Selasa, 24 April 2012

POTENTIALLY INAPPROPRIATE DRUGS FOR ELDERLY (BEERS LIST)*

  • ALPRAZOLAM (use lowest effective dose)
  • AMIODARONE (may cause arrhythmias; questionable efficacy in older adults)
  • AMITRIPTYLINE (anticholinergic effects and sedation)
  • AMPHETAMINES (may cause dependence, hypertension, angina, MI, CNS stimulation)
  • ANOREXIC AGENTS (may cause dependence, hypertension, angina, and MI)
  • BARBITURATES, except phenobarbital or for seizures (highly addictive, cause more adverse effects in elderly than most other hypnotic/sedatives)
  • BELLADONNA ALKALOIDS (anticholinergic effects and questionable effectiveness; avoid its use, esp. long-term)
  • BISACODYL (bowel dysfunction with long-term use; may be appropriate with opiate analgesics)
  • CARISOPRODOL (poorly tolerated due to anticholinergic effects and possibly less effective at tolerated doses)
  • CASCARA SAGRADA (bowel dysfunction with long-term use; may be appropriate with opiate analgesics)
  • CHLORAZEPATE (prolonged sedation; short-acting benzodiazepines are preferred)
  • CHLORDIAZEPOXIDE (prolonged sedation; short-acting benzodiazepines are preferred)
  • CHLORDIAZEPOXIDE-AMITRIPTYLINE (anticholinergic effects and prolonged sedation; short-acting benzodiazepines preferred)
  • CHLORPHENIRAMINE (causes anticholinergic effects; non-anticholinergic antihistamines preferred for treating allergic reactions)
  • CHLORPROPAMIDE (may cause prolonged hypoglycemia and/or SIADH)
  • CHLORZOXAZONE (poorly tolerated by elderly due to anticholinergic effects and possibly less effective at tolerated doses)
  • Cimetidine (may cause confusion, other CNS adverse effects)
  • CLIDINIUM-CHLORDIAZEPOXIDE (anticholinergic effects, prolonged sedation; short-acting benzodiazepines preferred) clidinium is of questionable effectiveness; avoid its use, esp. long-term)
  • Clonidine (may cause orthostatic hypotension, adverse CNS effects)
  • Cyclandelate (uncertain efficacy at doses studied)
  • CYCLOBENZAPRINE (poorly tolerated by elderly due to anticholinergic effects and possibly less effective at tolerated doses)
  • CYPROHEPTADINE (causes anticholinergic effects; non-anticholinergic antihistamines preferred for treating allergic reactions)
  • DEXCHLORPHENIRAMINE (causes anticholinergic effects; non-anticholinergic antihistamines preferred for treating allergic reactions)
  • DIAZEPAM (prolonged sedation; short-acting benzodiazepines preferred)
  • DICYCLOMINE (causes anticholinergic effects and is of questionable effectiveness; avoid its use, esp. long-term)
  • Digoxin (increased risk of toxic effects with decreased renal function; use low doses except when treating atrial arrhythmias)
  • DIPHENHYDRAMINE (causes anticholinergic effects and sedation; non-anticholinergic antihistamines preferred for treating allergic reactions; should be used only at lowest effective dose if used for allergic reactions; should not be used as a hypnotic)
  • Dipyridamole, short-acting (may cause ortho-static hypotension)
  • DISOPYRAMIDE (may cause heart failure and anticholinergic effects; avoid its use)
  • Doxazosin (hypotension, dry mouth, urinary problems)
  • DOXEPIN (anticholinergic effects and sedation)
  • Ergot mesyloids (uncertain efficacy at doses studied)
  • Estrogens only, oral forms (carcinogenicity and lack of cardioprotective effect in older women)
  • Ethacrynic acid (may cause hypertension, fluid/electrolyte imbalances; use safer alternatives)
  • Ferrous sulfate (doses over 325mg/day are not reliably absorbed but may cause constipation)
  • FLUOXETINE, daily use forms (may cause excessive CNS stimulation, agitation, sleep disturbances; use safer alternatives)
  • FLURAZEPAM (prolonged sedation may result in falls/fractures; medium or short-acting benzodiazepines preferred)
  • GUANADREL (orthostatic hypotension)
  • GUANETHIDINE (orthostatic hypotension)
  • HALAZEPAM (prolonged sedation; shortacting benzodiazepines preferred)
  • HYDROXYZINE (causes anticholinergic effects; non-anticholinergic antihistamines preferred for treating allergic reactions)
  • HYOSCYAMINE (causes anticholinergic effects and is of questionable effectiveness; avoid its use, esp. long-term)
  • INDOMETHACIN (causes the most CNS side effects among NSAIDs)
  • Isoxsurpine (uncertain efficacy)
  • KETOROLAC (avoid immediate and long-term use in elderly, because they may have asymptomatic pathological GI conditions)
  • LORAZEPAM (use lowest effective dose)
  • MEPERIDINE (may cause confusion; is of questionable efficacy at commonly used oral doses)
  • MEPROBAMATE (very addicting and sedating; slow withdrawal needed after prolonged use)
  • MESORIDAZINE (CNS and extrapyramidal adverse effects)
  • METAXALONE (poorly tolerated by elderly due to anticholinergic effects; possibly less effective at tolerated doses)
  • METHOCARBAMOL (poorly tolerated by elderly due to anticholinergic effects; possibly less effective at tolerated doses)
  • METHYLDOPA and METHYLDOPA-HCTZ (may cause bradycardia and worsen depression in elderly)
  • METHYLTESTOSTERONE (may cause prostatic hypertrophy, cardiac problems)
  • MINERAL OIL (potential for aspiration and other adverse effects; use safer alternatives)
  • NAPROXEN (avoid long-term, full-dose use due to potential to cause GI bleed, renal failure, high BP, heart failure)
  • NEOLOID (bowel dysfunction with long-term use; may be appropriate with opiate analgesics)
  • NIFEDIPINE, short acting (may cause hypotension, constipation)
  • NITROFURANTOIN (may cause renal impairment; use safer alternatives)
  • ORPHENADRINE (sedation, anticholinergic effects; use safer alternatives)
  • OXAPROZIN (avoid long-term, full-dose use due to potential to cause GI bleed, renal failure, high BP, heart failure)
  • OXAZEPAM (use lowest effective dose)
  • OXYBUTYNIN (poorly tolerated by elderly due to anticholinergic effects; possibly less effective at tolerated doses; do not consider extended-release form)
  • PENTAZOCINE (may cause more CNS adverse effects than other narcotics)
  • PERPHENAZINE-AMITRIPTYLINE (anticholinergic effects, sedation)
  • PIROXICAM (avoid long-term, full-dose use due to potential to cause GI bleed, renal failure, high BP, heart failure)
  • PROMETHAZINE (causes anticholinergic effects; non-anticholinergic antihistamines preferred for treating allergic reactions)
  • PROPANTHELINE (causes anticholinergic effects and is of questionable effectiveness; avoid its use, esp. long-term)
  • Propoxyphene and combination products (risks may outweigh benefits)
  • QUAZEPAM (prolonged sedation; short-acting benzodiazepines preferred)
  • RESERPINE (may cause depression, impotence, sedation, and orthostatic hypotension at doses over 0.25mg)
  • TEMAZEPAM (use lowest effective dose)
  • THIORIDAZINE (greater potential for CNS and extrapyramidal adverse effects)
  • THYROID, DESSICATED (possible cardiac effects; use safer alternatives)
  • TICLOPIDINE (aspirin, or other alternative drugs, may be preferable due to efficacy and safety)
  • TRIAZOLAM (use lowest effective dose)
  • TRIMETHOBENZAMIDE (less effective, and may cause extrapyramidal symptoms)
  • TRIPELENNAMINE (causes anticholinergic effects; non-anticholinergic antihistamines preferred for treating allergic reactions)
*Listings in ALL CAPS denotes “high severity”
Source: ARCHIVES OD INTERNAL MEDICINE
by
AKSHAYA SRIKANTH
Pharm.D RESIDENT
Hyderabad, India

Tidak ada komentar:

Posting Komentar