrillation, digoxin, quinidine, procainamide, sotalol, flecainide15,27
More. . .
Copyright ? 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ P.O. Box 8190, Stockton, CA 95208
Phone: 209-472-2240 ~ Fax: 209-472-2249 ~
(Detail-Document #230907: Page 5 of 12)
Drug
Diabetes Drugs Chlorpropamide (Diabinese) (B)
Concern
Prolonged hypoglycemia; SIADH5
Gastrointestinal Drugs
Antispasmodics, long- Anticholinergic AE;
term use (B); for IBS worsened cognition &
in dementia patient behavioral problems
(C): belladonna
in dementia; urinary
alkaloids (Donnatal), retention or
Clindinium (in
incontinence;
Librax),
questionable
Dicyclomine (Bentyl), efficacy5,15
Hyoscyamine (Levsin,
etc),
Propantheline (Pro-
Banthine)
Cimetidine (Tagamet) Confusion, other CNS
(B); in patient taking AE, interaction with
warfarin (C)
warfarin5,15
Diphenoxylate
Dependence, sedation,
(Lomotil, etc), long- cognitive
term use (C)
impairment15
Metoclopramide (Reglan) in patient
Antidopaminergic effect5
with Parkinson's
disease (B) Mineral oil (B)
Aspiration5
Stimulant laxatives (e.g., bisacodyl [Dulcolax, etc]), longterm use, except with opiates (B) Trimethobenzamide (Tigan) (B)
May worsen bowel function5
Poor efficacy; extrapyramidal AE5
Alternative Treatment
Glimepiride (Amaryl), glipizide (Glucotrol)19
Avoid glyburide (Micronase, etc) and Glucotrol XL due to hypoglycemia risk.33
Diet therapy (fiber, fluids)15,23 Constipation: Psyllium, polyethylene glycol (Miralax, etc), stool softener (e.g., docusate), lubiprostone (Amitiza)19,23 Diarrhea: loperamide (Imodium, etc), aluminum hydroxide (e.g., AlternaGel), cholestyramine (Questran, etc)15,19
Alternative H2 blocker (ranitidine [Zantac], famotidine [Pepcid], nizatidine [Axid])15
Change in diet; loperamide (Imodium, etc)15
Nausea: ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet)19
Diet therapy (fiber, fluids)15,23 Constipation: Psyllium, polyethylene glycol (Miralax, etc), stool softener (e.g., docusate), lubiprostone (Amitiza)19,23 Diet therapy (fiber, fluids)15,23 Constipation: Psyllium, polyethylene glycol (Miralax, etc), stool softener (e.g., docusate), lubiprostone (Amitiza)19,23
Ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet)19
Prochlorperazine (Compazine, etc), metoclopramide
(Reglan) (avoid long-term use, and avoid in Parkinson's disease)26
Hormones
Estrogens (oral)
Breast, endometrial Hot flashes: nondrug therapy (cool environment,
(Premarin, etc) (B)
cancer; not cardioprotective5
layered clothing, cool compress), SSRIs, gabapentin, venlafaxine24
Bone density: calcium, vitamin D, bisphosphonates,
raloxifene (Evista)
More. . .
Copyright ? 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ P.O. Box 8190, Stockton, CA 95208
Phone: 209-472-2240 ~ Fax: 209-472-2249 ~
(Detail-Document #230907: Page 6 of 12)
Drug
Concern
Alternative Treatment
Hormones, cont.
Methyltestosterone (Android, etc) (B)
Thyroid, desiccated (B)
Prostatic hyperplasia, cardiac AE5 Cardiac AE5
None Levothyroxine (Levoxyl, Synthroid, etc)
Hypnotics
Barbiturates, except Dependence; higher Nondrug therapy (See our Detail-Document #211015
phenobarbital for
risk of AE (falls,
[U.S.]/#210918 [Canada]); temazepam (Restoril)
seizures (B); long- fractures, confusion, 7.5 mg*, zolpidem (Ambien) 5 mg*, Ambien CR
term for insomnia (C) cognitive impairment) 6.25 mg, zaleplon (Sonata) 5 mg*, ramelteon
than other hypnotics5,15
(Rozerem) 8 mg, eszopiclone (Lunesta) 1 mg* for
difficulty falling asleep, 2 mg for difficulty staying asleep 15,19,32 *Initial dose
Long-acting
See entry under
See entry under Anxiolytics.
benzodiazepines (B, Anxiolytics.
C) (See entry under
Anxiolytics)
Diphenhydramine
Confusion, sedation, Nondrug therapy (See our Detail-Document #211015
(Benadryl, etc) (B)
anticholinergic effects5
[U.S.]/#210918 [Canada]); temazepam (Restoril) 7.5 mg*, zolpidem (Ambien) 5 mg*, Ambien CR
6.25 mg, zaleplon (Sonata) 5 mg,* ramelteon
(Rozerem) 8 mg, eszopiclone (Lunesta) 1 mg* for
difficulty falling asleep, 2 mg for difficulty staying asleep 15,19,32 *Initial dose
Flurazepam (Dalmane) (B)
Sedation, falls, accumulation5
Nondrug therapy (See our Detail-Document #211015 [U.S.]/#210918 [Canada]); temazepam (Restoril)
7.5 mg*, zolpidem (Ambien) 5 mg*, Ambien CR
6.25 mg, zaleplon (Sonata) 5 mg*, ramelteon
(Rozerem) 8 mg, eszopiclone (Lunesta) 1 mg* for
difficulty falling asleep, 2 mg for difficulty staying asleep 15,19,32 *Initial dose
Triazolam (Halcion) Cognitive/behavioral Nondrug therapy (See our Detail-Document #211015
(C)
disturbances15
[U.S.]/#210918 [Canada]); temazepam (Restoril)
7.5 mg*, zolpidem (Ambien) 5 mg*, Ambien CR
6.25 mg, zaleplon (Sonata) 5 mg*, ramelteon
(Rozerem) 8 mg, eszopiclone (Lunesta) 1 mg* for
difficulty falling asleep, 2 mg for difficulty staying asleep15,19,32 *Initial dose
Muscle Relaxants Muscle relaxants (B): Anticholinergic
Physiotherapy; correct seating & footwear15,19
Carisoprodol (Soma), effects, sedation,
For spasticity, use antispasmodics (e.g, baclofen,
Chlorzoxazone, Cyclobenzaprine
cognitive impairment, tizanidine [Zanaflex]) or nerve blocks; treat problems
weakness, urine
that may worsen condition19
(Flexeril) (C),
retention;
Metaxalone (Skelaxin),
questionable efficacy at lower doses5
Methocarbamol
(Robaxin) (C),
Orphenadrine
(Norflex)
More. . .
Copyright ? 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ P.O. Box 8190, Stockton, CA 95208
Phone: 209-472-2240 ~ Fax: 209-472-2249 ~
(Detail-Document #230907: Page 7 of 12)
Drug
NSAIDs Aspirin for pain in patient on warfarin (C) NSAIDs, longer halflife, full dose, long duration (B): Naproxen (Aleve, Naprosyn, etc), Oxaprozin (Daypro), Piroxicam (Feldene) (C) Indomethacin (Indocin) (B); longterm use (C)
Concern
Bleeding15
GI bleeding, renal failure, hypertension, heart failure5
CNS AE, GI effects, fluid retention5,15
Alternative Treatment
Acetaminophen15
Ibuprofen (Motrin, Advil, etc), acetaminophen, topical agents (e.g., lidocaine patch [Lidoderm], capsaicin [Zostrix, etc]), choline magnesium trisalicylate (Trilisate); start with lowest dose and increase slowly19 *See Detail-Document #221003, "Cardiovascular Risks of NSAIDs and COX-2 inhibitors"
Ibuprofen (Motrin, Advil, etc), acetaminophen, topical agents (e.g., lidocaine patch [Lidoderm], capsaicin [Zostrix, etc]), choline magnesium trisalicylate (Trilisate); start with lowest dose and increase slowly19
NSAID, long-term for osteoarthritis (C)
NSAID for osteoarthritis patient receiving warfarin (C) NSAID in patient with history of peptic ulcer (B, C) NSAID, long-term in patient with hypertension (C) Respiratory Drugs Corticosteroids, oral, long-term for COPD, patient with diabetes (C) Pseudoephedrine in patient with hypertension or bladder outflow obstruction(B) Theophylline, patient with insomnia (B)
GI bleeding, renal failure, hypertension, heart failure15 Bleeding risk15
New ulcers; bleeding risk5,15
Gout, chronic treatment: allopurinol15 Gout, acute: alternative NSAID, short-term indomethacin15,19 Acetaminophen,15 capsaicin [Zostrix, etc]
Acetaminophen; NSAID with gastroprotective agent (e.g., proton pump inhibitor; misoprostol [Cytotec]),15 capsaicin [Zostrix, etc] Acetaminophen; NSAID with gastroprotective agent (e.g., proton pump inhibitor; misoprostol [Cytotec])15
Worsening hypertension15
Acetaminophen15
Worsening glucose control15
Inhaled corticosteroid and bronchodilator15
Increased blood
Saline nasal spray, nasal steroid25
pressure; incontinence5
May contribute to insomnia5
Inhaled corticosteroid and bronchodilator
More. . .
Copyright ? 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ P.O. Box 8190, Stockton, CA 95208
Phone: 209-472-2240 ~ Fax: 209-472-2249 ~
Drug
Stimulant Drugs Amphetamines, anorexics (B)
Concern
(Detail-Document #230907: Page 8 of 12)
Alternative Treatment
Dependence,
hypertension, myocardial ischemia,
CNS stimulation (agitation, insomnia)5
For weight control: Diet and lifestyle modification;
For depression: Tricyclic without active metabolites (Nortriptyline [Pamelor], desipramine [Norpramin])15 Trazodone19 SSRI15 Bupropion (Wellbutrin) (for cardiac patient)19 Mirtazapine (Remeron) (for insomnia or anorexia)19
Any stimulant in patient with anorexia/malnutrition (B)
Appetite suppression5
Methylphenidate for CNS stimulation,
depression (C)
agitation, seizures15
For depression:
Tricyclic without active metabolites (Nortriptyline [Pamelor], desipramine [Norpramin])15 Trazodone (for insomnia)19 SSRI15 Mirtazapine (Remeron) (for insomnia or anorexia)19
Tricyclic without active metabolites (Nortriptyline [Pamelor], desipramine [Norpramin])15 Trazodone19 SSRI15 Bupropion (Wellbutrin) (for cardiac patient)19 Mirtazapine (Remeron) (for insomnia or anorexia)19
Urinary Drugs Nitrofurantoin (Macrodantin, etc) (B) Oxybutyninb (Ditropan), in patient with bladder outflow obstruction (B)
Nephrotoxicity5
Urine retention, confusion, hallucinations, sedation5,34
Tolterodineb (Detrol) in patient with bladder outflow obstruction (B)
Urinary retention,
confusion,
hallucinations, sedation5,34
Miscellaneous Anticholinergic (e.g., trihexyphenidyl) to manage antipsychotic extrapyramidal effects (C) Ergot mesylates (Hydergine) (B)
Agitation, delirium, cognitive impairment15
Unproven efficacy5
Depends on infection
For urge incontinence: Behavioral therapy (e.g., urge suppression, bladder retraining)28
For BPH: 5-alpha-reductase inhibitor (finasteride [Proscar], dutasteride [Avodart]) For urge incontinence: Behavioral therapy (e.g., urge suppression, bladder retraining)28
For BPH: 5-alpha-reductase inhibitor (finasteride [Proscar], dutasteride [Avodart])
Decrease antipsychotic dose or discontinue;15 atypical antipsychotic
Donepezil (Aricept), rivastigmine (Exelon), etc.
More. . .
Copyright ? 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ P.O. Box 8190, Stockton, CA 95208
Phone: 209-472-2240 ~ Fax: 209-472-2249 ~
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- guidelines for switching between specific antidepressants
- sample goals and objectives decisionhealth
- interpretation of opiate urine drug screens
- sign in roster for training
- rule 45 washington
- department of the army letterhead
- modifications guide
- controlled substances alphabetical order justice
- potentially harmful drugs in the elderly beers list and more
- scoring rubric for oral presentations example 1
Related searches
- harmful effects of the internet
- more and more people synonym
- harmful ingredients in vaccines
- how many more days in the year
- more and more synonym
- how many more weeks in the year
- in home care for the elderly prices
- beers list medications 2018
- pneumonia in the elderly mortality
- pneumonia in the elderly patient
- aging and the elderly issues
- healthcare and the elderly population