Cautionary Drugs

Among seniors, 30% of hospital admissions can be linked to drug-related problems, and a study that was published in 2004, found that more than 20% of seniors in the United States use a medication that is probably not appropriate for them. Click on the links below to learn more about certain medications that may not be good choices for seniors. If you are taking one of the medications listed, talk to your doctor at your next appointment to see if you should continue using the medication.

• Allergy medications
• Antibiotics
• Antidepressants
• Antiemetics
• Antipsychotics
• Bladder Medications
• Blood pressure medications
• Blood-thinning medications
• Diabetes medications
• Heart medications
• Hormones
• Laxatives
• Medications for Sleep Disorders
• Muscle relaxers
• Pain relief medications
• Stomach medications
• Supplements
• Vasodilators

Allergy Medications

1. Diphenhydramine (Benadryl)
   • This non-prescription medication can cause an increased incidence of drowsiness, dry mouth, dry eyes, constipation, and decreased urination in seniors.
   • Using this drug on a daily basis to help treat insomnia is generally not recommended because of these side effects.

2. Hydroxyzine (Vistaril, Atarax)
   • This medication can cause an increased incidence of dry mouth, dry eyes, constipation, and decreased urination in seniors.

3. Chlorpheniramine (Chlor-Trimeton)
   • This medication can cause an increased incidence of dry mouth, dry eyes, constipation, and decreased urination in seniors.

4. Cyproheptadine (Periactin)
   • This medication can cause an increased incidence of dry mouth, dry eyes, constipation, and decreased urination in seniors.

5. Promethazine (Phenergan)
   • This medication can cause an increased incidence of dry mouth, dry eyes, constipation, and decreased urination in seniors.

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Antibiotics

1. Nitrofurantoin (Macrodantin)
   • Seniors are at increased risk for experiencing kidney damage with this medication.

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Antidepressants

1. Amitriptyline (Elavil) or combination products containing amitriptyline (Triavil, Limbitrol)
   • These medications can predispose a senior to develop arrhythmias (irregular heart rate).
   • They can also cause orthostatic hypotension (a drop in blood pressure resulting in lightheadedness when standing up).
   • These medications can also cause an increased incidence of dry mouth, dry eyes, constipation, and decreased urination in seniors.
   • These medications can have a strong sedating effects in seniors.

2. Doxepin (Sinequan)
   • This medication can predispose a senior to develop arrhythmias (irregular heart rate).
   • It can also cause orthostatic hypotension (a drop in blood pressure resulting in lightheadedness when standing up).
   • This medication can also cause an increased incidence of dry mouth, dry eyes, constipation, and decreased urination in seniors.
   • This medication can have a strong sedating effect in seniors.

3. Fluoxetine (Prozac)
   • When this medication is taken daily, it can cause sleep disturbances and agitation.

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Antiemetics

1. Trimethobenzamide (Tigan)
   • This medication can cause an increased incidence of involuntary movements of the mouth, lips, tongue; tremors; body restlessness (pacing and inability to sit still); changes in breathing and heart rate.

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Antipsychotics

1. Mesoridazine (Serentil)
   • Seniors are more likely to experience sedation and other adverse effects including; muscle spasms of face, neck, body, arms, or legs, causing unusual postures or expressions on face; sticking out of tongue; tic-like or twitching movements; or trouble in breathing, speaking, or swallowing.

2. Thioridazine (Mellaril)
   • Seniors are more likely to experience sedation and other adverse effects including; muscle spasms of face, neck, body, arms, or legs, causing unusual postures or expressions on face; sticking out of tongue; tic-like or twitching movements; or trouble in breathing, speaking, or swallowing.

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Bladder Medications

1. Oxybutynin (Ditropan)
   • Seniors are at increased risk for experiencing certain side effects from this medication including dry mouth, dry eyes, constipation, difficulty urinating, confusion, blurred vision, or fast heart rate.

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Blood Pressure Medications

1. Clonidine (Catapres)
   • This medication can cause orthostatic hypotension (a drop in blood pressure resulting in lightheadedness when standing up).
   • Seniors are more likely to experience side effects, like drowsiness, anxiety or depression from this medication.

2. Doxazosin (Cardura)
   • This medication can cause dry mouth and urinary problems in seniors.

3. Ethacrynic acid (Edecrin)
   • This medication can cause high blood pressure or too much loss of fluid.

4. Guanadrel (Hylorel)
   • This medication can cause orthostatic hypotension (a drop in blood pressure resulting in lightheadedness when standing up).

5. Guanethidine (Ismelin)
   • This medication can cause orthostatic hypotension (a drop in blood pressure resulting in lightheadedness when standing up).

6. Methyldopa (Aldomet) or combination products containing methyldopa (Aldoril)
   • Methyldopa can lower heart rate, especially in seniors.
   • It can cause an increase in sedation.
   • Methyldopa can cause orthostatic hypotension (a drop in blood pressure resulting in lightheadedness when standing up).

7. Reserpine (Serpasil) or combination products containing reserpine (Hydropres, Hydroserp, Salutensin)
   • Reserpine at high doses can cause an increase in sedation or depression in seniors.
   • Reserpine at high doses and combination products containing this medication can cause orthostatic hypotension (a drop in blood pressure resulting in lightheadedness when standing up).

8. Short-acting nifedipine (Procardia and Adalat)
   • The short-acting forms of these medications are more likely to cause sudden drops in blood pressure.
   • These medications can also cause constipation.

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Blood-Thinning Medications

1. Ticlodipine (Ticlid)
   • This medication is used in seniors but can cause changes in blood cell concentrations. Seniors who take Ticlid need to be monitored closely by their doctor, who will order certain laboratory tests to check blood cell counts.

2. Dipyridamole (Persantine)
   • This medication is no more effective than aspirin in preventing stroke and should generally not be used instead of aspirin in seniors, except in cases of intolerance or allergy to aspirin.
   • Dipyridamole commonly causes orthostatic hypotension (a drop in blood pressure resulting in lightheadedness when standing up).

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Diabetes Medications

1. Chlorpropamide (Diabinese)
   • This drug stays in the body for a long time and, because of this, can cause prolonged low blood sugar levels. Low blood sugar levels can cause weakness and dizziness, which can contribute to falls.
   • Newer blood sugar-lowering medications that are shorter-acting and safer for seniors to use are available.

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Heart Medications

1. Amiodarone (Cordarone)
   • This medication is not as effective in seniors and is associated with irregular heart rhythms.

2. Digoxin (Lanoxin)
   • High doses of this medication can increase the risk of adverse effects, like irregular heart rhythm, nausea, diarrhea, confusion or vision changes.

3. Disopyramide (Norpace/Norpace CR)
   • This medication can possibly cause heart failure in seniors and should be used with caution.
   • It can also cause side effects like dry mouth, dry eyes, constipation or decreased urination.

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Hormones

1. Desiccated thyroid
   • This medication can cause heart problems, including an abnormal heart rhythm.

2. Methyltestosterone (Android, Virilon and Testrad)
   • This medication can cause growth of the prostate gland.
   • This medication can cause heart problems.

3. Oral estrogens
   • When oral estrogen is used alone it can increase the risk of breast and endometrial cancer.

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Laxatives

1. Bisacodyl (Dulcolax)
   • Long-term use of stimulant laxatives, like bisacodyl, can make bowel problems worse.

2. Cascara sagrada
   • Long-term use of stimulant laxatives, like cascara sagrada, can make bowel problems worse.

3. Mineral Oil
   • If mineral oil is accidentally inhaled into the lungs it can cause serious lung disease. There are safer laxatives available for use.

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Medications for Sleep Disorders

1. Alprazolam (Xanax), doses greater than 2 mg
   • Alprazolam can be addictive if used improperly.
   • This medication can cause sedation and, because of this, use of alprazolam by seniors can contribute to falls and accidents and cause confusion and amnesia.

2. Chlordiazepoxide (Librium)
   • Chlordiazepoxide can be addictive if used improperly.
   • Seniors are at increased risk for experiencing certain side effects from this medication including confusion, hallucinations, dry mouth, constipation, difficulty urinating.
   • Because of the effects of this medication, use of chlordiazepoxide by seniors can contribute to falls and accidents and cause confusion and sedation.

3. Diazepam (Valium)
   • Diazepam can be addictive if used improperly.
   • Seniors are at increased risk for experiencing certain side effects from this medication including confusion, hallucinations, dry mouth, constipation, difficulty urinating.
   • Because of the effects of this medication, use of diazepam by seniors can contribute to falls and accidents and cause confusion and sedation.

4. Flurazepam (Dalmane)
   • Flurazepam can be addictive if used improperly.
   • This medication stays in the body for a long time (days). Because of this, it can produce a prolonged feeling of sleepiness.
   • Due to the effects of this medication, use of flurazepam by seniors can contribute to falls and accidents and cause confusion and sedation.

5. Quazepam (Doral)
   • Quazepam can be addictive if used improperly.
   • This medication stays in the body for a long time (days). Because of this, it can produce a prolonged feeling of sleepiness.
   • Due to the effects of this medication, use of quazepam by seniors can contribute to falls and accidents and cause confusion and sedation.

6. Lorazepam (Ativan), doses greater than 3 mg
   • Lorazepam can be addictive if used improperly.
   • This medication can cause sedation and, because of this, use of lorazepam by seniors can contribute to falls and accidents and cause confusion and amnesia.

7. Oxazepam (Serax), doses greater than 60 mg
   • Oxazepam can be addictive if used improperly.
   • This medication can cause sedation and, because of this, use of oxazepam by seniors can contribute to falls and accidents and cause confusion and amnesia.

8. Meprobamate (Miltown, Equanil)
   • Meprobamate can be addictive if used improperly.
   • This medication can cause sedation and, because of this, use of meprobamate by seniors can contribute to falls and accidents and cause confusion.

9. Temazepam (Restoril), doses greater than 15 mg
   • Temazepam can be addictive if used improperly.
   • This medication can cause sedation and, because of this, use of temazepam by seniors can contribute to falls and accidents and cause confusion and amnesia.

10. Triazolam (Halcion), doses greater than 0.25 mg
    • Triazolam can be addictive if used improperly.
    • This medication can cause sedation and, because of this, use of triazolam by seniors can contribute to falls and accidents and cause confusion and amnesia.

11. Amphetamine (Adderall)
    • Amphetamine can be addictive if used improperly.
    • This medication can cause high blood pressure and heart disease.
    • This medication may cause behavior problems or irritability.

12. Dextroamphetamine (Dexedrine)
    • Dextroamphetamine can be addictive if used improperly.
    • This medication can cause high blood pressure and heart disease.
    • This medication may cause behavior problems or irritability.

13. Methamphetamine (Desoxyn)
    • Methamphetamine can be addictive if used improperly.
    • This medication can cause high blood pressure and heart disease.
    • This medication may cause behavior problems or irritability.

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Muscle Relaxers

1. Carisopodol (Soma)
   • Seniors are at increased risk for experiencing certain side effects from this medication including dry mouth, dry eyes, constipation, and difficulty urinating.

2. Cyclobenzaprine (Flexeril)
   • Seniors are at increased risk for experiencing certain side effects from this medication including dry mouth, dry eyes, constipation, and difficulty urinating.

3. Methocarbamol (Robaxin)
   • Seniors are at increased risk for experiencing certain side effects from this medication including dry mouth, dry eyes, constipation, and difficulty urinating.

4. Orphenadrine (Norflex)
   • Seniors are at increased risk for experiencing certain side effects from this medication including sedation, dry mouth, dry eyes, constipation, and difficulty urinating.

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Pain relief medications

1. Meperidine (Demerol)
   • Use of this medication in seniors can increase the risk for seizures and side effects such as dry mouth, dry eyes, constipation, and decreased urination.

2. Pentazocine (Talwin)
   • Of all the narcotic pain medications, pentazocine causes the most confusion and hallucinations.

3. Proproxyphene with Acetaminophen (Darvocet or Darvon)
   • Rated no more effective than acetaminophen (Tylenol) or aspirin for pain relief; Darvocet or Darvon can increase the risk of dependence, increase sedation, and increase confusion.
   • The proproxyphene component of these medications can also cause constipation.

4. Indomethacin (Indocin/Indocin SR)
   • Of all the non-steroidal anti-inflammatory drugs (NSAIDs), this medication is associated with the highest incidence of confusion and dizziness. Other available NSAIDs are associated with a lower incidence of these side effects.

5. Ketorolac (Toradol)
   • This NSAID is associated with a high incidence of stomach irritation and can increase the risk of developing an ulcer.

6. Naproxen (Naprosyn, Avaprox and Aleve)
   • This NSAID can increase the risk of experiencing a bleed into the stomach or intestine or kidney failure.
   • It can also worsen high blood pressure or heart failure.

7. Oxaprozin (Daypro)
   • This NSAID can increase the risk of experiencing a bleed into the stomach or intestine or kidney failure.
   • It can also worsen high blood pressure or heart failure.

8. Piroxicam (Feldene)
   • This NSAID can increase the risk of experiencing a bleed into the stomach or intestine or kidney failure.
   • It can also worsen high blood pressure or heart failure.

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Stomach Medications

1. Cimetidine (Tagamet)
   • This medication can cause confusion, anxiety or depression.

2. Clidinium/chlordiazepoxide (Librax)
   • Seniors are at increased risk for experiencing certain side effects from this medication including: confusion, hallucinations, dry mouth, constipation, and difficulty urinating.
   • Because of the effects of this medication, use by seniors can contribute to falls and accidents and cause confusion and sedation.

3. Dicyclomine (Bentyl)
   • Seniors are at increased risk for experiencing certain side effects from this medication including: confusion, hallucinations, dry mouth, constipation, difficulty urinating.

4. Hyoscyamine (Levsin)
   • Seniors are at increased risk for experiencing certain side effects from this medication including: confusion, hallucinations, dry mouth, constipation, difficulty urinating.

5. Propantheline (Pro-Banthine)
   • Seniors are at increased risk for experiencing certain side effects from this medication including: confusion, hallucinations, dry mouth, constipation, difficulty urinating. Long-term use should be avoided.

6. Belladonna alkaloids (Donnatal and others)
   • Seniors are at increased risk for experiencing certain side effects from this medication including: confusion, hallucinations, dry mouth, constipation, difficulty urinating. Long-term use should be avoided.

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Supplements

1. Ferrous sulfate (Iron)
   • Iron doses greater than 325mg per day are not likely to be more effective, but can cause more constipation in seniors.

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Vasodilators

1. Isoxsuprine (Vasodilan)
   • This medication can cause a sudden drop in blood pressure, which could result in falls and fractures.

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References

1. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Archives of Internal Medicine. 2003;163:2716-2724.

2. Curtis LH, Ostbye T, Sendersky V, et al. Inappropriate Prescribing for Elderly Americans in a Large Outpatient Population. Archives of Internal Medicine. 2004 Aug;164(15):1621-1625.
   
   
   
   
   
   Last Updated: July 2007