Beers List Criteria: Dependent on Condition/Disease

Special Note

[potentially inappropriate drugs in patients 65 yo and older known to have a specific condition or disease]

Info: recommendation is to avoid use unless otherwise marked as (C) = caution advised, (D) = decr. dose; for tx alternatives, refer to Beers Criteria: Medication Alternatives Dependent on Condition/Disease table

CKD/Renal Impairment

[CrCl >95: edoxaban (non-valvular atrial fibrillation patients)]

Info: may incr. risk of ischemic stroke due to decr. efficacy

[CrCl <80: levetiracetam (D)]

Info: may incr. risk of CNS ADRs

[CrCl <60: gabapentin (D); pregabalin (D)]

Info: may incr. risk of CNS ADRs

[eGFR <60: baclofen]

Info: may incr. risk of CNS ADRs, including encephalopathy

[CrCl 20-59: dofetilide (D)]

Info: may incr. risk of QT prolongation, torsades de pointes

[CrCl <50: cimetidine (D); famotidine (D); nizatidine (D)]

Info: may incr. risk of mental status change

[CrCl 15-50: edoxaban (D); rivaroxaban (D)]

Info: may incr. risk of bleeding

[CrCl <30: amiloride; ciprofloxacin (D); colchicine (D); dabigatran etexilate; duloxetine; enoxaparin (D); fondaparinux; nitrofurantoin; NSAIDs (oral or parenteral); probenecid; spironolactone; tramadol extended-release; tramadol immediate-release (D); triamterene]

Info: may incr. risk of hyponatremia (amiloride, triamterene); may incr. risk of hyperkalemia (amiloride, spironolactone, triamterene); may incr. risk of CNS ADRs, tendon rupture (ciprofloxacin); may incr. risk of bleeding (dabigatrin etexilate, enoxaparin, fondaparinux); may incr. risk of GI, neuromuscular, bone marrow toxicity (colchicine); may incr. risk of GI ADRs (duloxetine); may incr. risk of pulmonary toxicity, hepatoxicity, peripheral neuropathy (nitrofurantoin); may incr. risk of nephrotoxicity (NSAIDs); decr. effectiveness (probenecid); may incr. risk of CNS ADRs (tramadol)

[CrCl 15-29: sulfamethoxazole/trimethoprim (D)]

Info: may incr. risk of worsening renal function, hyperkalemia

[CrCl <20: dofetilide]

Info: may incr. risk of QT prolongation, torsades de pointes

[CrCl <15: edoxaban; rivaroxaban; sulfamethoxazole/trimethoprim]

Info: may incr. risk of bleeding (edoxaban, rivaroxaban); may incr. risk of worsening renal function, hyperkalemia (sulfamethoxazole/trimethoprim)

Colorectal CA, Primary Prevention

[aspirin (patients 70 yo and older) (C)]

Info: may incr. risk of bleeding

Delirium

[anticholinergics; antipsychotics; benzodiazepines; corticosteroids (oral or parenteral); H2 blockers; non-benzodiazepine hypnotics; opioids]

Info: may induce/exacerbate delirium

Dementia & Cognitive Impairment

[anticholinergics; antipsychotics; benzodiazepines; dextromethorphan/quinidine (except pseudobulbar affect use) (C); non-benzodiazepine hypnotics ]

Info: may incr. risk of CNS ADRs (anticholinergics; antipsychotics; benzodiazepines; non-benzodiazepine hypnotics); limited efficacy, may incr. risk of falls (dextromethorphan/quinidine); incr. risk of stroke and rate of cognitive decline, mortality (antipsychotics)

Fall/Fracture History

[anticholinergics; anticonvulsants; antipsychotics; benzodiazepines; non-benzodiazepine hypnotics; opioids; SNRIs; SSRIs; TCAs]

Info: may produce ataxia, impaired psychomotor function, syncope, additional falls; avoid opioid use, excluding tx for severe acute pain including recent fracture or joint replacement

Gastric/Duodenal Ulcers

[aspirin; NSAIDs (excluding COX-2 inhibitors)]

Info: may exacerbate existing or produce new/additional ulcers

Heart Failure

[calcium channel blockers, non-dihydropyridine (reduced ejection fraction heart failure use); cilostazol; dextromethorphan/quinidine; dronedarone, NSAIDs, thiazolidinediones (C) (asymptomatic heart failure use); dronedarone, NSAIDs, thiazolidinediones (symptomatic heart failure use)]

Info: may promote fluid retention, exacerbate heart failure (non-dihydropyridine calcium channel blockers, NSAIDs, thiazolidinediones); may incr. mortality (cilostazol, dronedarone)

Hyponatremia/SIADH

[antipsychotics (C); carbamazepine (C); diuretics (C); mirtazapine (C); oxcarbazepine (C); SNRIs (C); SSRIs (C); TCAs (C); tramadol (C)]

Info: may exacerbate/cause SIADH

Parkinson Disease

[antipsychotics (except clozapine, pimavanserin, quetiapine); metoclopramide; prochlorperazine; promethazine]

Info: may worsen Parkinson symptoms

Syncope

[alpha-1 blockers; cholinesterase inhibitors; chlorpromazine; olanzapine; tertiary TCAs; thioridazine]

Info: may incr. risk of orthostatic hypotension, bradycardia

Urinary Incontinence, Females

[alpha-1 blockers; estrogens (systemic)]

Info: may aggravate incontinence (alpha-1 blockers); lack of efficacy (oral estrogen); may use vaginal estrogen

Urinary Tract Symptoms, Lower/BPH

[anticholinergics (except antimuscarinics)]

Info: may decr. urine flow leading to urinary retention