Ask a Pharmacist

Too Old for These Drugs?

dangers of some drugs in older adults - scriptsave wellrx blog image

by Gabriel K. Rallison, PharmD Candidate Class of 2020,
University of Arizona College of Pharmacy

As we age, many of us may struggle to do things that were once so easy. With age, the way your body handles medication can change, too. Side effects may become more noticeable and last longer than they used to.

Potentially Inappropriate Medications for Older Adults

Due to these changes, the American Geriatrics Society published a list of medications that are potentially inappropriate for use by persons over 65 years old, commonly called the Beers Criteria.1

There are several common over-the-counter (OTC) medications on this list that should be avoided.

Antihistamines

The first OTC drug to avoid is diphenhydramine (Benadryl). Diphenhydramine is an antihistamine drug commonly used to treat cold and allergy symptoms and as a sleep aid. However, in older adults, diphenhydramine can cause very unpleasant and sometimes dangerous side effects. Side effects include confusion, dry mouth, difficulty urinating, constipation, and blurred vision.2 Diphenhydramine will often be found alone in products, or in combination with other medications. When buying cold or allergy medicine, make sure to check the active ingredient list to make sure it doesn’t contain diphenhydramine.

A sister drug to diphenhydramine, chlorpheniramine (ChlorTabs), can cause many of the same side effects in older adults and should likewise be avoided.3 As alternatives for treating cold and allergy symptoms, look for products that contain loratadine (Claritin), fexofenadine (Allegra), or cetirizine (Zyrtec).2 These are newer medications of the same type as diphenhydramine, but without the side effects that make diphenhydramine dangerous.

Aside from treating allergy symptoms, drugs from this class are also used to treat motion sickness. These drugs, including dimenhydrinate (Dramamine) and meclizine (Antivert), cause many of the same side effects are diphenhydramine and chlorpheniramine, and should likewise be avoided.1

Non-drug options for prevention of motion sickness should be used instead. To prevent motion sickness, current advice is to keep your eyes closed or looking at the horizon, while avoiding close-up visual tasks like reading when moving.4                      

NSAIDs

NSAIDs, or non-steroidal anti-inflammatory drugs, are a class of medications including ibuprofen (Advil, Motrin) and naproxen (Aleve).2 These drugs are generally used to treat mild to moderate pain, but also have side effects that become more noticeable and dangerous in older adults. NSAIDs can cause stomach ulcers, stomach bleeding, increased blood pressure, kidney damage, and can even make heart failure worse.3 Additionally, these medications can interact with blood thinner medications such as warfarin and increase your risk of bleeding.

While occasional use may not present as great a risk, regular use of either ibuprofen or naproxen should be avoided unless closely followed by your doctor. As an alternative to NSAIDs, you can use acetaminophen (Tylenol). When using acetaminophen, it is important to limit your dose to 1,000 mg or less per dose, and less than 3,000 mg per day to avoid causing liver damage. If you regularly drink alcohol, you should use even less acetaminophen.

Are There Other Medications Older Adults Should Avoid?

The medications mentioned are by no means an exhaustive list, and there may be other medications, OTC or prescription, that should be stopped or adjusted for use in older adults. You should never stop taking a prescription medication without first talking to the doctor who prescribed it, even if it is on the Beers Criteria.

Any questions you have concerning any prescription medication you may be taking should be directed to your doctor or pharmacist. Your pharmacist can recommend OTC medications to help treat what ails you while minimizing undesirable side effects. While we all get older, you can rely on the direction and training of health professionals around you to make the trip as comfortable as possible, helping to minimize the bumps along the way.

References

  1. For Older People, Medications Are Common; Updated AGS Beers Criteria® Aims to Make Sure They’re Appropriate, Too. (n.d.). Retrieved October 10, 2019, from https://www.americangeriatrics.org/media-center/news/older-people-medications-are-common-updated-ags-beers-criteriar-aims-make-sure.
  2. Eng, M. (2008, June 19). Potentially Inappropriate OTC Medications in Older Adults. Retrieved October 11, 2019, from https://www.uspharmacist.com/article/potentially-inappropriate-otc-medications-in-older-adults.
  3. Ten Medications Older Adults Should Avoid or Use with Caution. (n.d.). Retrieved October 11, 2019, from https://www.healthinaging.org/tools-and-tips/ten-medications-older-adults-should-avoid-or-use-caution.
  4. Brainard, A., & Gresham, C. (2014, July 1). Prevention and Treatment of Motion Sickness. Retrieved October 24, 2019, from https://www.aafp.org/afp/2014/0701/p41.html.


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