Polypharmacy Factors Pt 5

This is #5 in the series about why we should be concerned with seniors taking so many pills:   Beer’s List of Potentially Inappropriate Medications – the Category II Drugs.


Category II has drugs to be avoided because those drugs may significantly worsen a disease or other condition.  I’ve chosen a sample of some of the diseases, followed by a few of the problematic drugs and why they’re included; again, for the complete listing, go on-line and search for Beers Criteria.

-Heart Failure:  Anti-inflammatories, such as ibuprofen, because they promote fluid retention and make heart failure worse.

– Syncope [fainting]:  drugs to slow down the decline of Alzheimer’s disease, such as donepezil [Aricept]; certain antihypertensives, such as doxazosin [Cardura], terazosin [Hytrin], because they often drop blood pressure when standing up, causing dizziness and falling.

– Delirium [confusion]:  all anti-anxiety meds, like diazepam [Valium]; the antihistamines, like diphenhydramine [Benadryl]; the steroids, like prednisone.

– Dementia:  antihistamines, like diphenhydramine [Benadryl]—and many more.

– History of falls or fractures:  anticonvulsants, like phenytoin [Dilantin]; all the antianxiety drugs and the hypnotics [sleeping pills]; all the anti-psychotics [like Seroquel].

– Insomnia [can’t sleep]:  decongestants with pseudoephedrine; any caffeine.

– Parkinson’s Disease:  all antipsychotics; anti-vomiting drugs, like metoclopramide [Reglan].

– Chronic constipation:  drugs for bladder urgency, like oxybutynin [Detrol]; antihistamines, like chlorpheniramine [Dramamine], diphenhydramine [Benadryl]; the anticholinergics and antispasmodics [muscle or bowel relaxants].

– History of stomach ulcers:  aspirin [ASA]; all anti-inflammatories, such as ibuprofen [Motrin].

– Chronic kidney disease:  any anti-inflammatory can make the kidney damage worse.

– Remember, not everyone will have side-effects.  But, sometimes it’s worthwhile stopping a particular drug for awhile and see if you feel better off it.


Next time:  the Category III drugs.