Potential Problems with Medications Commonly Prescribed for the Elderly

Potential Problems with Medications Commonly Prescribed for the Elderly

Benzodiazepines (e.g., lorazepam [Ativan], diazepam [Valium], alprazolam [Xanax])

■ Can be addictive. ■ Can accumulate in elderly and cause daytime sleepiness, confusion, and increased risk of falls. Shorter-acting benzodiazepines have less tendency to accumulate. ■ Daily long-term use and long-acting products should be avoided whenever possible.

Beta-Blockers (e.g., timolol [Blocadren], esmolol [Brevibloc], propranolol [Inderal])

■ Can worsen heart failure, asthma, and emphysema. ■ Lipid-soluble beta-blockers (propranolol and metoprolol) cross the bloodbrain barrier more easily than water-soluble beta-blockers (atenolol and nadolol) and have a greater potential to produce adverse CNS reactions such as vivid dreams, fatigue, and depression.

Calcium Channel Blockers (e.g., nifedipine [Adalat], verapamil [Calan], diltiazem [Cardizem])

■ Can worsen heart failure.

Digoxin (e.g., Lanoxin, Lanoxicaps)

■ Digitalis toxicity occurs more frequently in the elderly. ■ Cardiac arrhythmias and conduction disturbances are first sign of toxicity more often than nausea, anorexia, and visual disturbances. ■ The risk for digitalis toxicity is greater when given concurrently with diuretics, verapamil, amiodarone, and/or quinidine.

H2 Histamine Antagonists (e.g., famotidine [Pepcid], cimetidine [Tagamet], ranitidine [Zantac])

■ Cimetidine interferes with the metabolism of phenytoin, carbamazepine, theophylline, warfarin, and quinidine and increases their half-life. Ranitidine has a similar but lesser effect. ■ Cimetidine has been associated with confusion, psychosis, and hallucinations, most commonly in elderly and/or severely ill Pts. These CNS effects resolve within a few days after discontinuation of the drug.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) (e.g., ibuprofen [Motrin], celecoxib [Celebrex])

■ Chronic use of NSAIDs contributes to gastric ulceration and bleeding, acute tubular necrosis, and renal failure. ■ There are often no warning signs, such as abdominal pain or nausea, of NSAID-induced gastric ulcers or bleeding. ■ Upper GI bleeding is first sign of GI toxicity in elderly Pts.

Thiazides (e.g., benzthiazide [Exna], hydrochlorothiazide [HydroDIURIL], metolazone [Zaroxolyn])

■ Can cause greater potassium loss (hypokalemia) in elderly Pts, often requiring potassium supplementation. ■ Can cause low serum sodium (hyponatremia), which can manifest as delirium.

Tricyclic Antidepressants (e.g., amitriptyline [Elavil], imipramine [Tofranil PM])

■ Can aggravate glaucoma and cause urinary retention. ■ Amitriptyline can cause severe hypotension in elderly Pts.