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Top Prescription Drugs Older Adults Should Avoid page 1 of 2 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. clevelandclinic.org/geriatrics 10-GER-004 Top Prescription Drugs Older Adults Should Avoid page 2 of 2 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) clevelandclinic.org/geriatrics 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. 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 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 clevelandclinic.org/geriatrics Used to treat iron deficiency anemia. Doses greater than 325 mg per day do not dramatically increase the amount absorbed but greatly worsen constipation. 10-GER-004 Top Over-the-Counter Drugs Older Adults Should Avoid page 2 of 2 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. clevelandclinic.org/geriatrics 10-GER-004