Potentially inappropriate medications for older persons

Potentially Inappropriate Medications for Older Persons
Medications
Reason that Use is a Problem
Pain Relievers
propoxyphene and combination products
Used to control pain. Propoxyphene offers little pain-relieving advantage over acetaminophen (Tylenol), yet has the side effectsof other narcotics.
Used to control pain and swelling. Indomethacin produces manyside effects, especially confusion, agitation, and ulcers.
Used to control pain. Pentazocine is a narcotic pain reliever thatcauses confusion and hallucinations, more commonly than othernarcotic medications.
Used to ease muscle spasms. Most drugs used to relax muscles and reduce muscle spasms are poorly tolerated by older persons.
These medications can cause sleepiness and weakness.
oxybutynin (Ditropan);chlorzoxazone (Paraflex);metaxalone (Skelaxin);Meperidine (Demerol) Used to treat pain. Meperidine is not an effective oral pain relieverand has many disadvantages compared to other narcotics. Avoidusing in older persons.
Antidepressants
amitriptyline (Elavil)
Used to treat depression. These medications can cause sedation, chlordiazepoxide/amitriptyline (Limbitrol) weakness, blood pressure changes, dry mouth, problems with urination, and can lead to falls and fractures.
doxepin (Sinequan)
Sleeping Pills and Antianxiety Medications
flurazepam (Dalmane)
Used to treat insomnia. This medication produces prolongedsedation/sleepiness (often lasting for days and can worsen if takendaily) and can increase the risk of falls and fractures.
Used to treat anxiety. Meprobamate is a highly addictive andsedating. Those who have been using it for long periods may beaddicted and may need to be withdrawn slowly.
Medications
Reason that Use is a Problem
Sleeping Pills and Antianxiety Medications
alprazolam (Xanax) 2 mg
Used to treat insomnia and anxiety. Older people should be prescribed small doses of these medications. Total daily doses should rarely exceed the suggested maximum doses noted to the triazolam (Halcion) 0.25mgzolpidem (Ambien) 5 mgchlordiazepoxide (Librium) Used to treat insomnia and anxiety. Chlordiazepoxide and chlordiazepoxide/amitriptyline (Limbitrol) diazepam produce prolonged sedation (often lasting several days and can worsen if taken daily) and can increase the risk of falls and Used to treat insomnia and anxiety. Barbiturates cause more sideeffects than most other drugs used to induce sleep in the elderlyand are highly addictive. They should not be started as newtherapy in the elderly except when used to control seizures;patients who have used barbiturates for a long period may beaddicted.
Heart Medications
disopyramide (Norpace, Norpace CR)
Used to treat abnormal heart rhythms (arrhythmias).
Disopyramide, of all drugs used to treat arrhythmias, is the mostlikely to decrease the pumping action of the heart, which can leadto heart failure in older persons. When appropriate, otherantiarrhythmics should be used.
Used to treat abnormal heart rhythms and heart failure. Because of decreased processing of digoxin by the kidney, doses in olderpersons should rarely exceed 0.125 mg daily, except when treatingcertain types of abnormal heart rhythms.
Used to help stop blood from clotting in people who haveexperienced strokes, heart attacks, and other conditions.
Dipyridamole frequently causes light-headedness upon standing inolder persons. Dipyridamole has been proven beneficial only inpatients with artificial heart valves. Whenever possible, its use inolder persons should be avoided.
Medications
Reason that Use is a Problem
Heart Medications
methyldopa (Aldomet)
Used to treat high blood pressure. Methyldopa may cause a slowed heart beat and worsen depression. Alternate treatments forhypertension are generally preferred.
Used to treat high blood pressure. Reserpine imposes unnecessary risk in older persons, inducing depression, impotence,sedation, and light-headedness upon standing. Safer alternativesexist.
Used to help prevent blood from clotting in people who have hadstrokes, heart attacks, and other conditions. Ticlopidine has beenshown to be no better than aspirin in preventing clotting (except ina few specific conditions, such as after use of a cardiac arterystent) and is considerably more toxic. Avoid use in older people.
Diabetes Medications
chlorpropamide (Diabinese)
Used to control blood sugar in people with diabetes.
Chlorpropamide can cause prolonged and serious low blood sugar.
Stomach and Intestinal Medications
dicyclomine (Bentyl)
Used to treat stomach and intestinal cramps. These medications can cause sedation, weakness, blood pressure changes, dry mouth, problems with urination, and can lead to falls and fractures.
All of these drugs are best avoided in older persons, especially for Used to control nausea. Trimethobenzamide is one of the leasteffective medications used to control nausea and vomiting, yet itcan cause severe side effects, such as stiffness, shuffling gate,difficulty swallowing, and tremor.
Medications
Reason that Use is a Problem
Antihistamines
chlorpheniramine (Chlor-Trimeton)
Used to treat the runny nose of the common cold and allergy symptoms. Most nonprescription and many prescription antihistamines can cause sedation, weakness, blood pressure changes, dry mouth, problems with urination, and can lead to falls and fractures. Many cough and cold preparations are available without antihistamines, and these are safer substitutes in olderpersons.
dexchlorpheniramine (Polaramine)Actifed CPoly-Histine CSBromfed DMAmbenylNovahistine DHPolyhistine DMTussionexdiphenhydramine (Benadryl) Used to treat allergies and insomnia. Diphenhydramine can causesedation, weakness, blood pressure changes, dry mouth, problemswith urination, and can lead to falls and fractures. When used totreat or prevent allergic reactions, it should be used in the smallestpossible dose and with great caution.
Miscellaneous
iron supplements
Used to treat low iron, but frequently given to older people with other types of anemia, for which they do not help. Ironsupplements rarely need to be given in doses exceeding 325 mg offerrous sulfate daily. A common side effect of iron supplements isconstipation.

Source: http://profilesinc.homestead.com/files/inappropriate_medications.pdf