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MDLinx7 Drugs to Avoid as You Age

Age-Sensitive Prescribing: Ensuring Safe Medication Practices for the Elderly

In the realm of geriatric care, the optimization of medication therapy is crucial due to the altered pharmacokinetics and pharmacodynamics observed in older adults. The American Geriatrics Society (AGS) provides updated guidelines, known as the AGS Beers Criteria, which list potentially inappropriate medications (PIMs) for individuals aged 65 and above. The AGS Beers Criteria serves as a crucial resource for physicians prescribing medications to older adults, highlighting drugs that may pose significant risks in this age group. This guidance aims to mitigate adverse drug reactions and improve overall treatment outcomes in elderly populations by informing safer prescription practices.

Key Points:

  1. Growth hormones, generally prescribed to improve various health metrics, are discouraged for the elderly due to adverse effects like edema and impaired glucose levels unless a deficiency is confirmed.
  2. Nifedipine and other calcium-channel blockers should be avoided in elderly patients due to increased risks of hypotension and myocardial ischemia.
  3. Amiodarone, although effective for sinus rhythm maintenance, is recommended against in the elderly except for specific heart conditions due to its strong side effects.
  4. Direct oral anticoagulants (DOACs) are preferred over warfarin for elderly patients with atrial fibrillation or venous thromboembolism to reduce bleeding risks.
  5. Antidepressants with high anticholinergic activity, such as amitriptyline, should be avoided as they can cause sedation and orthostatic hypotension in the elderly.
  6. Sulfonylureas, particularly longer-acting types, are linked to heightened risks of cardiovascular events and hypoglycemia in older adults and should be used cautiously.
  7. Proton pump inhibitors are associated with serious side effects like increased infection risks and bone loss; their use should be limited to the shortest duration necessary.

The prevalence of PIMs in older adults ranges from 20 to 60% based on the healthcare settings or criteria used to define PIM (Beers Criteria® or STOPP criteria). Potentially inappropriate medication prescriptions are associated with 10 to 30% increased risk of hospitalization, increased risk of adverse drug events (ADEs), emergency department (ED) visits, and a poor health status. (Frontiers in Public Health)

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