The body is a fascinating structure. It’s constantly evolving and changing, especially as you grow older. These developments aren’t always welcomed, as issues with your health start to percolate with each birthday — 85% of Americans over the age of 60 use prescription drugs, according to the National Center for Health Statistics.
These drugs, along with over-the-counter medications, have side effects. They vary in each individual depending on a variety of factors, including age. When you age, your liver and kidney decrease in size, leading to functional changes. You also keep more water and experience body fat percentage increases.
What does this mean? Your kidneys slow down, making it harder to process medications. This can lead to more toxic reactions and doses that last longer than normal, thus magnifying the side effects. To help keep you safe and feeling comfortable with your medications, we used the American Geriatrics Society (AGS) Criteria for Potentially Inappropriate Medication Use in Older Adults to highlight medications to shy away from, prescription drugs to reduce or be mindful of, and certain drug-drug interactions that can become problematic.
Drugs to Stay Away From
You can find the full updated list of medications to avoid or reduce here. To make it easier to digest, we highlighted some of the more notable and popular medications older adults may use.
Each individual is different, and the list isn’t meant to preclude every elderly person from taking certain medications. Instead, it groups together certain drugs that cause side effects. In some cases, it provides specific dosages to adhere to.
In any event, discuss medication changes with your doctor and remember to read your prescription labels to familiarize yourself with the active ingredients. To help avoid any mishaps or complications along the way, be sure to keep a running list of medications you’re on each time you visit your doctor. Plus, this will help you manage multiple prescriptions.
Used for: Treating depression and anxiety
Main risk: The sedative qualities in antidepressants become problematic for the elderly and can increase your risk of falls or accidents. Additionally, you’re at higher risk of developing orthostatic hypotension, a form of low blood pressure.
Common drugs: Amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, paroxetine, protriptyline, and trimipramine.
Used for: The medication targets dopamine receptors to end hallucinations or episodes of paranoia.
Main risk: Stroke and chance of death are heightened in patients with dementia. In general, avoid these drugs unless they’re needed to treat a serious disorder like bipolar or schizophrenia.
Common drugs: Aripiprazole, lurasidone, olanzapine, and risperidone.
Used for: Treating anxiety by making your brain less sensitive to stimulation
Main risk: Cognitive impairment, leading to falls or vehicle crashes, is the biggest concern. Side effects can linger since older adults can have a hard time breaking down or passing benzodiazepines through their system. The AGS considers benzodiazepines appropriate in certain cases to treat seizures or severe anxiety.
Common drugs: Alprazolam, diazepam, lorazepam, chlordiazepoxide, and clonazepam.
Used for: Managing type 2 diabetes by increasing insulin to help lower blood sugar levels
Main risk: These medications can lead to hypoglycemia, a condition caused by low blood sugar levels.
Common drugs: Chlorpropamide, glimepiride, and glyburide.
Used for: Treating gastroesophageal reflux disease (GERD). Proton pump inhibitors (PPIs) also help with stomach ulcers.
Main risk: Metoclopramide can cause movement disorders, like muscle spasms, contractions, jerky movements, and restlessness. PPIs increase your risk of an inflamed colon, known as C. Diff. Colitis.
Common drugs: Metoclopramide, omeprazole, lansoprazole, and esomeprazole.
Used for: Treating heart failure and irregular heartbeats
Main risk: The AGS recommends avoiding digoxin for first-line therapy of atrial fibrillation and heart failure. There are other safer and more effective drugs out there, like metoprolol and atenolol. Digoxin can be fatal or harmful to patients who don’t have proper kidney function.
Common drugs: Digoxin
Used for: Peripheral alpha-1 blockers and central alpha-agonists treat hypertension (high blood pressure).
Main risk: Both types of medications can increase your risk of orthostatic hypotension. You should avoid using clonidine to treat hypertension.
Common drugs: Peripheral alpha-1 blockers include doxazosin, prazosin, and terazosin; central alpha-agonists include clonidine, guanabenz, guanfacine, methyldopa, and reserpine.
Used for: Reducing muscle spasms (involuntary contractions) and muscle spasticity (chronic spasms). The latter is what we associate with diseases such as multiple sclerosis and cerebral palsy.
Main risk: You can become drowsy and groggy, which could lead to falls or accidents. The medicine has a tendency to last for long periods of time.
Common drugs: Carisoprodol, cyclobenzaprine, metaxalone, and methocarbamol.
Used for: Blocking histamine to treat allergies and colds
Main risk: Confusion, dry mouth, constipation, blurred vision, and dementia-related effects are common issues. These drugs have anticholinergic properties, meaning they can reduce your ability to control metabolism, which can lead to overheating.
Common drugs: Many of these are used on a daily basis, such as diphenhydramine for allergies, brompheniramine for cough and cold, dimenhydrinate for motion sickness, and doxylamine for sleep aid.
Used for: OTC pain relievers are used in day-to-day life to treat anything from headaches to aches and pains. Prescription pain relievers, such as opioids, are mainly used for severe, chronic pain.
Main risk: They can increase your risk of bleeding and have an impact on your blood pressure, kidneys, and can lead to heart failure. If you do use NSAIDs, a proton pump inhibitor can reduce the bleeding risk. You may be more exposed to stomach ulcers if you’re 75 or older or if you’re on oral steroids or blood thinners. We go into further detail later, but NSAIDs disrupt the stomach lining, increasing the risk of ulcers and gastrointestinal bleeding. Prescription pain medications meperidine and pentazocine can lead to higher instances of confusion and risk of seizures compared to other opioids.
Common drugs: Aspirin (more than 325 mg per day), diclofenac, ketorolac, ibuprofen, naproxen, meperidine, and pentazocine.
Used for: Barbiturates used to be the drug of choice to treat things such as sleep disorders and, in some cases, seizures. Nowadays, nonbenzodiazepines, sedatives used to treat insomnia and anxiety, are more popular.
Main risk: Barbiturates have a high rate of physical dependence, tolerance to sleep benefits, and put patients at risk of overdosing. They can also cause paranoia and impair judgment and memory. Nonbenzodiazepines, known as Z-drugs, cause confusion, which can lead to falls and accidents.
Common drugs: Barbiturates — butabarbital, pentobarbital, phenobarbital, and secobarbital; nonbenzodiazepines — eszopiclone, zaleplon, and zolpidem.
Used for: Symptoms associated with menopause
Main risk: They can heighten your risk of cancer in the uterus and breasts and blood clots.
One side note: Estrogens (cream or tablets) used to treat vaginal dryness are safe and effective, according to the ASG.
Common drugs: Estradiol, estropipate, and ospemifene.
Avoiding Certain Drug-Drug Reactions
You shouldn't use renin-angiotensin (RAS) inhibitors (ACEIs or ARBs) with another RAS Inhibitor. These blood pressure medications can increase your risk of developing high potassium levels, especially in patients with chronic kidney disease. Elevated potassium levels can cause abnormal heart rhythms.
As we outlined before, opioids, in general, can be problematic due to their increased likelihood of causing falls. You shouldn’t use opioids with benzodiazepines or gabapentin and pregabalin, two medications used to treat nerve pain and seizures. This combination can increase the risk of overdose and cardiac and respiratory incidents related to sedation.
Your doctor may prescribe certain antidepressants, antipsychotics, opioids, or benzodiazepines, but you shouldn’t combine more than three of these together at the same time as they can impact your central nervous system and lead to falls.
Avoid combining corticosteroids with NSAIDs to limit peptic ulcer disease or gastrointestinal bleeding.
If you take lithium, a popular drug to treat bipolar disorder, you’re at an increased risk of developing lithium toxicity if you combine the drug with ACE Inhibitors or loop diuretics. Loop diuretics can also cause adverse reactions when combined with peripheral alpha-1 blockers, leading to urinary incontinence (leakage) in older women.
Toxicity issues arise when combining phenytoin with trimethoprim-sulfamethoxazole or theophylline with cimetidine or ciprofloxacin.
To avoid any increased risk of bleeding, don’t use warfarin with any of the following: amiodarone, ciprofloxacin, macrolides (excluding azithromycin), trimethoprim-sulfamethoxazole, or NSAIDs. Avoid herbal supplements and vitamins if you take an anticoagulant since it can affect the way it thins your blood.
Use Caution With These Medications
Regular use of aspirin in patients 70 or older as a way to treat cardiovascular disease and colorectal cancer can be problematic. The older you get, the more aspirin can interfere with blood clotting.
Long-term use of dabigatran and rivaroxaban can increase the risk of gastrointestinal bleeding. The AGS recommends using this medication with caution for the treatment of venous thromboembolism (VTE) or atrial fibrillation in adults over the age of 75.
Use antipsychotics carbamazepine, diuretics, mirtazapine, tramadol, serotonin–norepinephrine reuptake inhibitors, and selective serotonin reuptake inhibitors with caution to avoid developing syndrome of inappropriate antidiuretic hormone secretion (SIADH). This syndrome occurs when your body makes too much antidiuretic hormone, causing the body to retain too much water.
Trimethoprim-sulfamethoxazole can make your potassium levels increase to unhealthy levels (known as hyperkalemia) if you use the medication with an ACE inhibitor or angiotensin II receptor blockers, two types of drugs used for high blood pressure.
Avoid/Reduce These Medications if You Have Poor Kidney Function
- Ciprofloxacin, an antibiotic commonly used to treat pneumonia and other bacterial infections, can increase the risk of seizures and confusion.
- Amiloride, spironolactone, triamterene are diuretics known as water pills that can increase potassium and decrease sodium levels in elderly people.
- Enoxaparin and fondaparinux, two drugs used for cardiovascular health, can increase your risk of bleeding.
- Duloxetine can increase gastrointestinal effects such as nausea and diarrhea.
- Pain medications or drugs to address nerve issues such as gabapentin, levetiracetam, pregabalin, and tramadol all have adverse effects on the central nervous system. You shouldn’t outright avoid these medications, but it’s recommended you decrease the dosage.
- High doses of gastrointestinal drugs such as cimetidine, famotidine, nizatidine, and ranitidine can affect a patient’s mental status. It’s best to consume these drugs in smaller doses.
Avoid These Medications if You Have an Existing Disease/Syndrome
Avoid cilostazol, diltiazem, and verapamil and use caution with NSAIDs, COX-2 inhibitors, pioglitazone, rosiglitazone, and dronedarone. These drugs can worsen heart failure and increase mortality.
Also known as fainting, syncope occurs when there’s not enough blood flow to your brain. Taking acetylcholinesterase inhibitors (AChEls) can lead to a slower than normal heart rate, called bradycardia. If you have syncope due to orthostatic hypotension, taking nonselective peripheral alpha-1 blockers can worsen your symptoms. Additionally, orthostatic hypotension is a common cardiac side effect of taking tertiary TCAs and antipsychotics such as chlorpromazine, thioridazine, and olanzapine.
If you suffer from any central nervous system issues, such as delirium, dementia, or cognitive impairment, there’s a laundry list of medications you should avoid. Anticholinergics, antipsychotics, benzodiazepines, corticosteroids, H2-receptor antagonists, meperidine, nonbenzodiazepines, and benzodiazepine receptor agonist hypnotics can increase the risk of strokes for people with dementia and lead to behavioral problems for those suffering from delirium. The exception is for patients where behavioral interventions haven’t worked and they are harmful to themselves or others.
History of Falls
Taking antiepileptics, antipsychotics, benzodiazepines, nonbenzodiazepines, benzodiazepine receptor agonist hypnotics, antidepressants, or opioids can cause side effects that include drowsiness, vision problems, poor coordination and balance, and dizziness. These side effects are problematic for patients with a history of falls since any of the aforementioned issues can lead to repeat problems.
The AGS recommends finding safer alternatives to use. If you must take one of these medications, avoid mixing them with another drug listed above to limit side effects. You can use antiepileptics to help treat seizures and mood disorders. You should only take opioids for acute pain, such as after surgery or a joint replacement.
Avoid antiemetics and antipsychotics (except quetiapine, clozapine, pimavanserin) due to the possibility of these drugs making Parkinson-related symptoms worse.
If you have a history of gastric or duodenal ulcers, you should avoid more than 325 mg of aspirin per day and other NSAIDs such as naproxen, ibuprofen, and diclofenac. Using these medications can block certain enzymes the stomach needs to shield itself from gastric acids that can erode the stomach lining and lead to ulcers.
- Kidney disease (stage 4 or higher) — Avoid NSAIDs as they can heighten exposure to acute kidney injury.
- Urinary incontinence — Women should avoid estrogen medications and peripheral alpha-1 blockers. Doxazosin, prazosin, and terazosin can exacerbate issues with urinary leakage.
- Lower urinary tract symptoms — Men should avoid anticholinergic drugs (except antimuscarinics). These medications can cause urinary retention.
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