Beers List Criteria: Independent of Condition/Disease

Special Note

[potentially inappropriate drugs in patients 65 yo and older, independent of a specific condition or disease]

Info: recommendation is to avoid use unless marked as caution (C); for specific recommendations in renal impairment, refer to Beers Criteria: Dependent on Condition/Disease table; for tx alternatives, refer to Beers Criteria: Medication Alternatives Independent of Condition/Disease table

Allergy/Cold Agents

[antihistamines, 1st generation]

Agents: brompheniramine; carbinoxamine; chlorpheniramine; clemastine; cyproheptadine; dexchlorpheniramine; dimenhydrinate; diphenhydramine (oral); doxylamine; hydroxyzine; meclizine; promethazine; pyrilamine; triprolidine

Info: incr. risk of anticholinergic ADRs; incr. risk of tolerance (hypnotic use)

Analgesics/Musculoskeletal Agents

[muscle relaxants]

Agents: carisoprodol; chlorzoxazone; cyclobenzaprine; metaxalone; methocarbamol; orphenadrine

Info: incr. risk of anticholinergic ADRs, sedation, fractures

[NSAIDS]

Agents: aspirin (>325 mg/day); diclofenac; diflunisal; etodolac; fenoprofen; flurbiprofen; ibuprofen; indomethacin; ketoprofen; ketorolac; meclofenamate; mefenamic acid; meloxicam; nabumetone; naproxen; oxaprozin; piroxicam; sulindac; tolmetin

Info: incr. risk of GI bleeding, PUD, HTN, acute kidney injury; incr. risk of CNS ADRs (indomethacin)

[opioids]

Agents: meperidine; pentazocine/naloxone

Info: incr. risk of neurotoxicity (meperidine); incr. risk of CNS ADRs (pentazocine/naloxone)

Cardiovascular Agents

[alpha-1 blockers (HTN use)]

Agents: doxazosin; prazosin; terazosin

Info: incr. risk of orthostatic hypotension

[alpha agonists]

Agents: clonidine (1st-line HTN use); guanfacine; methyldopa

Info: incr. risk of adverse CNS effects, bradycardia, orthostatic hypotension

[antiarrhythmics]

Agents: amiodarone; digoxin (>0.125 mg/day); disopyramide; dronedarone

Info: avoid as 1st-line in atrial fibrillation except in heart failure or substantial left ventricular hypertrophy, incr. risk of thyroid, pulmonary toxicity, QT prolongation (amiodarone); avoid as 1st-line in atrial fibrillation and heart failure, incr. risk of mortality, toxicity, hospitalization in patients with heart failure, consider dose reduction in patients with stage IV or V CKD (digoxin); incr. risk of negative inotropic effects, anticholinergic ADRs (disopyramide); avoid use in permanent atrial fibrillation or with severe or recently decompensated heart failure (dronedarone)

[anticoagulants/antithrombotics]

Agents: aspirin (primary prevention use in patients 70 yo and older); dabigatran etexilate (long-term VTE or nonvalvular afib use in patients 75 yo and older) (C); dipyridamole (oral IR); prasugrel (patients 75 yo and older) (C); rivaroxaban (long-term VTE or nonvalvular afib use in patients 75 yo and older); ticagrelor (C); warfarin (VTE or nonvalvular afib tx initiation)

Info: incr. risk of bleeding; incr. risk of orthostatic hypotension (dipyridamole)

[calcium channel blockers]

Agents: nifedipine (IR)

Info: incr. risk of hypotension, myocardial ischemia

CNS Agents

[antidepressants]

Agents: amitriptyline; amoxapine; clomipramine; desipramine; doxepin (>6 mg/day); imipramine; nortriptyline; paroxetine; protriptyline; trimipramine

Info: incr. risk of anticholinergic ADRs, orthostatic hypotension

[antipsychotics]

Agents: aripiprazole; asenapine; brexpiprazole; cariprazine; chlorpromazine; clozapine; fluphenazine; haloperidol; iloperidone; loxapine; lurasidone; molindone; olanzapine; paliperidone; perphenazine; pimavanserin; pimozide; prochlorperazine; quetiapine; risperidone; thioridazine; thiothixene; trifluoperazine; ziprasidone

Info: avoid use except in schizophrenia, bipolar disorder, short-term chemo antiemetic use; incr. risk of stroke, cognitive decline, mortality (dementia use); incr. risk of anticholinergic ADRs (chlorpromazine; clozapine; loxapine; olanzapine; perphenazine; thioridazine; trifluoperazine); incr. risk of QT prolongation (thioridazine)

[anxiolytics, non-benzodiazepine]

Agents: meprobamate

Info: incr. risk of dependence, sedation

[barbiturates]

Agents: butalbital; pentobarbital; phenobarbital; primidone

Info: incr. risk of dependence, tolerance (hypnotic use); incr. risk of overdose at low doses

[benzodiazepines (insomnia, agitation, delirium use)]

Agents: alprazolam; chlordiazepoxide; clobazam; clonazepam; clorazepate; diazepam; estazolam; lorazepam; midazolam; oxazepam; quazepam; temazepam; triazolam

Info: incr. risk of cognitive impairment, delirium, falls, fractures, motor vehicle accidents

[ergot mesylates]

Agents: dihydroergotamine; ergotamine

Info: lack of efficacy

[hypnotics, non-benzodiazepine]

Agents: eszopiclone; zaleplon; zolpidem

Info: incr. risk of delirium, falls, fractures, ED/hospitalization, motor vehicle accidents

Endocrine Agents

[androgens ]

Agents: methyltestosterone; testosterone

Info: avoid use except for confirmed hypogonadism with clinical symptoms; incr. risk of cardiac ADRs; contraindicated in patients with prostate CA

[estrogens (+/- progestogen)]

Agents: estradiol; estrogens, conjugated; estrogens, esterified; estropipate

Info: incr. risk of breast, endometrial CA; low-dose vaginal estrogen (<25 mcg twice weekly) acceptable

[growth hormones]

Agents: somatropin

Info: avoid except for confirmed growth hormone deficiency; incr. risk of edema, arthralgia, carpal tunnel syndrome, gynecomastia, impaired fasting glucose

[insulins]

Agents: short or rapid-acting as monotherapy (sliding scale); glulisine; lispro; regular

Info: incr. risk of hypoglycemia

[progestogens]

Agents: megestrol

Info: incr. risk of thrombotic events

[SGLT2 inhibitors]

Agents: canagliflozin (C); dapagliflozin (C); empagliflozin (C); ertugliflozin (C)

Info: incr. risk of urogenital infection, especially in females, euglycemic diabetic ketoacidosis

[sulfonylureas]

Agents: glimepiride; glipizide; glyburide

Info: incr. risk of cardiovascular events, all-cause mortality, hypoglycemia

[thyroid hormones, dessicated]

Agents: thyroid (porcine)

Info: incr. risk of cardiac ADRs

Gastrointestinal/Genitourinary Agents

[antidiuretic agents]

Agents: desmopressin (nocturia or nocturnal polyuria use)

Info: incr. risk of hyponatremia

[antispasmodics]

Agents: atropine (excludes ophthalmic); belladonna alkaloids; chlordiazepoxide/clidinium; dicyclomine; hyoscyamine; methscopolamine; scopolamine

Info: incr. risk of anticholinergic ADRs

[laxatives]

Agents: mineral oil (oral)

Info: incr. risk of aspiration, ADRs

[PPIs (long-term use)]

Agents: dexlansoprazole; esomeprazole; lansoprazole; omeprazole; pantoprazole; rabeprazole

Info: incr. risk of C. difficile infection, bone loss, fractures; avoid tx duration >8wk unless benefits outweigh risks

[prokinetic agents]

Agents: metoclopramide (except gastroparesis use)

Info: avoid except for gastroparesis use not to exceed 12wk duration except in rare cases; incr. risk of extrapyramidal symptoms, tardive dyskinesia

[urinary antimicrobials]

Agents: nitrofurantoin (long-term use or CrCl <30)

Info: incr. risk of pulmonary toxicity, hepatoxicity, peripheral neuropathy

Neurologic Agents

[antiparkinson agents]

Agents: benztropine (oral); trihexyphenidyl

Info: incr. risk of anticholinergic ADRs