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