7 drugs to avoid as you age

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published May 1, 2024

Key Takeaways

  • Certain drugs act differently in older adults; depending on pharmacokinetics and pharmacodynamics, some medications may need to be avoided entirely by the elderly.

  • Optimizing drug therapy for older adults involves careful consideration of individual patient characteristics, potential risks, and benefits.

  • Physicians should weigh the evidence provided by the AGS Beers Criteria when making prescribing decisions and monitor patients closely for adverse effects.

Physicians know that some drugs used in younger patients act differently in older populations. To guide the safe prescription of drugs in patients who are aged 65 years or older, the American Geriatrics Society (AGS) publishes guidelines about potentially inappropriate medications (PIMs) for older adults in ambulatory, acute, and institutionalized care settings.[]

These guidelines aim to reduce adverse events and evaluate the quality of care, cost, and patterns of drug use in this population. 

Here’s a look at seven medications on the latest AGS Beers Criteria list of PIMs for the elderly.

Growth hormones

Growth hormone replacement therapy aims at ameliorating lean/fat mass ratio, bone metabolism, blood pressure, and quality of life.[]

Growth hormones offer minimal benefit to elderly patients, says the AGS. Instead, this therapy leads to edema, impaired fasting glucose levels, gynecomastia, and more. These drugs should be avoided in all patients except those with verified growth hormone deficiency. 

Nifedipine

In older patients, calcium-channel blockers are used to treat hypertension, angina pectoris, isolated systolic hypertension, and coronary vasospasm.[]

However, this calcium-channel blocker places elderly patients at higher risk of hypotension and myocardial ischemia and should be avoided in this population.

Amiodarone

Although effective at maintaining sinus rhythm, this drug should be avoided in elderly patients. One exception is first-line treatment of atrial fibrillation in patients presenting with heart failure or substantial left ventricular hypertrophy.

Warfarin

In cases of atrial fibrillation or venous thromboembolism, direct oral anticoagulants (DOACs) are preferred to warfarin as a means of anticoagulation in older populations. Warfarin increases the risk of intracranial and other bleeds.

Despite an elevated risk of bleeding, oral anticoagulation is correlated with net clinical benefit in older patients.[]

Amitriptyline 

This and other antidepressants with high anticholinergic activity, such as clomipramine or paroxetine, should be avoided by elderly patients. The AGS warns that these drugs can lead to sedation and orthostatic hypotension. 

Sulfonylureas

These antidiabetic drugs increase the risk of cardiovascular events, hypoglycemia, and all-cause mortality. Longer-acting sulfonylureas such as glyburide result in longer periods of hypoglycemia than shorter-acting sulfonylureas such as glipizide. 

According to the results of one meta-analysis, sulfonylureas could compound the risk of fractures in elderly patients with diabetes.

Proton pump inhibitors

Proton pump inhibitors (PPIs) heighten the risk of C. difficile infection, GI malignancies, pneumonia, bone loss, and fractures. The AGS recommends not prescribing scheduled dosages for more than 8 weeks, except for high-risk populations—like those taking corticosteroids or chronic NSAID users. 

If an elderly patient is taking a PPI but without a medical indication for them, this treatment should be tapered and discontinued. The patient should then self-monitor for relapse of symptoms once they have discontinued the PPIs. If heartburn, indigestion, or chest pain recur, the patient can be placed on a trial period of the lowest possible PPI dosage or started on an H2-receptor antagonist, with an eye toward discontinuation.[]

What this means for you

The optimization of drug therapy is especially necessary in older populations. Adverse drug events should be avoided. Resources such as the 2023 AGS Beers Criteria can be helpful in decision-making, as this guide provides evidence-based recommendations for why certain drugs are inappropriate in older patients. Physicians should consider differences in pharmacokinetics and pharmacodynamics between the elderly and younger adults when prescribing drugs for older individuals, and should monitor patients for adverse effects.

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