Medications to Avoid in the Elderly

Medication Effect
Propoxyphene (Darvon) and combination products Offers few advantages over acetaminophen, yet has
(Darvon with ASA, Darvon-N, and Darvocet-N) the same adverse effects as other narcotic
medications.
Amitriptyline (Elavil), Chlordiazepoxide-amitriptyline Strong anticholinergic and sedation effects
(Limbitrol), and perphenazine-amitriptyline (Triavil)
Diphenhydramine (Benadryl) May cause confusion and sedation; use in smallest
possible dose for emergency allergic reactions
All barbiturates, except when used to control seizures Highly addictive, more adverse effects in the older
adults
Meperidine (Demerol) May cause confusion
Short-acting nifedipine (Procardia and Adalat) Potential hypotension and constipation
Clonidine (Catapres) Potential for orthostatic hypotension and CNS
adverse effects
Medication Effect
Mineral Oil Potential for aspiration and adverse effects; other options
readily available

Estrogens only Lack of cardioprotective effect in older women; evidence

of carcinogenic potential

Nitrofurantoin (Macrodantin) Potential for renal impairment; other alternatives

available

Cimetadine (Tagamet) CNS effects including confusion

Indomethacin (Indocin and Indocin SR) CNS adverse effects; other NSAIDS available with fewer
adverse effects

Mithocarbamol (Robaxin), carisoprodol (Soma), Anticholinergic effects; sedation, weakness

chlorzoxaxone (Paraflex), cyclobenzaprine (Flexeril),
oxybutynin (Ditropan)

Short-acting dipyridamole (Persantine) Orthostatic Hypotension

Methyldopa (Aldomet) and May cause bradycardia and exacerbate depression in
methyldopahydrochlorothiazide (Aldoril) older adults
 Changes in Lab Values with Age
Increases with Age Decreases with Age Unchanged with Age
Alkaline Phosphate Albumin Hepatic function tests (serum
bilirubin, AST, ALT, GGPT)
ANA Aldosterone Coagulation Tests
C-Reactive protein Serum Calcitonin Biochemical tests (serum
electrolytes, total protein*, serum
folate)
Cholesterol, total HDL cholesterol (women) Arterial blood tests (pH, PaC02)
Clotting Factors VII and VIII Creatine Kinase Renal Function tests (serum
creatinine)
Copper Creatinine clearance Thyroid function test (T4)
D-dimers Dihydroepiandrosterone Complete Blood Count (hematocrit,
hemoglobin, erythrocyte indices)
Ferritin 1 ,25-dihydroxyvitamin D
Febrinogen Estradiol
Increases with Age Decreases with Age Unchanged with Age
Gastrin Growth Hormone
2 h pp glucose IGF-1
Interleukin 6 Interleukin 1
PSA Magnesium
PTH Pa02
Rheumatiod factor Phosphorus
Sedimentation rate Platelets
Triglycerides Free testosterone
Uric Acid Total protein
Zinc, serum