Polypharmacy IV

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 includes drugs potentially inappropriate in general and therefore should be avoided by all seniors. 

Each ‘Class’ is underlined and lists a few of the better known drugs: the generic, with brand name in brackets, is followed by the main reason for concern.  For a complete description, search for Beers Criteria on-line (Wikipedia 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; not recommended for ‘routine’ treatment  (there are others that are better for daily use).

Anti-arrhythmics [control heart rhythm] – amiodarone [Cordarone] is strongly discouraged because it’s toxic to so many organs; guidelines advise safer alternatives.

Antipsychotics, such as risperidone [Risperdal], haloperidol [Haldol] – slightly increase the risk of stroke and dying; intended principally for schizophrenias; however, Haldol is 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 plus the same anti-anxiety group side-effects.

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

Anti-inflammatories [pain relief], such as ibuprofen [Motrin, Advil], naproxen [Aleve] – all increase the risk of bleeding, kidney failure, and confusion.  Using one occasionally is not 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.