sign in sign up
<<
Home , Amiodarone, Diphenhydramine, Loratadine, Melatonin, Methyldopa, Tylenol (brand)

Top Prescription Older Adults Should Avoid page 1 of 2

Drug Problem

Pain Relievers

Amitriptyline (Elavil) can cause dry mouth, , drowsiness, and even .

Indomethacin (Indocin) Of all nonsteroidal anti-inflammatory drugs, indomethacin affects the the most. It can cause confusion or .

Narcotics

Propoxyphene (Darvon) These are all . Any can cause constipation, urinary and combination products retention, drowsiness and confusion. However, those listed here that includes it (Darvocet-N) are particularly problematic. Propoxyphene, the main ingredient in Darvon and Darvocet, provides no more pain relief than acetaminophen. It may interfere with and cause confusion.

Meperidine (Demerol) Meperidine lowers the threshold in older adults, particularly those with renal insufficiency. It may be more likely to cause confusion than other .

Pentazocine (Talwin) is more likely to cause confusion and hallucinations than other opioids.

Antidepressants

Fluoxetine (Prozac) ’s effect lasts a long time. It may cause sleep taken daily disturbances, restlessness and increased agitation. It also may decrease appetite in some older adults who do not need to lose weight. If used, consider once weekly dosing.

Doxepin (Sinequan) Used to treat or sleep. These can Amitriptyline (Elavil) cause , weakness, changes, dry mouth, problems with urination, and can lead to falls and fractures. These are rarely the drugs of choice for older adults. clevelandclinic.org/geriatrics 10-GER-004 Top Prescription Drugs Older Adults Should Avoid page 2 of 2

Drug Problem

Sleep and Anti- Medications

Benzodiazepines (long-acting): The effect of these medications last a long time (often days) (Dalmane) producing prolonged sedation and increasing the incidence of falls Diazepam (Valium) and fractures. Chlordiazepoxide (Librium) (Doral) (Tranxene)

Heart Medications

Digoxin Because aging kidneys cannot excrete this drug well, doses in older adults should rarely exceed 0.125 mg daily. Adverse effects include poor appetite, , weight loss, confusion, and sometimes hallucinations, even when levels appear therapeutic.

Amiodarone Used to treat abnormal rhythms (arrythmias). This drug can cause , and problems in any person. Older adults may develop additional adverse effects, including gait abnormalities, depression, difficulty concentrating and confusion. This is not a good choice for an atrial such as unless all other drugs have been tried first.

Methyldopa (Aldomet) May slow the and worsen depression.

Diabetes Medications

Chlorpropamide (Diabinase) This drug’s effects last a long time. In older adults, can lower blood levels for several hours. This drug also can lower the serum in the blood. A low sodium level can lead to changes in personality, confusion and sluggishness.

clevelandclinic.org/geriatrics 10-GER-004 Top Over-the-Counter Drugs Older Adults Should Avoid page 1 of 2

Drug Problem

Stomach and Intestinal Medications

Cimetidine (Tagamet) Used to treat , indigestion or ulcers. Typical doses of cimeti- dine may have side effects, especially confusion.

Mineral oil Used to treat constipation. There is potential for aspiration and adverse effects. Safer alternatives are available.

Stimulant laxatives: Used to treat constipation. May be acceptable to use if patient also is Bisacodyl (Dulcolax) taking opiate . Long-term use may cause bowel dysfunction. Cascara sagrada

Allergies

Diphenhydramine May cause confusion and sedation. Should not be used to aid sleep. () Consider use of non-sedating like as an alter- native. If is used to treat emergency allergic reactions, it should be used at the smallest dose possible.

Insomnia

Diphenhydramine (Compoz Aids containing diphenhydramine may cause confusion, blurred vision, Nighttime Sleep Aid, dry mouth, or incontinence, and sedation. Consider Maximum Strength, containing products, wearing amber-colored glasses for two Sominex Nighttime Sleep hours prior to bedtime, tea, soft music, and/or a warm bath Aid, Unisom Sleepgels, before bedtime instead. Bayer PM, Excedrin PM, PM)

Anemia

Ferrous sulfate in doses Used to treat deficiency anemia. Doses greater than 325 mg per greater than 325 mg day do not dramatically increase the amount absorbed but greatly worsen constipation.

clevelandclinic.org/geriatrics 10-GER-004 Top Over-the-Counter Drugs Older Adults Should Avoid page 2 of 2

Drug Problem

Cold Medications

Combination Products: Most of these products contain antihistamines and , Aleve Cold and Sinus, which may cause confusion, increased blood pressure, urinary inconti- Alka-Seltzer Plus Cold nence or retention, and sedation. Recommend discussing with physician and Sinus, Dimetapp Cold before using. Also, some products contain and sugar sweeten- and , Robitussin ers, which may interact with prescription drugs. Cold Severe Congestion, Sudafed Cold and Sinus, TheraFlu Severe Cold and Congestion

Oral decongestants: Avoid with high blood pressure, , diabetes, history of heart attack or stroke, or impaired function. (Sudafed, Drixoral 12-Hour Non-Drowsy)

Vitamins

Vitamin A Because A is stored in the body, high doses of it can lead to toxic syndrome. The incidence of is increasing because of publicity regarding the potential benefits in , skin disorders and wound healing. Monitor for , double vision, nausea, , or drowsiness. It is not recommended to take doses above the daily recommended intake from and dietary supplements. Also, intake of beta-carotene (a vitamin A product) has been linked to increased risk for lung cancer in smokers.

Vitamin E doses equal or greater than 400 units in older adults with chronic illnesses are associated with an increased risk of death.

clevelandclinic.org/geriatrics 10-GER-004