), Teldrin]
Diphenhydramine [Benadryl]
Hydroxyzine [Vistaril, Atarax
Promethazine [Phenergan]
Anticholinergic effects: constipation, urinary retention, blurred vision Second-generation antihistamines, such as cetirizine [Zyrtec], fexofenadine [Allegra], or loratadine [Claritin] ANTIHYPERTENSIVES, ALPHA-ADRENERGIC BLOCKING AGENTS Alpha1 blockers (e.g., doxazosin [Cardura], prazosin [Minipress], terazosin [Hytrin]) High risk for orthostatic hypotension and falls; less dangerous drugs are available Thiazide diuretic, ACE inhibitor, beta-adrenergic blocker, calcium channel blocker Centrally acting alpha2 agonists (e.g., clonidine [Catapres], methyldopa) Risk for bradycardia, orthostatic hypotension, adverse CNS effects, depression, sedation SEDATIVE-HYPNOTICS Barbiturates Physical dependence; compared with other hypnotics, higher risk for falls, confusion, cognitive impairment Short-term zolpidem [Ambien], zaleplon [Sonata], or eszopiclone [Lunesta]
Low-dose ramelteon [Rozerem] or doxepin
Nonpharmacologic interventions (e.g., cognitive behavioral therapy)
Benzodiazepines, both short acting (e.g., alprazolam [Xanax], lorazepam [Ativan]) and long acting (e.g., chlordiazepoxide [Librium], diazepam [Valium]) Sedation, cognitive impairment, risk for falls, delirium risk Low-dose ramelteon [Rozerem] or doxepin
Nonpharmacologic interventions (e.g., cognitive behavioral therapy)
DRUGS FOR URGE INCONTINENCE Oxybutynin [Ditropan]
Tolterodine [Detrol]
Anticholinergic effects, urinary retention, confusion, hallucinations, sedation Behavioral therapy (e.g., bladder retraining, urge suppression) MUSCLE RELAXANTS Carisoprodol [Soma]
Cyclobenzaprine
Metaxalone [Skelaxin]
Methocarbamol [Robaxin]
Anticholinergic effects, sedation, cognitive impairment; may not be effective at tolerable dosage Antispasmodics, such as baclofen [Lioresal]
Nonpharmacologic interventions (e.g., exercises, proper body mechanics)
PROTON PUMP INHIBITORS Esomeprazole [Nexium]
Lansoprazole [Prevacid]
Omeprazole [Prilosec]
Increased risk for Clostridium difficile infection, decreased bone integrity, and fractures Histamine-2 receptor antagonists (e.g., famotidine [Pepcid], ranitidine [Zantac])
Nonpharmacologic interventions (e.g., deleting foods that increase gastric acidity such as high-fat foods and deleting substances that lower esophageal sphincter pressure such as alcohol)
ACE, angiotensin-converting enzyme; CNS, central nervous system; COX-2, cyclooxygenase-2; GI, gastrointestinal; NSAIDs, nonsteroidal antiinflammatory drugs; SNRI, serotonin/norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.
Adapted from American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015;63:62227-62246. (Note: The original document lists many drugs in addition to those in this table.)
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