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Top Prescription Drugs Older Adults Should Avoid
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Drug
Problem
Pain Relievers
Amitriptyline (Elavil)
Amitriptyline can cause dry mouth, constipation, drowsiness,
confusion and even hallucinations.
Indomethacin (Indocin)
Of all nonsteroidal anti-inflammatory drugs, indomethacin affects
the brain the most. It can cause confusion or dizziness.
Narcotics
Propoxyphene (Darvon)
and combination products
that includes it (Darvocet-N)
These are all opioids. Any opioid can cause constipation, urinary
retention, drowsiness and confusion. However, those listed here
are particularly problematic. Propoxyphene, the main ingredient
in Darvon and Darvocet, provides no more pain relief than
acetaminophen. It may interfere with sleep and cause confusion.
Meperidine (Demerol)
Meperidine lowers the seizure threshold in older adults,
particularly those with renal insufficiency. It may be more likely to
cause confusion than other narcotics.
Pentazocine (Talwin)
Pentazocine is more likely to cause confusion and hallucinations
than other opioids.
Antidepressants
Fluoxetine (Prozac)
taken daily
Fluoxetine’s effect lasts a long time. It may cause sleep
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)
Amitriptyline (Elavil)
Used to treat depression or sleep. These medications can
cause sedation, weakness, blood pressure changes, dry mouth,
problems with urination, and can lead to falls and fractures. These
are rarely the drugs of choice for older adults.
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Top Prescription Drugs Older Adults Should Avoid
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Drug
Problem
Sleep and Anti-Anxiety Medications
Benzodiazepines (long-acting):
Flurazepam (Dalmane)
Diazepam (Valium)
Chlordiazepoxide (Librium)
Quazepam (Doral)
Clorazepate (Tranxene)
The effect of these medications last a long time (often days)
producing prolonged sedation and increasing the incidence of falls
and fractures.
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, nausea, weight loss, confusion, and
sometimes hallucinations, even when levels appear therapeutic.
Amiodarone
Used to treat abnormal heart rhythms (arrythmias). This drug
can cause thyroid, lung and liver 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 arrhythmia such as atrial
fibrillation unless all other drugs have been tried first.
Methyldopa (Aldomet)
May slow the heart rate and worsen depression.
Diabetes Medications
Chlorpropamide (Diabinase)
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This drug’s effects last a long time. In older adults,
chlorpropamide can lower blood sugar levels for several hours.
This drug also can lower the serum sodium in the blood. A low
sodium level can lead to changes in personality, confusion and
sluggishness.
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Drug
Problem
Stomach and Intestinal Medications
Cimetidine (Tagamet)
Used to treat heartburn, indigestion or ulcers. Typical doses of cimetidine 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:
Bisacodyl (Dulcolax)
Cascara sagrada
Used to treat constipation. May be acceptable to use if patient also is
taking opiate analgesics. Long-term use may cause bowel dysfunction.
Allergies
Diphenhydramine
(Benadryl)
May cause confusion and sedation. Should not be used to aid sleep.
Consider use of non-sedating antihistamines like loratadine as an alternative. If diphenhydramine is used to treat emergency allergic reactions,
it should be used at the smallest dose possible.
Insomnia
Diphenhydramine (Compoz
Nighttime Sleep Aid,
Sominex Maximum Strength,
Sominex Nighttime Sleep
Aid, Unisom Sleepgels,
Bayer PM, Excedrin PM,
Tylenol PM)
Aids containing diphenhydramine may cause confusion, blurred vision,
dry mouth, urinary retention or incontinence, and sedation. Consider
melatonin containing products, wearing amber-colored glasses for two
hours prior to bedtime, chamomile tea, soft music, and/or a warm bath
before bedtime instead.
Anemia
Ferrous sulfate in doses
greater than 325 mg
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Used to treat iron deficiency anemia. Doses greater than 325 mg per
day do not dramatically increase the amount absorbed but greatly
worsen constipation.
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Top Over-the-Counter Drugs Older Adults Should Avoid
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Drug
Problem
Cold Medications
Combination Products:
Aleve Cold and Sinus,
Alka-Seltzer Plus Cold
and Sinus, Dimetapp Cold
and Fever, Robitussin
Cold Severe Congestion,
Sudafed Cold and Sinus,
TheraFlu Severe Cold and
Congestion
Most of these products contain antihistamines and decongestants,
which may cause confusion, increased blood pressure, urinary incontinence or retention, and sedation. Recommend discussing with physician
before using. Also, some products contain alcohol and sugar sweeteners, which may interact with prescription drugs.
Oral decongestants:
Pseudoephedrine
(Sudafed, Drixoral 12-Hour
Non-Drowsy)
Avoid with high blood pressure, dementia, diabetes, history of heart
attack or stroke, or impaired kidney function.
Vitamins
Vitamin A
Because vitamin A is stored in the body, high doses of it can lead to
toxic syndrome. The incidence of vitamin A toxicity is increasing because
of publicity regarding the potential benefits in cancer, skin disorders and
wound healing. Monitor for headache, double vision, nausea, vertigo,
fatigue or drowsiness. It is not recommended to take doses above the
daily recommended intake from multivitamins 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
Vitamin E doses equal or greater than 400 units in older adults with
chronic illnesses are associated with an increased risk of death.
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