Polypharmacy Factors Pt 4

This is #4 in the series about why we should be concerned with seniors taking so many pills:   Beer’s List of Potentially Inappropriate Medications – the Category I Drugs.



Category I is drugs which are potentially inappropriate in general and therefore should be avoided by all seniors—even though some folks may never be bothered, others may experience problematic side-effects.  Side-effects tend to be similar among drugs in the same class.

Each ‘Class’ is underlined and I will name a few of the better known drugs within each; the generic is followed by the brand name in brackets, followed by the main reason for concern.  For a complete description of all the drugs, do a search for Beers Criteria on-line (Wikepedia has it).

– Anti-histamines and anti-cholinergics, such as diphenhydramine [Benadryl], hydroxyzine [Vistaril], and promethazine [Phenergan]:  all tend to cause drowsiness, dry mouth, constipation, and confusion, increasing the risk of falling especially at night (because they’re often used in ‘sleep aids’).

– Anti-hypertensives [for blood pressure]:  doxazosin [Cardura], methyldopa [Aldomet], clonidine [Catapres] – often drop blood pressure when you stand, causing dizziness and falls, and are not recommended for ‘routine’ treatment  (there are others that are better for daily use).

– Anti-arrhythmics [control heart rhythm] – amiodarone [Cordarone] is discouraged because it’s toxic to the thyroid, the lung, etc.; clinical guidelines advise safer alternatives.

– Antipsychotics, such as risperidone [Risperdal], haloperidol [Haldol] – slightly increase the risk of stroke and dying; intended principally for schizophrenias; minimally effective for controlling agitation in dementias, but can be helpful in delirium.

– Anti-anxiety meds [benzodiazepines], such as diazepam [Valium], alprazolam [Xanax], lorazepam [Ativan] – risk of confusion, falls, fractures.

– Hypnotics [for insomnia], such as zolpidem [Ambien]—risk of amnesia as well as all the same side-effects that the anti-anxiety group has.

– Muscle relaxants, such as carisoprodol [Soma], cyclobenzaprine [Flexeril] – increased drowsiness, falls, risk of fracture; and are of questionable effectiveness.

– Anti-inflammatories [pain relief], such as ibuprofen [Motrin, Advil], naproxen [Aleve] – all increase the risk of bleeding and of kidney failure and confusion.  Using one occasionally will not likely cause a problem; it’s the daily use that needs to be avoided.


Next time:  Category II drugs – those to avoid if you have a particular disease.