Some medications are simply too risky for older adults. The American Geriatrics Society's Beers Criteria identifies potentially inappropriate medications for people 65+. If your parent takes any of these, don't panic—but do discuss alternatives with their doctor.
Important: Don't Stop Medications Without Medical Guidance
This guide is for education and discussion with doctors—not for self-prescribing or stopping medications on your own. Always consult a healthcare provider before changing any medication regimen.
Why Some Medications Are Risky in Elderly
Aging bodies process medications differently:
- Slower metabolism - Drugs stay in the body longer
- Reduced kidney/liver function - Harder to clear medications
- Changes in body composition - Fat-soluble drugs accumulate more
- More sensitive nervous system - Higher risk of confusion, falls
- Multiple medications - Greater chance of interactions
A medication that's perfectly safe at 45 may be dangerous at 75. The Beers Criteria helps identify these risky drugs.
The Most Problematic Drug Categories
Anticholinergic Medications (Highest Risk)
These drugs block the neurotransmitter acetylcholine. In elderly adults, they cause confusion, memory problems, constipation, urinary retention, dry mouth, and increased fall risk. Long-term use may increase dementia risk.
First-Generation Antihistamines
Examples: Benadryl (diphenhydramine), Chlor-Trimeton (chlorpheniramine), Dimetapp, many PM sleep aids
Risks: Confusion, sedation, falls, urinary retention, worsening dementia
Safer alternatives: Loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra) for allergies; melatonin or sleep hygiene for sleep
Tricyclic Antidepressants
Examples: Amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil), nortriptyline
Risks: Sedation, confusion, falls, cardiac arrhythmias, orthostatic hypotension
Safer alternatives: SSRIs (sertraline, citalopram) or SNRIs for depression
Bladder Antimuscarinics
Examples: Oxybutynin (Ditropan), tolterodine (Detrol), solifenacin (Vesicare)
Risks: Cognitive impairment, confusion, dry mouth, constipation
Safer alternatives: Mirabegron (Myrbetriq), behavioral therapy, pelvic floor exercises
Sedative-Hypnotics & Benzodiazepines
Benzodiazepines
Examples: Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), Restoril (temazepam)
Risks: Falls, fractures, confusion, memory impairment, paradoxical agitation, dependence. Elderly metabolize these slowly—effects can last days.
Safer alternatives: For anxiety: SSRIs, buspirone, therapy. For sleep: sleep hygiene, melatonin, trazodone (low dose). For acute anxiety: short course only with plan to taper.
Non-Benzodiazepine Sleep Aids (Z-Drugs)
Examples: Ambien (zolpidem), Lunesta (eszopiclone), Sonata (zaleplon)
Risks: Falls, confusion, next-day impairment, complex sleep behaviors (sleep-walking, sleep-driving)
Safer alternatives: Sleep hygiene, melatonin, low-dose trazodone, CBT for insomnia
Pain Medications
NSAIDs (Long-Term Use)
Examples: Ibuprofen (Advil, Motrin), naproxen (Aleve), Celebrex (celecoxib), indomethacin
Risks: GI bleeding (risk increases with age), kidney damage, increased blood pressure, heart attack/stroke risk, worsening heart failure
Safer alternatives: Acetaminophen (Tylenol), topical NSAIDs (Voltaren gel), physical therapy, capsaicin cream. If NSAID needed: lowest dose, shortest duration, with stomach protection.
Muscle Relaxants
Examples: Flexeril (cyclobenzaprine), Soma (carisoprodol), Robaxin (methocarbamol), Skelaxin (metaxalone)
Risks: Sedation, falls, anticholinergic effects, questionable effectiveness
Safer alternatives: Physical therapy, stretching, heat/ice, acetaminophen, short-term use only if absolutely necessary
Certain Opioids
Particularly avoid: Meperidine (Demerol) - neurotoxic metabolite; tramadol - seizure risk, serotonin syndrome
Risks: Confusion, falls, constipation, respiratory depression, dependence
If opioid needed: Lower doses of short-acting options (oxycodone, hydrocodone) with multimodal pain management
Diabetes Medications
Sulfonylureas (Long-Acting)
Examples: Glyburide (Diabeta), glimepiride (Amaryl), glipizide (Glucotrol)
Risks: Severe, prolonged hypoglycemia (low blood sugar), which is dangerous in elderly—can cause falls, confusion, seizures
Safer alternatives: Metformin (if kidney function allows), DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 agonists—consult endocrinologist
GI Medications
Proton Pump Inhibitors (Long-Term)
Examples: Omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid)
Risks (with long-term use): C. diff infection, bone fractures, vitamin B12 deficiency, low magnesium, possible dementia link (controversial)
Safer approach: Use lowest effective dose for shortest time. Try H2 blockers (famotidine) for maintenance. Lifestyle modifications. Periodic attempts to stop.
Metoclopramide (Reglan)
Used for: Nausea, gastroparesis, GERD
Risks: Movement disorders (tardive dyskinesia—can be permanent), parkinsonism, especially with use beyond 12 weeks
Safer alternatives: Ondansetron (Zofran) for nausea, dietary modifications for gastroparesis
Dangerous Over-the-Counter Medications
Many OTC drugs contain the same problematic ingredients as prescription medications:
PM Sleep Aids
Tylenol PM, Advil PM, ZzzQuil—all contain diphenhydramine
Benadryl
Highly anticholinergic, causes confusion and falls
Advil/Motrin/Aleve
NSAIDs risk GI bleeding and kidney problems
Cold Medicines
Often contain antihistamines and decongestants—avoid multi-symptom products
Decongestants
Pseudoephedrine/phenylephrine raise blood pressure
Antidiarrheal Loperamide
Safe in normal doses, but overdose causes cardiac problems
Check the Medicine Cabinet
Go through your parent's medications—including OTC products. Many seniors take Benadryl or PM sleep aids regularly without realizing the risks. Share concerns with their doctor.
Drug-Drug Interactions to Watch
Some dangerous combinations commonly seen in elderly patients:
- Warfarin + NSAIDs - Greatly increased bleeding risk
- ACE inhibitors + potassium supplements - Dangerous potassium levels
- Multiple sedating medications - Compounded fall and confusion risk
- Metformin + contrast dye - Risk of lactic acidosis
- Digoxin + amiodarone - Digoxin toxicity
- SSRIs + tramadol - Serotonin syndrome
How to Talk to the Doctor
If you notice your parent is on a potentially inappropriate medication:
- Bring a complete medication list to the appointment, including OTC drugs and supplements
- Ask specifically: "I've read that [medication] may have risks for older adults. Is there a safer alternative?"
- Share any symptoms: Falls, confusion, dizziness, constipation—these may be medication side effects
- Request a medication review: Ask the doctor or pharmacist to review all medications for appropriateness
- Consider a geriatrician: Doctors specializing in elderly care are most familiar with appropriate prescribing
Deprescribing: Sometimes Less Is More
Deprescribing means safely stopping unnecessary medications. It can improve quality of life, reduce side effects, and prevent drug interactions. Ask if any of your parent's medications can be discontinued.
The Annual Medication Review
Every year, your parent should have a complete medication review:
- Bring all medications - Including bottles, OTC drugs, supplements
- Review each one: Is it still needed? Is the dose appropriate?
- Check kidney and liver function - May require dose adjustments
- Discuss any new symptoms - Could be medication side effects
- Ask about alternatives - Especially for Beers list medications
Medicare Annual Wellness Visit includes a medication reconciliation—take advantage of this free benefit.
What To Do If You're Concerned
- Don't panic or stop medications - Some "inappropriate" medications are still the best option in certain situations
- Document your concerns - Note specific symptoms you've observed
- Schedule an appointment - Specifically to discuss medications
- Consult a pharmacist - They can identify interactions and suggest alternatives
- Get a second opinion - If needed, consult a geriatrician
Keep Medications Organized
Our caregiver resources include medication tracking tools to keep everything organized and catch potential problems early.
View Caregiver Resources