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Class
Drug
Prescribing Concern
first generation (sedating) antihistamines
diphenhydramine
chlorpheniramine
promethazine
cyproheptadine
clemastine
hydroxyzine
doxylamine (and others)sedating and strongly anticholinergic; promote delirium, falls, urinary retention, dry mouth, constipation; use of diphenhydramine may be appropriate for acute treatment of severe allergic reactions
antispasmodic
dicyclomine
hyocyamine
propantheline
oxybutynin (immediate release)
scopolamine
belladonna alkaloids
clinidiniumsedating and strong anticholinergic properties; promote delirium, falls, urinary retention, dry mouth, constipation; use of hyoscyamine, scopolamine, and belladonna alkaloids to dry secretions in palliative medical care may be appropriate
Tricyclic antidepressants
amitriptylinebr
doxepin
imipramine
nortriptyline (and others)avoid in the elderly; sedating and strong anticholinergic properties promote delirium, falls, urinary retention, constipation, and orthostatic hypotension
Anti-cholinergic antiparkinson agent
benztropine
trihexyphenidylavoid due to sedation, anti-cholinergic properties; not recommended for prevention of antipyramidal side effects from antipsychotic medications and better medications available for Parkinson
muscle relaxants
cyclobenzaprine
methocarbamol
carisoprodol
metaxalone (and others)avoid in the elderly due to sedation and anti-cholinergic properties; questionable effectiveness in tolerable doses, and promotes delirium, sedation, and falls
benzodiazepines
alprazolam
lorazepam
diazepam
chlordiazepoxide
chlorazepate (and others)avoid in the elderly for control of delirium, sleep disorders, or agitation; elders are more sensitive to the delirium promoting and fall promoting side effects of these medications; may be appropriate for some conditions such as alcohol withdrawal, or benzodiazepine withdrawal
Non-benzodiazepine hypnotics
Zolpidem (and others)
Avoid due to sedation; promotes delirium, falls, and fractures in the elderly like the benzodiazepines do
Antipsychotic agents (atypical and conventional)
Haloperidol
Thioridazine
Chlorpromazine
Olanzapine
Quetiapine
Risperidone (and others)Because of increased risk of stroke and death, avoid for behavioral problems in the elderly unless non-pharmacologic measures have failed and the patient is a risk to themselves or others
Alpha 1 blockers
doxazosin
prazosin
terazosinavoid use as antihypertensive due to high risk of orthostatic hypotension and better agents are available
CNS acting alpha agonist hypotensive agents
clonidine
methyldopaassociated with bradycardia, orthostatic hypotension, sedation, delirium, depression; avoid methyldopa and clonidine should not be first-line for hypertension
cardiac glycoside
Digoxin over 0.125mg daily
Higher doses used in heart failure increases risk of toxicity without adding benefit; reduced renal function may increase risk of toxicity
antiarrhythmic drugs
amiodarone
flecainide
procainamide
sotalol
quinidine
disopyramide (and others)risk - benefit analysis favours rate control over rhythm control in most older adults; amiodarone associated with thyroid problems, pulmonary problems and QT prolongation; disopyramide may have a negative inotropic effect and may precipitate heart failure, it is also anticholinergic
Non-COX selective NSAIDS
Aspirin > 325mg/day
Ibuprofen
Naproxen
Piroxicam
Indomethacin (and others)Avoid chronic use unless other measures fail and can use PPI with it; risk of GI bleeding, reduced renal function, exacerbation of heart failure
Long acting sulfonylureas
Chlorpropamide
glyburideAvoid in the elderly because of increased risk of prolonged hypoglycemia
a urinary anti-infective agent
nitrofurantoin
contraindicated in those with creatinine clearances below 60ml/min because of failure to reach therapeutic concentrations in the urine and increased risk of nerve and liver toxicity
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Drugs to avoid Elderly
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