What Are the Most Dangerous Drugs for Older Adults?

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?