7 drugs to avoid as you age
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Where are clinicians likely to run into challenges with the Beers Criteria—and where would having clear alternatives be most helpful?
—Todd P. Semla, MS, PharmD, AGS press release
Physicians know that some drugs used in younger patients act differently in older populations.
To support safer prescribing for patients aged 65 and older, the American Geriatrics Society (AGS) publishes guidance on potentially inappropriate medications across outpatient, inpatient, and long-term care settings. The goal: reduce adverse events while improving quality of care and medication use.[]
In 2025, AGS released Alternative Treatments to Selected Medications in the 2023 AGS Beers Criteria—a companion to the well-known Beers Criteria. This new resource goes a step further, helping clinicians identify safer, evidence-based pharmacologic and nonpharmacologic alternatives for older adults, with the aim of improving prescribing decisions and patient outcomes. []
Related: New study finds 1 in 4 dementia patients receive high-risk drugs: Why it happens and alternative tools to consider“We really took a step back and asked, ‘Where are clinicians likely to run into challenges with the Beers Criteria—and where would having clear alternatives be most helpful?’” said Todd P. Semla, MS, PharmD, co-chair of the Alternative List Panel and AGS Beers Criteria, in a press release. []
Here’s a closer look at seven medications in the 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.[]
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