Transcription of Potentially Harmful Drugs in the Elderly: Beers List …
1 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 Mild pain: APAP, short-acting NSAID ( , (B); long-term use (C) ibuprofen). Meperidinea Not effective at (Demerol) (B); long- commonly used oral Moderate or severe pain: morphine, term use (C) doses; confusion, hydrocodone/APAP (Vicodin, etc), oxycodone falls, factures, (OxyContin, etc), oxycodone/APAP (Percocet, etc), dependency, fentanyl patch (Duragesic)19. withdrawal5,15. Pentazocine (Talwin) More CNS effects Topicals (neuropathic pain, arthritis): lidocaine (B); long-term use (C) ( , confusion, (Lidoderm), capsaicin (Zostrix, etc). hallucinations) than other opioids; ceiling to analgesic effect5.
2 Propoxyphene ( , No better than Darvon, etc) (B) acetaminophen, but has narcotic AE5. Antidepressants Amitriptyline (Elavil) Anticholinergic AE, Tricyclic without active metabolites (Nortriptyline (B, C), doxepin sedation, urinary [Pamelor], desipramine [Norpramin])15. (Sinequan, etc) (B), retention or Trazodone (for insomnia)19. imipramine incontinence, SSRI15. (Tofranil)(C) constipation, Bupropion (Wellbutrin) (for cardiac patient)19. arrhythmias, falls5,15 Mirtazapine (Remeron) (for insomnia or anorexia)19. Neuropathic pain: topicals (lidocaine [Lidoderm], capsaicin [Zostrix, etc]). Bupropion May cause seizure5 Tricyclic without active metabolites (Nortriptyline (Wellbutrin), seizure [Pamelor], desipramine [Norpramin])15. disorder (B) Trazodone (for insomnia)19. SSRI15. Mirtazapine (Remeron) (for insomnia or anorexia)19. Fluoxetine (Prozac) Long half-life; SSRI with shorter half-life ( , escitalopram used daily (B) agitation, insomnia, [Lexapro], sertraline [Zoloft]).
3 Anorexia5. Tricyclic for Fall risk; urinary SSRI, with blood pressure monitoring15. depression in patient retention; worsening with postural glaucoma, heart hypotension, BPH, block15. glaucoma, heart block (C). More.. Copyright 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ 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 Urinary retention or Antidepressant with little anticholinergic or alpha- with stress incontinence5 blocking effect ( , citalopram [Celexa]), bupropion incontinence or [Wellbutrin]). bladder outflow obstruction (B). SSRIs in patient with May cause or worsen Tricyclic without active metabolites (Nortriptyline SIADH (B) SIADH5 [Pamelor], desipramine [Norpramin])15. Trazodone (for insomnia)19. Bupropion (Wellbutrin) (for cardiac patient)19.
4 Mirtazapine (Remeron) (for insomnia or weight loss)19. SSRI in patient on Enhanced SSRI side Avoid combination. If switching from MAOI to MAOI (C) 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 ( , fluoxetine).30. Antihistamines Antihistamines, anticholinergic Anticholinergic AE, Cetirizine (Zyrtec), fexofenadine (Allegra), (B): urine retention, loratadine (Claritin), desloratadine Chlorpheniramine (Chlor- confusion, sedation5 (Clarinex), levocetirizine (Xyzal), low-dose Trimeton, etc), diphenhydramine19,26. Cyproheptadine (Periactin), Dexchlorpheniramine (Polaramine), Diphenhydramine (Benadryl, etc), Hydroxyzine (Vistaril, Atarax), Promethazine (Phenergan, etc). Antihypertensives Alpha-blockers Hypotension, dry mouth, Thiazide, ACE inhibitor, beta-blocker, (doxazosin [Cardura], incontinence5 calcium channel blocker22.)
5 Prazosin [Minipress], terazosin [Hytrin])(B). Clonidine (Catapres) Orthostatic hypotension, CNS Thiazide, ACE inhibitor, beta-blocker, (B) AE5 calcium channel blocker22. Ethacrynic acid Hypotension; fluid, electrolyte Furosemide (Lasix), bumetanide (Bumex). (Edecrin) (B) imbalances5. Guanethidine (B) Orthostatic hypotension, Thiazide, ACE inhibitor, beta-blocker, depression5 calcium channel blocker22. Methyldopa Bradycardia; depression5 Thiazide, ACE inhibitor, beta-blocker, (Aldomet) (B) calcium channel blocker22. Nifedipine, short- Hypotension, constipation5 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 ~ Box 8190, Stockton, CA 95208. Phone: 209-472-2240 ~ Fax: 209-472-2249. ~ (Detail-Document #230907: Page 3 of 12). Drug Concern Alternative Treatment Antihypertensives, cont.
6 Reserpine > Depression, impotence, Thiazide, ACE inhibitor, beta-blocker, (B, C) sedation, orthostatic calcium channel blocker22. hypotension, extrapyramidal effects5,15. Thiazide in patient May precipitate gout attack15 ACE inhibitor, beta-blocker, calcium with gout (C) channel blocker22. Antiplatelet Drugs Dipyridamole, short- Ineffective for stroke For stroke prevention: low-dose aspirin, clopidogrel acting (Persantine) prevention & (Plavix), aspirin/dipyridamole (Aggrenox)19. (B); for dementia or dementia; orthostatic stroke (C) hypotension5,15. Ticlopidine (Ticlid) Not more effective Low dose aspirin, clopidogrel (Plavix), (B) than aspirin, but more aspirin/dipyridamole (Aggrenox)19. toxic5. Antipsychotics Mesoridazine CNS AE, seizures, Risperidone (Risperdal)*, haloperidol (Haldol)26. (Serentil) (B), extrapyramidal effects5. Thioridazine *Atypicals associated with increased mortality when (Mellaril) (B) used to treat behavioral problems in elderly with dementia31.
7 Chlorpromazine Fall risk15 Haloperidol, with blood pressure monitoring15. (Thorazine) in patient with history of postural hypotension (C). Clozapine (Clozaril) Lower seizure Risperidone (Risperdal)*, haloperidol (Haldol)26. in patient with threshold5. seizures (B) *Atypicals associated with increased mortality when used to treat behavioral problems in elderly with dementia31. Olanzapine (Zyprexa), Increased appetite, Risperidone (Risperdal)*, haloperidol (Haldol)26. obesity (B) weight gain *Atypicals associated with increased mortality when used to treat behavioral problems in elderly with dementia31. Thiothixene Lower seizure Risperidone (Risperdal)*, haloperidol (Haldol)26. (Navane), in patient threshold5. with seizure disorder *Atypicals associated with increased mortality when (B) used to treat behavioral problems in elderly with dementia31. More.. Copyright 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ Box 8190, Stockton, CA 95208.
8 Phone: 209-472-2240 ~ Fax: 209-472-2249. ~ (Detail-Document #230907: Page 4 of 12). Drug Concern Alternative Treatment Anxiolytics Long-acting Dependence, For anxiety: shorter acting benzodiazepines benzodiazepines (B, depression, prolonged (appropriately dosed) (alprazolam C): sedation, confusion, [Xanax],lorazepam [Ativan], oxazepam [Serax];. clorazepate falls, fractures, buspirone (Buspar)15,19. (Tranxene, etc), respiratory depression chlordiazepoxide in COPD, For sleep: nondrug therapy (See our Detail- (Librium), diazepam incontinence5,15 Document #211015 [ ]/#210918 [Canada]);. (Valium), quazepam temazepam (Restoril) mg*, zolpidem (Ambien). (Doral) 5 mg*, Ambien CR 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 Short-acting Falls5 For anxiety: shorter acting benzodiazepines benzodiazepines, (appropriately dosed) (alprazolam daily doses greater [Xanax],lorazepam [Ativan], oxazepam [Serax].))
9 Than (B): buspirone (Buspar)15,19. alprazolam (Xanax). 2 mg, lorazepam For sleep: nondrug therapy (See our Detail- (Ativan) 3 mg, Document #211015 [ ]/#210918 [Canada]);. oxazepam (Serax) temazepam (Restoril) mg*, zolpidem (Ambien). 60 mg 5 mg*, Ambien CR mg, zaleplon (Sonata). Meprobamate Dependence, sedation5 5 mg*, ramelteon (Rozerem) 8 mg, eszopiclone (Miltown) (B) (Lunesta) 1 mg* for difficulty falling asleep, 2 mg for difficulty staying asleep15,19,32. *Initial dose Cardiac Drugs Amiodarone QT prolongation, Depends on type of arrhythmia; flecainide (Cordarone, torsades de pointes, (Tambocor), sotalol (Betapace), beta-blocker, Pacerone) (B) lack of efficacy in dofetilide (Tikosyn)27. elderly5. Beta-blockers in Worsening disease15 Alternate antihypertensive; nitrate or calcium patient with asthma, channel blocker15. COPD, or Raynaud's disease (C)15. Calcium channel Worsening heart Diuretic, ACE inhibitor, appropriately titrated beta- blocker in patient failure; blocker15.
10 With systolic heart constipation5,15. failure (C) or chronic constipation (B, C). Digoxin (Lanoxin) Toxicity due to Dose reduction, with monitoring19. doses > mg/d reduced renal except for atrial clearance5. arrhythmias (B). Disopyramide Negative inotrope; Depends on type of arrhythmia; for atrial fibrillation, (Norpace) (B, C) anticholinergic; digoxin, quinidine, procainamide, sotalol, sudden death5,15 flecainide15,27. More.. Copyright 2007 by Therapeutic Research Center Pharmacist's Letter / Prescriber's Letter ~ Box 8190, Stockton, CA 95208. Phone: 209-472-2240 ~ Fax: 209-472-2249. ~ (Detail-Document #230907: Page 5 of 12). Drug Concern Alternative Treatment Diabetes Drugs Chlorpropamide Prolonged Glimepiride (Amaryl), glipizide (Glucotrol)19. (Diabinese) (B) hypoglycemia;. SIADH5 Avoid glyburide (Micronase, etc) and Glucotrol XL. due to hypoglycemia Gastrointestinal Drugs Antispasmodics, long- Anticholinergic AE; Diet therapy (fiber, fluids)15,23.
