The optimisation of drug therapy is especially necessary in older populations. Adverse drug events should be avoided. This article discusses the seven medications on the latest AGS Beers Criteria list of PIMs for the elderly.

Physicians know that some drugs used in younger patients act differently in older populations. To guide the safe prescription of drugs in patients who are aged 65 years or older, the American Geriatrics Society (AGS) publishes guidelines about potentially inappropriate medications (PIMs) for older adults in ambulatory, acute, and institutionalised care settings.[1]

These guidelines aim to reduce adverse events and evaluate the quality of care, cost, and patterns of drug use in this population. 

7 medications on the latest AGS Beers Criteria

Here’s a look at seven medications on the latest AGS Beers Criteria list of PIMs for the elderly.

1. Growth hormones

Growth hormone replacement therapy aims at ameliorating lean/fat mass ratio, bone metabolism, blood pressure, and quality of life.[2]

Growth hormones offer minimal benefit to elderly patients, says the AGS. Instead, this therapy leads to oedema, impaired fasting glucose levels, gynecomastia, and more. These drugs should be avoided in all patients except those with verified growth hormone deficiency. 

2. Nifedipine

In older patients, calcium channel blockers are used to treat hypertension, angina pectoris, isolated systolic hypertension, and coronary vasospasm.[3]

However, this calcium-channel blocker places elderly patients at higher risk of hypotension and myocardial ischemia and should be avoided in this population.

3. Amiodarone

Although effective at maintaining sinus rhythm, this drug should be avoided in elderly patients. One exception is the first-line treatment of atrial fibrillation in patients presenting with heart failure or substantial left ventricular hypertrophy.

4. 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.[4]

5. 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. 

6. 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. 

7. 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. Suppose heartburn, indigestion, or chest pain recur. In that case, 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.[5]

Disclaimer: This story is contributed by Dr Naveed Saleh and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.