Microsoft word - potentially inappropriate medications in the elderly 07_08.doc
Potentially Inappropriate Medications in the Elderly Medications with Severity Rating of High1,2 Medication Prescribing Concern2 Possible Alternatives Amitriptyline (Elavil®)
• Has strong anticholinergic and sedating
Consider an antidepressant agent with less sedation and
Amitriptyline/ chlordiazepoxide
fewer anticholinergic effects (Pamelor® (g), Norpramin® (g),
(Limbitrol®, Limbitrol DS®)
• Rarely the antidepressant of choice in elderly
• Cause more side effects than most other
Avoid use in the elderly, except when used to control
Barbiturates (except phenobarbital)
sedative or hypnotic drugs in the elderly
• These anti-anxiety agents have a long half-life in
If a benzodiazepine is necessary, consider a smaller dose of
Chlordiazepoxide (Librium®)
a short or intermediate-acting agent (Ativan® <3mg (g),
Diazepam (Valium®)
• May cause prolonged sedation and increase the
Serax® <60mg (g), Xanax® <2mg (g), Restoril® <15mg (g),
• Has a prolonged half-life in the elderly
• Can cause prolonged and serious hypoglycemia
Consider a second generation sulfonylurea (Glucotrol® (g),
Chlorpropamide (Diabinese®)
• May also cause syndrome of inappropriate
secretion of antidiuretic hormone (SIADH)
• Gastrointestinal antispasmodic agents are highly
Dicyclomine (Bentyl®) Hyosycamine (Levsin®, Levsinex®)
• Generally produce substantial toxic effects in the
Avoid gastrointestinal antispasmodics in the elderly,
Belladonna alkaloids (Donnatal®) Clidinium-chlordiazepoxide (Librax®)
• Effectiveness at doses tolerated by the elderly is
Use the smallest dose possible if the use of Benadryl® is
Diphenhydramine (Benadryl®)
• The most potent negative inotrope of all the
When appropriate, other antiarrhythmic drugs should be
Disopyramide (Norpace®, Norpace CR®)
• May induce heart failure in the elderly
• Has strong anticholinergic and sedating
Consider an antidepressant with less sedation and fewer
Doxepin (Sinequan®)
anticholinergic effects (Pamelor® (g), Norpramin® (g),
• Rarely the antidepressant of choice in the elderly Celexa® (g), Lexapro®3).
Medication Prescribing Concern2 Possible Alternatives
Consider safer alternatives (Celexa (g)®, Lexapro®3,
Fluoxetine (Prozac®) daily
• May produce excessive CNS stimulation, sleep
• Has an extremely long half-life in the elderly
If a benzodiazepine is necessary, consider a medium- or
Flurazepam (Dalmane®)
short-acting benzodiazepine (Restoril® <15mg (g), Halcion®
May cause prolonged sedation and increase the
• Causes the most CNS adverse events of all the
Indomethacin (Indocin®, Indocin SR®)
available nonsteroidal anti-inflammatory agents
Avoid use in the elderly, safer alternatives exist.
• May cause renal failure and/or hypertension • May cause confusion
Meperidine (Demerol®)
• Not an effective oral analgesic in doses
Avoid use in the elderly, morphine is the preferred agent.
Meprobamate (Equanil®, Miltown®)
• If used for prolonged periods of time, the drug
Methocarbamol (Robaxin®) Chlorzoxazone (Parafon Forte DSC)
• Most muscle relaxants and antispasmodics are
Orphenadrine (Norflex)
Avoid use of any skeletal muscle relaxants in the elderly.
Carisoprodol (Soma®)
• Can cause anticholinergic adverse events,
Metaxalone (Skelaxin®) Cyclobenzaprine (Flexeril®)
• May cause bradycardia and exacerbate
Consider an alternative treatment for hypertension (a
Methyldopa (Aldomet®, Aldoril®)
• Causes a higher incidence of confusion,
Pentazocine (Talwin compound®,
Consider other moderate pain relievers (acetaminophen or
hallucinations and other CNS side effects than
Talacen®, Talwin NX®)
• Offers few analgesic advantages over
Propoxyphene (Darvon®)
Consider other moderate pain relievers (acetaminophen or
Propoxyphene/acetaminophen
• May cause prolonged sedation and increase the
(Darvocet®)
Consider alternative antiplatelet agents (aspirin, or Plavix® if
Ticlopidine (Ticlid®)
• Not much better than aspirin in clot prevention
• Least effective of all antiemetic drugs
Consider safer alternatives (Compazine® <10mg (g),
Trimethobenzamide (Tigan®)
• Causes the most extrapyramidal side effects of
1 Potentially Inappropriate Medications in the Elderly- alternative medications. Approved by BCBSM/BCN Pharmacy and Therapeutics Committee April 15, 2004.
3 BCN requires step therapy for use of Lexapro.
Drug Foundation summary of recent research on ‘party pills’ containing BZP February 2007 This paper summarises recent research findings on BZP/party pills, and outlines the current legislative status of BZP. It is being made available to assist organisations or people wanting to make submissions on the proposal to reclassify BZP and its analogues. Please note that these are the Drug Foundati
M. Votava · M. Krsˇiak · J. Podhorná · K.A. Miczek Alprazolam withdrawal and tolerance measured in the social conflict test in mice Abstract Rationale: It is difficult to assess withdrawal locomotion while aggression tended to be increased. from benzodiazepines, and preclinical assessment of be- Conclusions: Tolerance to the alprazolam effects on ag-haviour during social conflict
Potentially Inappropriate Medications in the Elderly