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What Are the Most Dangerous Drugs for Older Adults?

Are you an older adult? Have you ever heard of the Beers list of PIMs (potentially inappropriate medications)? There are many dangerous drugs that should rarely be prescribed to older people.
Senior sitting behind a lot of pill bottles holding his head in his hands isolated on white

Imagine you are a space alien from the Planet Xelziga. You land somewhere in North America and turn on your television monitoring system. As you attempt to learn the basics about human behavior, you might quickly conclude that people in the United States are burdened with a lot of diseases. But there is virtually a pill for every ill. What our space aliens would not learn from TV commercials, however, is what remedies are most effective and which are the most dangerous drugs in the drugstore.

Aging Baby Boomers Are At Risk from Dangerous Drugs

The information on TV commercials wouldn’t alert our new visitors that some medicines have significant dangers, especially for older people. Too many Americans are also unaware of the hazards of over-medicating senior citizens. We recently received this frightening message from a nurse:

A Nurse Speaks Up:

I am an RN with certification in gerontological nursing. I was working in an urgent care clinic on a Saturday when a woman brought her mother (who was in her eighties) in for evaluation because in the previous 24 hours, she began to experience dizziness and needed physical support to keep from falling.

“On review of her medications, I found that her physician had ordered Librium to treat nervousness. This medication is on the Beers list of those that should be avoided in the elderly.

“The daughter said that was the only new medication her mother was taking, and the dizziness started after she took her first dose. I shared that with the urgent care physician, but he discounted the medication as a cause for her change in condition. He told me, ‘It can’t be Librium–the dose is too low.’ He instructed the patient and her daughter to continue the medication.

“Alarmed by the doctor’s instructions, I took a substantial professional risk by telling the daughter not to give her mother any more of the medication for the rest of the weekend. I urged her to speak as soon as possible with the prescribing physician to ensure he knew about her mother’s condition and the timing of the onset. I feared the patient could have suffered injury due to the effects of medication.”

Benzos: Dangerous Drugs for Older Adults

Chlordiazepoxide (Librium) is a benzodiazepine drug used to treat anxiety. Like similar drugs such as diazepam (Valium) or clonazepam (Klonopin), it can make people unsteady on their feet, especially older adults. That could lead to a fall with potentially tragic consequences for a frail elderly woman. We commend the nurse for “sticking her neck out” to protect the patient.

The Beers List of Dangerous Drugs:

Just what is the “Beers” list this nurse referred to in her account? It is named for Dr. Mark Beers, a physician who was concerned about drug reactions that could be especially dangerous for his older patients. In 1991 Dr. Beers introduced the criteria that bear his name. These were drugs which would be potentially inappropriate for older patients.

Geriatricians are quite familiar with the Beers list. They have also created another acronym: PIMS (potentially inappropriate medications). The list is periodically updated. As we learn about other dangerous drugs for people over 65, these PIMS are added to the list. The American Geriatrics Society updated the list in 2015 (Journal of the American Geriatrics Society, Nov. 2015).

New Potentially Dangerous Drugs:

Here is what the American Geriatrics Society noted when it updated the Beers Criteria in 2015:

New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug–drug interactions documented to be associated with harms in older adults.”

“…Beers Criteria PIMs have been found to be associated with poor health outcomes, including confusion, falls, and mortality. Avoiding PIMs in older adults is one strategy to decrease the risk of adverse events.”

Added to the list of PIMS “best avoided in older adults are:

Non-Benzo “Z”-Type Sleeping Pills

Eszopiclone (Lunesta)
Zaleplon (Sonata)
Zolpidem (Ambien)

Here is what the expert panel had to say about such drugs:

The nonbenzodiazepine, benzodiazepine receptor agonist hypnotics (eszopiclone, zaleplon, zolpidem) are to be avoided without consideration of duration of use because of their association with harms balanced with their minimal efficacy in treating insomnia.”

We wonder how many physicians are aware of this update. Because many older people often complain that they don’t get a good night’s sleep, such PIMS are frequently prescribed for insomnia.

PM Pain Relievers and Brain Fog:

Many older adults also suffer aches and pains, so it is no wonder that nighttime pain relievers are best sellers in the pharmacy. Diphenhydramine (DPH), is a common component of “PM” pain relievers. It has strong anticholinergic activity.

Older people who take such sleep aids regularly may wonder why they don’t feel as sharp as they should. Family members may conclude that their loved ones are developing dementia, when the true culprit could be the medication. Not surprisingly, products containing diphenhydramine are on the Beers list.

PPIs (Proton Pump Inhibitors) for Heartburn:

It will come as a shock to many health professionals to learn that the revised Beers Criteria from 2015 includes long-term use of PPIs. The experts note that:

“An addition…is the avoidance of the use of proton-pump inhibitors beyond 8 weeks without justification. Multiple studies and five systematic reviews and meta-analyses support an association between proton-pump inhibitor exposure and Clostridium difficile infection, bone loss, and fractures.”

PPIs Include:

Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)

A Reader Responds to the Beers List:

E.M. shared this perspective:

This is the first time I have heard of Beers. I am glad to have read this information. I have been prescribed Lupron injections monthly. I have also been prescribed methotrexate, Januvia and Glipizide. I also take Folic Acid, Cinnamon and garlic.

“My hands have swollen so large, I cannot get my wedding band or any rings on. Oh, I almost forgot I take Norvasc (amlodipine) for blood pressure control.

“No pharmacy has given me any information on side effects. They (the pharmacists) say they would be alerted in their auto system if there were any problems. Over the 15 years I have been on some of these drugs I have never been alerted to any concerns. Boy! Am I glad to hear of Beers. And my wife takes Nexium and has for years. I am 74 and she is 72.”

Drugs that may have been perfectly appropriate 15 years ago may pose a problem for someone over 65. Thanks for sharing your thoughts E.M.

Beware Reduced Kidney Function and Dangerous Drugs!

When was the last time you had your kidney function tested? The experts who compiled the updated Beers list note that as people age kidney function can change. Rarely do your kidneys become more efficient as you get older. That means dosage adjustment is essential, especially for dangerous drugs.

In addition, older brains may have less resilience to withstand highly anticholinergic drugs. These may make them confused and forgetful. We have a list of anticholinergic drugs on our website:

Where Can I Find A List of Anticholinergic Drugs?

No one should ever stop any medication without careful consultation with the prescribing physician. But it is essential to ask about PIMS the next time you get a prescription. Make sure it is not on the BEERs list. If it is, ask your prescriber why you should be taking the medicine. If there is a good explanation, great. If not, inquire if there might be an alternate medicine that is not on the list.

Dangerous Drugs for Older Adults?

Which other drugs may be inappropriate for seniors? We have prepared a Guide to Drugs and Older People with a list, along with more detailed explanations. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (71 cents), self-addressed envelope:

Graedons’ People’s Pharmacy, No. O-85

P. O. Box 52027

Durham, NC 27717-2027.

It can also be downloaded for $2 from the website: www.peoplespharmacy.com.

Here is a free Guide to also download:

Drug Safety Questionnaire and Medical History

This questionnaire should go with you to every doctor visit. Share your own experience below. Has someone you know been given dangerous drugs?

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Drugs and Older People
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I am a 68 yr-old male who takes verapamil 120mg, valsartan 80, carvedilol 6.25, warfarin 5, a statin 40, xanax 5, flexural 5, andadvair. I feel good most of the time! Should I be concerned?

Very disappointed that I can’t just go online and access the Beers list. I think it is something every senior and their caregivers should have access to. As a home health RN, I see too many clients mislabeled with dementia, taking all the categories of meds you mention.

I think Tom in Vermont, Rita in Buffalo and Henry in Mocksville say it the same as I feel: and that is there are jsut too many people going to too many doctors and taking too many drugs. Thanks to listening to your programs and this format on the web, we are able to be far more educated re these drugs. We must NOT be like sheep “cause we all know what happened to them!”

A cardiologist just ordered 2.5 mg low dose Concor at night for heart issues. It is a beta blocker.
I regularly check morning glucose levels.

The first day it was elevated. I was a bit alarmed. The 2nd day even a bit higher. I then checked Google and found they DO affect blood glucose levels.

The 3rd night I only took 1/2 and it was still elevated next morning.

Not worth bringing on diabetes to counteract other issues. I am 79.
Will be asking the doctor for a different option. He told me the drug did not mess with blood sugar. Maybe he should Google it himself?

People, TAKE HEED! This is an excellent article in so many ways! Having been given the wrong mix of Rx’s put me in the emergency room. No Dr. would attribute it to the drugs (which they are somehow being compensated for dispensing). They ALWAYS say it’s ALCOHOL no matter how much or little you drink. I recently proved a Dr. wrong after her prescribed Trazadone & said I could take up to three a day. GREAT! Pop one if it’s a rough day, take one at bedtime and one when I wake up in the middle of the night. A month later I had bloodwork taken and it was so bad I was scared to death (not quite). My prior bloodwork was fine. . .the only change in my life was taking Trazadone. So I quit it cold turkey. Went back a month or so later for another blood test. Results were normal, Dr. was shocked, kept asking what changes I made in my lifestyle. Answer? I STOPPED TAKING THE TRAZADONE! Folks, Drs. are writing Rx’s for this like it’s candy! Do your research. It could have killed me!

I am 65 years old. I was diagnosed with mitral valve prolapse/anxiety and depression in 1988. I have been on anti depressant and anti anxiety (clonazapam .5mg) since then. I also suffer terribly from migraine headaches and take preventive zonegran daily to prevent them. It sounds great theoretically to wean oneself off of all drugs but HOW do you do it without a physician’s assistance? I would LOVE to be off all of my medication with the exception of the antidepressant. What type physician would help me get off of the other medication? Also, although I know clonazapam has such a bad reputation – what is an alternative? Is there a drug that can reduce anxiety that is safe? Any advice would be appreciated.

2 doctors 2 different opinions 1 says”statins could actually improve your memory due to reducing cholesterol and plaque.Another says(as in drug literature) statins can cause cognitive impairment?? who is right??

anyone with thoughts on statins for people over 80 -your comments would be appreciated

Is there any information on the blood pressure medicine (tekturna HCT). I have been on it for about 4 yrs. I also take atenolole. Any comments on that.

These comments and thoughts are in keeping with the thesis of “RETHINKING AGING”, by Dr. Nortin Hadler, in which he postulates that we should stop regarding old age as a disease, and allow those of us who make it into the 7th, 8th & 9th decades of human existence to do so with grace and respect, and not with chemistry and “fixes” that the human body was never meant to tolerate.

Thanks for your comment. I totally agree. I have also read – Rethinking Ageing” although I live in Sweden.
Many countries (who can afford) have problems with overprescribing and it`s not just about the elderly – it starts much earlier. The pharmaceutical industry can pay for research. “brainwash” people and market in many different ways.
I think the change will have to come from ordinary people – read many different books and try to make up your own mind. Remember it`s your body.
Here are some books:
Selling Sickness (Alan Cassels and Ray Moynihan)
Seeking Sickness (Alan Cassels, also read his articles on http://www.commonground.ca)
Death by Prescription (Terence H. Young)
Doctoring Data (Malcolm Kendrick)
Statins Toxic Side Effects (David Evans)
There is also an interesting book by Armon B. Neel and Bill Hogan (can´t rememember the title now)

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