Did you know that some medications (drugs) can be harmful to people 65 years or older?

What’s the risk?  Some drugs can be unsafe to people 65 years of age or older.  As we get older, our bodies change. These changes can put us at a greater risk of serious, and sometimes even deadly, side effects. o Some of these side effects include confusion, weakness, sleepiness, impaired kidney and brain function, trouble with bladder control, and falling.  Some drugs also may not work as well in treating conditions for older adults.  Many of these drugs require prior approval or are not covered under your drug plan, causing you more cost and effort.

How do I know which medications can be harmful?  Experts have developed a list of drugs that can be unsafe for people 65 years or older. This list is called the “Beers List”.  Some of the drugs found on this list are included below.

High Risk Medication Drug Class Safer Alternatives on the Absolute Total Care List Drug List Alora Hormones For dryness, itching, and burning of the vagina or vulva, pain during sexual intercourse: Premarin vaginal cream For bone density: calcium/vitamin D (not covered), alendronate For hot flashes: sertraline, citalopram, venlafaxine Amitriptyline Tricyclic For depression: citalopram, sertraline, Antidepressants mirtazapine, nortriptyline For nerve pain or pain: duloxetine, topical lidocaine, gabapentin For insomnia: trazodone, Rozerem Benztropine Antiparkinson agents ropinirole, pramipexole, carbidopa/levodopa (+entacapone), selegiline

H1723_HRM16_Approved_03032016 High Risk Medication Drug Class Safer, Formulary Alternatives Chlorzoxazone Skeletal Muscle Baclofen, tizanidine Relaxants Climara Pro Hormones For dryness, itching, and burning of the vagina or vulva, pain during sexual intercourse: Premarin vaginal cream For bone density: calcium/vitamin D (not covered), alendronate For hot flashes: sertraline, citalopram, venlafaxine Clomipramine Tricyclic For depression: citalopram, sertraline, Antidepressants mirtazapine For nerve pain or pain: duloxetine, topical lidocaine, gabapentin For insomnia: trazodone, Rozerem Cyclobenzaprine Skeletal Muscle Baclofen, tizanidine Relaxants Cyproheptadine Antihistamines levocetirizine, azelastine nasal spray Diazepam Benzodiazepines For anxiety: buspirone, duloxetine Digoxin >0.125mg/day Cardiovascular agents For heart failure: digoxin 0.125mg, lisinopril, enalapril, losartan, metoprolol XL Diphenhydramine-oral Antihistamines For allergies: levocetirizine, azelastine nasal spray For insomnia: trazodone, rozerem For nausea: meclizine, ondansetron oral tabs Dipyridamole Antithrombotics Low dose aspirin, clopidogrel Disopyramide Phosphate Antiarrhythmics Quinidine, Procainamide

Doxepin >6mg/day Tricyclic For depression: citalopram, sertraline, Antidepressants mirtazapine For nerve pain or pain: duloxetine, topical lidocaine, gabapentin For insomnia: trazodone, Rozerem Ergoloid mesylate Antidementias donepezil, galantamine, rivastigmine, Namenda

Estradiol (oral tabs and Hormones For dryness, itching, and burning of the topical patches) vagina or vulva, pain during sexual intercourse: Premarin vaginal cream For bone density: calcium/vitamin D (not covered), alendronate For hot flashes: sertraline, citalopram,

venlafaxine High Risk Medication Drug Class Safer, Formulary Alternatives Estropipate Hormones For dryness, itching, and burning of the vagina or vulva, pain during sexual intercourse: Premarin vaginal cream For bone density: calcium/vitamin D (not covered), alendronate For hot flashes: sertraline, citalopram, venlafaxine Glyburide, Glyburide Oral Hypoglycemics glipizide (+metformin), glimepiride Micronized, (+metformin) Glyburide/Metformin Guanfacine Antihypertensive lisinopril, losartan, felodipine ER, amlodipine, chlorothiazide Hydroxyzine Oral tablets Antihistamines For allergies: levocetirizine, azelastine and solution nasal spray For anxiety: buspirone For nausea: meclizine, ondansetron oral tabs Indomethacin, ER Caps Analgesics acetaminophen, short acting non-steroidal anti-inflammatory drugs Ketorolac tabs Analgesics acetaminophen, short acting non-steroidal anti-inflammatory drugs Megestrol acetate Hormones For HIV/AIDS wasting syndrome only: suspension Serostim (authorization required)

Menest Hormones For dryness, itching, and burning of the vagina or vulva, pain during sexual intercourse: Premarin vaginal cream For hot flashes: sertraline, citalopram, venlafaxine Meprobamate Antianxiety Buspirone Methocarbamol Skeletal Muscle baclofen, tizanidine Relaxants Methyldopa Antihypertensive lisinopril, losartan, felodipine ER, amlodipine, chlorothiazide Nitrofurantoin Urinary Anti-infective Dependent on the infection: sulfamethoxazole/trimethoprim, ciprofloxacin, cephalexin Orphenadrine Skeletal Muscle baclofen, tizanidine Relaxants Phenadoz Suppository Antiemetics ondansetron, meclizine 12.5 mg

High Risk Medication Drug Class Safer, Formulary Alternatives Premarin, Premphase, Hormones For dryness, itching, and burning of the Prempro vagina or vulva, pain during sexual intercourse: Premarin vaginal cream For bone density: calcium/vitamin D (not covered), alendronate For hot flashes: sertraline, citalopram, venlafaxine Promethazine Antihistamines For nausea: meclizine, ondansetron oral tabs For allergies: levocetirizine, azelastine nasal spray Reserpine Antihypertensive lisinopril, losartan, felodipine ER, amlodipine, chlorothiazide Talwin Analgesics acetaminophen, short acting non-steroidal anti-inflammatory drugs Thioridazine Antipsyhotics, aripiprazole, olanzapine, quetiapine, conventional risperidone Ticlopidine Antithrombotics low dose aspirin, clopidogrel Trihexyphenidyl Antiparkinson agent ropinirole, pramipexole, carbidopa/levodopa (+entacapone), selegiline Trimethobenzamide Antiemetics ondansetron oral tabs Zaleplon Hypnotics trazodone, rozerem

Zolpidem Hypnotics trazodone, rozerem

Please note: This is not a complete list of all the drugs that may be harmful for people 65 years or older. Please talk to your doctor or pharmacist for more information about high risk drugs.

What should I do if I am taking one of the medications on this list?  Please talk to your doctor.  Your doctor can decide if the risk of your drug(s) is greater than the benefit, and may give a safer drug that works just as well.  Safer options to drugs that may be harmful are listed above. o Remember, you should not stop taking any drug without talking to your doctor first.

What if I have questions about the safety of my drugs(s)?

 If you have any questions about your drugs or any of the high risk drugs listed above, please talk to your pharmacist.  Please call our Member Services number at 1-855-735-4398 from 8 p.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

More Information For a flyer containing Frequently Asked Questions and information on how to speak with your doctor about high risk drugs, visit: http://www.dow.com/friends/pdfs/What_to_Ask_Your_Healthcare_Provider.pdf

Also see: http://www.americangeriatrics.org/files/documents/beers/BeersCriteriaPublicTranslation.p df

Absolute Total Care is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to enrollees.

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

Benefits may change on January 1 of each year.

Limitations and restrictions may apply. For more information, call Absolute Total Care Member Services or refer to the Absolute Total Care Member Handbook.

This information is available for free in other languages. Please call our customer service number at 1-855-735-4398 from 8 a.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

Esta información está disponible gratis en otros idiomas. Llame a nuestro número de servicio al cliente al 1-855-735-4398 de 8:00 a. m. a 8:00 p. m., los siete días de la semana. Los usuarios de TTY deben llamar al 711. Los fines de semana y los días feriados nacionales, es posible que se le pida que deje un mensaje. Le devolveremos la llamada durante el próximo día hábil. La llamada es gratuita.