Medications and Aging

 In Senior Care

Medications and Aging


here are physiological changes that occur as a person ages which can increase the risk of adverse reactions from certain medications. Changes like decreased renal function, decreased hepatic metabolism in the liver, reduced gastrointestinal absorption, and changes in fat/water distribution can increase the time medications remain in their body.

The “Beer’s Criteria for Potentially Inappropriate Medication Use in Older Adults,” often referred to as the “Beer’s List,” has been an important resource for preventing adverse outcomes of medication use in the elderly population since it was first published in the Archives of Internal Medicine in 1991.[1]  It serves as a guideline for practitioners and pharmacists of medications to avoid in prescribing decisions. The list of medications has been updated several times, most recently in 2015.

The “Beer’s List” is meant to be a guideline and not to override professional judgement. If a person is taking a medication on the list, it does not mean it is inappropriate for them. One person may respond differently to a medication than another, and that is why the panel of experts that review and update the criteria use the phrase “potentially inappropriate.” Never stop taking medications without first checking with your healthcare provider.

Following is a summary of the “Beer’s List” medications:

Antihistamines (typically prescribed for allergies, hives and eczema)

  • Brompheniramine
  • Chlorpheniramine
  • Clemastine
  • Cyproheptadine
  • Dexbrompheniramine
  • Dexchlorpheniramine
  • Diphenhydramine (oral)
  • Doxylamine
  • Hydroxyzine
  • Promethazine
  • Triprolidine

They may cause many side effects in older adults, including confusion, drowsiness, blurred vision, difficulty urinating, dry mouth and constipation. Safer medications are available.

Antiparkinsonian (prescribed for Parkinson’s disease and other health problems)

  • Benztropine (oral)
  • Trihexyphenidyl

There are other medications that are usually more effective for Parkinson’s disease and related disorders than these. These drugs should not be used for other conditions, like treating side effects of other medications, for example the movement side effects of antipsychotic medications.

Antispasmodic medications (prescribed to relieve cramps or spasms)

  • Belladonna alkaloids
  • Clidinium-chlordiazepoxide
  • Dicyclomine
  • Hyoscyamine
  • Scopolamine

Nitrofurantoin (an antibacterial drug prescribed for urinary tract infections)

This drug may cause side effects that affect the lungs. Safer medications are available.

Alpha1 blockers (drugs for the prostate but also prescribed for high blood pressure)

  • Doxazosin
  • Prazosin
  • Terazosin

These drugs can cause a drop in blood pressure and dizziness when you stand up. This can lead to falls. Alternative treatments provide better results with lower risks.

Medications, called Alpha agonists (prescribed for high blood pressure)

  • Clonidine
  • Guanfacine
  • Methyldopa

These drugs may cause a slow heartbeat and dizziness. They are not recommended for routine treatment of high blood pressure.

Digoxin (at doses higher than 0.125 milligrams per day)

In older patients with heart failure, higher doses appear to offer no additional benefit and may increase risks of dangerous side effects. Older patients with kidney problems are at particular risk of side effects.

Spironolactone (at doses higher than 25 milligrams daily)

In people with heart failure, higher doses may boost risks of high potassium levels.

Tertiary Tricyclic Antidepressants (alone or in combination)

  • Amitriptyline
  • Chlordiazepoxide-amitriptyline
  • Clomipramine
  • Doxepin at doses of more than 6 milligrams per day
  • Imipramine
  • Perphenazine-amitriptyline

Potential side effects include: confusion, drowsiness, blurred vision, difficulty urinating, dry mouth and constipation in older adults. They can also cause a drop in blood pressure and dizziness when you stand up. Safer medications are available.


short- and intermediate-acting:

  • Alprazolam
  • Estazolam
  • Lorazepam
  • Oxazepam
  • Temazepam
  • Triazolam


  • Chlorazepate
  • Chlordiazepoxide
  • Chlordiazepoxide-amitriptyline
  • Clidinium-chlordiazepoxide
  • Clonazepam
  • Diazepam
  • Flurazepam

Older adults are especially sensitive to these medications. These drugs may increase risks of mental decline, delirium, falls, fractures, and car accidents in older adults. Despite these risks, they may be appropriate, in certain cases, for treating seizures, certain sleep disorders, anxiety disorders, withdrawal from benzodiazepine drugs and alcohol, and end-of-life care.

Estrogens (with or without Progestins)

These hormones may increase risks of breast cancer and cancer of the lining of the uterus. They don’t appear to help protect women from heart disease or loss of cognitive (thinking) ability in later life.

[1]  Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (December 8, 2003). “Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts“. Archives of Internal Medicine 163 (22): 2716–2724.doi:10.1001/archinte.163.22.2716.

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