ACP InternistUpdated Beers Criteria Highlight Medications That are Risky in Older Patients

Delve into the changes in the updated Beers criteria and their implications for medication use in older patients.

The American Geriatrics Society (AGS) has recently revised the Beers criteria. Significantly, these guidelines advise physicians to be cautious when prescribing medications like warfarin and sodium-glucose cotransporter-2 (SGLT2) inhibitors for patients over 65. Importantly, warfarin is now a drug to avoid in initial therapy for venous thromboembolism or nonvalvular atrial fibrillation unless alternatives are contraindicated or face significant usage barriers.

The Beers criteria are organized into five distinct categories. These include potentially inappropriate medications, ones that might be inappropriate for patients with certain conditions, medications requiring careful usage, potential drug-drug interactions, and medications needing renal function-based dosage adjustments.

An expert panel sifted through evidence from June 1, 2017, to May 31, 2022, to create these updates. These guidelines apply to patients aged 65 years and older in most care settings in the US, excluding hospice and end-of-life care situations.

Among the notable changes since 2019 is the inclusion of warfarin. For older patients using warfarin long-term, continuation might be reasonable if they show well-controlled international normalized ratios and no adverse effects. Additional drugs introduced since 2019 include ticagrelor and SGLT2 inhibitors (use with caution), and baclofen (adjust dosage for reduced kidney function). New drug-drug interactions to note involve skeletal muscle relaxants, lithium with angiotensin receptor blockers and inhibitors, and warfarin with selective serotonin reuptake inhibitors.

Although these criteria list certain medications, they aren’t definitely inappropriate. Physicians should understand the rationale behind their inclusion and adjust their prescribing approach accordingly. Shared decision-making is encouraged, considering the patient’s preferences and care goals.

In conclusion, the updated Beers criteria are accessible via an app and a pocket card on GeriatricsCareOnline.org, facilitating easy reference.