Criteria for Potentially Inappropriate Medication Use in Older Adults: Independent of Diagnoses or Conditions

A

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Adalat	Nifedipine	Similar to:Procardia	Short acting	Potential for hypotension and constipation.
Aldomet	Methyldopa	Similar to:Aldoril	NA	May cause bradycardia and exacerbate depression in elderly patients.
Aldoril	Methyldopa-hydrochlorothiazide	Similar to:Aldomet	NA	May cause bradycardia and exacerbate depression in elderly patients.
Aleve	Naproxen	Non–COX-selective NSAIDs (Non-Cyclooxygenase-Selective Nonsteroidal Anti-Inflammatory Drugs)	Long-term use of full-dosage, longer half-life	Have the potential to produce (GI: gastrointestinal) bleeding, renal failure, high blood pressure, and heart failure.
Amphetamines	Amphetamines	Excluding  : Methylphenidate hydrochloride Excluding : Anorexics		(CNS:central nervous system) stimulant adverse effects.
Amphetamines agents	Amphetamines agents	Amphetamines agents	NA	These drugs have potential for causing dependence, hypertension, angina, and myocardial infarction.
Android	Methyltestosterone	Similar to:Virilon and Testrad	NA	Potential for prostatic hypertrophy and cardiac problems
Anorexic agents	Anorexic agents	Anorexic agents	NA	These drugs have potential for causing dependence, hypertension, angina, and myocardial infarction.
Atarax	Hydroxyzine	Anticholinergics and antihistamines:	NA	All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions.
Ativan	Lorazepam	Benzodiazepines:Doses of short-acting	For doses greater than 3 mg	Because of increased sensitivity to benzoadiazepines in elderly patients, smaller doses may be effective as well as safer. Total daily doses should rarely exceed the suggested maximums.
Avaprox	Naproxen	Non–COX-selective NSAIDs (Non-Cyclooxygenase-Selective Nonsteroidal Anti-Inflammatory Drugs)	Long-term use of full-dosage, longer half-life	Have the potential to produce (GI: gastrointestinal) bleeding, renal failure, high blood pressure, and heart failure.

B

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Barbiturates	Barbiturates	All type except phenobarbital	Except when used to control seizures	Are highly addictive and cause more adverse effects than most sedative or hypnotic drugs in elderly patients.
Benadryl	Diphenhydramine	Anticholinergics and antihistamines:	NA	All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions. May cause confusion and sedation. Should not be used as a hypnotic, and when used to treat emergency allergic reactions, it should be used in the smallest possible dose.
Bentyl	Dicyclomine	Gastrointestinal antispasmodic drugs	NA	(GI: gastrointestinal) antispasmodic drugs are highly anticholinergic and have uncertain effectiveness. These drugs should be avoided (especially for long-term use).

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CCCC

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Cascara sagrada	Cascara sagrada	Stimulant Laxatives	Long-term use Except in the presence of opiate analgesic use	May exacerbate bowel dysfunction.
Chlor-Trimeton	Chlorpheniramine	Anticholinergics and antihistamines:	NA	All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions.
Cordarone	Amiodarone	Only This Drug	NA	Associated with QT interval problems and risk of provoking torsades de pointes. Lack of efficacy in older adults.

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DDDD

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Dalmane	Flurazepam	Only This Drug	NA	This benzodiazepine hypnotic has an extremely long half-life in elderly patients (often days), producing prolonged sedation and increasing the incidence of falls and fracture. Medium- or short-acting benzodiazepines are preferable.
Daypro	Oxaprozin	Non–COX-selective NSAIDs (Non-Cyclooxygenase-Selective Nonsteroidal Anti-Inflammatory Drugs)	Long-term use of full-dosage, longer half-life	Have the potential to produce (GI: gastrointestinal) bleeding, renal failure, high blood pressure, and heart failure.
Demerol	Meperidine	Only This Drug	NA	Not an effective oral analgesic in doses commonly used. May cause confusion and has many disadvantages to other narcotic drugs.
Desiccated thyroid	Desiccated thyroid	Only This Drug	NA	Concerns about cardiac effects. Safer alternatives available.
Diabinese	Chlorpropamide	Only This Drug	NA	It has a prolonged half-life in elderly patients and could cause prolonged hypoglycemia. Additionally, it is the only oral hypoglycemic agent that causes (SIADH:syndrome of inappropriate antidiuretic hormone secretionl)
Ditropan XL.	Oxybutynin XL	Muscle relaxants and antispasmodics	NA	Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable.
Ditropan	Oxybutynin	Muscle relaxants and antispasmodics	NA	Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable.
Donnatal	Belladonna alkaloids	Gastrointestinal antispasmodic drugs	NA	(GI: gastrointestinal) antispasmodic drugs are highly anticholinergic and have uncertain effectiveness. These drugs should be avoided (especially for long-term use).
Dulcolax	Bisacodyl	Stimulant Laxatives	Long-term use Except in the presence of opiate analgesic use	May exacerbate bowel dysfunction.

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EEEE

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Elavil	Amitriptyline	Similar to: (Limbitrol) Chlordiazepoxide-amitriptyline and (Triavil) Perphenazine-amitriptyline	NA	Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients.
Equanil	Meprobamate	Similar to:Miltown	NA	This is a highly addictive and sedating anxiolytic. Those using meprobamate for prolonged periods may become addicted and may need to be withdrawn slowly

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FFFF

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Flexeril	Cyclobenzaprine	Muscle relaxants and antispasmodics	NA	Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable.

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GGGG

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules

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HHHH

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Halcion	Triazolam	Benzodiazepines:Doses of short-acting	For doses greater than 0.25 mg	Because of increased sensitivity to benzoadiazepines in elderly patients, smaller doses may be effective as well as safer. Total daily doses should rarely exceed the suggested maximums.
Hylorel	Guanadrel	Only This Drug	NA	May cause orthostatic hypotension.

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IIII

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Indocin	Indomethacin	Only This Drug	NA	Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most (CNS:central nervous system) adverse effects.
Indocin SR	Indomethacin	Only This Drug	NA	Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most (CNS:central nervous system) adverse effects.
Ismelin	Guanethidine	Only This Drug	NA	May cause orthostatic hypotension. Safer alternatives exist.

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JJJJ

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules

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KKKK

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules

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LLLL

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Levsin	Hyoscyamine	Gastrointestinal antispasmodic drugs	NA	(GI: gastrointestinal) antispasmodic drugs are highly anticholinergic and have uncertain effectiveness. These drugs should be avoided (especially for long-term use).
Levsinex	Hyoscyamine	Gastrointestinal antispasmodic drugs	NA	(GI: gastrointestinal) antispasmodic drugs are highly anticholinergic and have uncertain effectiveness. These drugs should be avoided (especially for long-term use).
Librax	Clidinium-chlordiazepoxide	Gastrointestinal antispasmodic drugs	NA	(GI: gastrointestinal) antispasmodic drugs are highly anticholinergic and have uncertain effectiveness. These drugs should be avoided (especially for long-term use).
Limbitrol	Chlordiazepoxide-amitriptyline	Similar to: (Elavill) Amitriptylinee and (Triavil) Perphenazine-amitriptyline	NA	Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients.

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MMMM

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Macrodantin	Nitrofurantoin	Only This Drug	NA	Potential for renal impairment. Safer alternatives available.
Mellaril	Mellaril	Only This Drug	NA	Greater potential for (CNS:central nervous system) and extrapyramidal adverse effects.
Miltown	Meprobamate	Similar to:Equanil	NA	This is a highly addictive and sedating anxiolytic. Those using meprobamate for prolonged periods may become addicted and may need to be withdrawn slowly
Mineral oil	Mineral oil	Only This Drug	NA	Potential for aspiration and adverse effects. Safer alternatives available.

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NNNN

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Naprosyn	Naproxen	Non–COX-selective NSAIDs (Non-Cyclooxygenase-Selective Nonsteroidal Anti-Inflammatory Drugs)	Long-term use of full-dosage, longer half-life	Have the potential to produce (GI: gastrointestinal) bleeding, renal failure, high blood pressure, and heart failure.
Neoloid	Neoloid	Stimulant Laxatives	Long-term use Except in the presence of opiate analgesic use	May exacerbate bowel dysfunction.
Norflex	Orphenadrine	Only This Drug	NA	Causes more sedation and anticholinergic adverse effects than safer alternatives.
Norpace CR	Disopyramide CR	Similar to:Norpace	NA	Of all antiarrhythmic drugs, this is the most potent negative inotrope and therefore may induce heart failure in elderly patients. It is also strongly anticholinergic. Other antiarrhythmic drugs should be used.
Norpace	Disopyramide	Similar to:Norpace CR	NA	Of all antiarrhythmic drugs, this is the most potent negative inotrope and therefore may induce heart failure in elderly patients. It is also strongly anticholinergic. Other antiarrhythmic drugs should be used.

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OOOO

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules

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PPPP

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Paraflex	Chlorzoxazone	Muscle relaxants and antispasmodics	NA	Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable.
Periactin	Cyproheptadine	Anticholinergics and antihistamines:	NA	All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions.
Phenergan	Promethazine	Anticholinergics and antihistamines:	NA	All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions.
Polaramine	Dexchlorpheniramine	Anticholinergics and antihistamines:	NA	All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions.
Pro-Banthine	Propantheline	Gastrointestinal antispasmodic drugs	NA	(GI: gastrointestinal) antispasmodic drugs are highly anticholinergic and have uncertain effectiveness. These drugs should be avoided (especially for long-term use).
Procardia	Nifedipine	Similar to:Adalat	Short acting	Potential for hypotension and constipation.
Prozac	Fluoxetine		Daily Dose	Long half-life of drug and risk of producing excessive (CNS:central nervous system) stimulation, sleep disturbances, and increasing agitation. Safer alternatives exist.

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QQQQ

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules

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RRRR

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Restori	Temazepam	Benzodiazepines:Doses of short-acting	For doses greater than 15 mg	Because of increased sensitivity to benzoadiazepines in elderly patients, smaller doses may be effective as well as safer. Total daily doses should rarely exceed the suggested maximums.
Robaxin	Methocarbamol	Muscle relaxants and antispasmodics	NA	Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable.

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SSSS

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Serax	Oxazepam	Benzodiazepines:Doses of short-acting	For doses greater than 60 mg	Because of increased sensitivity to benzoadiazepines in elderly patients, smaller doses may be effective as well as safer. Total daily doses should rarely exceed the suggested maximums.
Serentil	Mesoridazine	Only This Drug	NA	(CNS:central nervous system) and extrapyramidal adverse effects.
Sinequan	Doxepin	Only This Drug	NA	Because of its strong anticholinergic and sedating properties, doxepin is rarely the antidepressant of choice for elderly patients.
Skelaxin	Metaxalone	Muscle relaxants and antispasmodics	NA	Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable.
Soma	Carisoprodol	Muscle relaxants and antispasmodics	NA	Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable.

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TTTT

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Talwin	Pentazocine	Only This Drug	NA	Narcotic analgesic that causes more (CNS:central nervous system) adverse effects, including confusion and hallucinations, more commonly than other narcotic drugs. Additionally, it is a mixed agonist and antagonist.
Testrad	Methyltestosterone	Similar to:Android and Virilon	NA	Potential for prostatic hypertrophy and cardiac problems
Ticlid	Ticlopidine	Only This Drug	NA	Has been shown to be no better than aspirin in preventing clotting and may be considerably more toxic. Safer, more effective alternatives exist.
Tigan	Trimethobenzamide	Only This Drug	NA	One of the least effective antiemetic drugs, yet it can cause extrapyramidal adverse effects.
Toradol	Ketorolac	Only This Drug	NA	Immediate and long-term use should be avoided in older persons, since a significant number have asymptomatic (GI: gastrointestinal) pathologic conditions.
Triavil	Perphenazine-amitriptyline	Similar to: (Elavill) Amitriptylinee and  (Limbitrol) Chlordiazepoxide-amitriptyline	NA	Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients.
Tripelennamine	Tripelennamine	Anticholinergics and antihistamines:	NA	All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions.

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UUUU

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules

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VVVV

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Virilon	Methyltestosterone	Similar to:Android and Testrad	NA	Potential for prostatic hypertrophy and cardiac problems
Vistaril	Hydroxyzine	Anticholinergics and antihistamines:	NA	All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions.

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WWWW

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules

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XXXX

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules
Xanax	Llprazolam	Benzodiazepines:Doses of short-acting	For doses greater than 2 mg	Because of increased sensitivity to benzoadiazepines in elderly patients, smaller doses may be effective as well as safer. Total daily doses should rarely exceed the suggested maximums.

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YYYY

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules

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ZZZZ

Drug (Brand Name)	Other Name (Generic)	Drug Class	Conditions	Concerns and Rules

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