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"Medications to be Used in the Elderly"
A Statewide Clinical Recommendation on Potentially Inappropriate Medications
Medication Detail: Cl - Fluo
Usage Ratings
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Level 1:
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Safer alternatives may exist; use of this medication is not suggested in the elderly
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Level 2:
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Medication use should be considered only in a specific patient population as appropriate
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Level 3:
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Medication use is not suggested in naïve patients; evaluate current therapy for tolerance and adverse effects
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Drug1,2,3
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Drug Class
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Concern(s)1,2,3,4
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Alternative Suggestions‡§1,2,3,4
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clidinium-chlordiazepoxide(LIBRAX®)
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Autonomic Agents, Anticholinergic, Antimuscarinic, Benzodiazepines, Long-Acting
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Long half-life, anticholinergic effects, sedative effects, uncertain effectiveness
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Pain, IBS/GI: APAP, fiber (psyllium), simethicone9,12; (Algorithm C) Constipation: increase fluids and fiber intake, psyllium, polyethylene glycol, stool softener (docusate), glycerin suppository; Diarrhea: loperamide, cholestyramine12 |
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clonidine(CATAPRES®)
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Antihypertensive Agents, Central-Acting Adrenergic
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Orthostatic hypotension, CNS adverse effects
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(Algorithm H) Hypertension: lifestyle modifications, thiazide (chlorthalidone), ACE inhibitor, ARB, CCB, (clonidine may be used in refractory hypertension, hypertensive emergency/urgency, or hospice patients)17,23
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cyclobenzaprine (FLEXERIL®)
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Musculoskeletal Agents, Skeletal Muscle Relaxant
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Anticholinergic effects, sedative effects, weakness, uncertain effectiveness
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Spasticity: treat underlying problem, correct seating/footwear, APAP, NSAID+PPI, baclofen, tizanidine13 |
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cyproheptadine(PERIACTIN®)
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Antihistamines, H1 Receptor Antagonist
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Anticholinergic effects
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(Algorithm A/R) Allergic Rhinitis: nasal corticosteroid, opthalmic antihistamine, fexofenadine, loratadine, desloratadine, cetirizine, levocetirizine5,14,28; Pruritis: non-drug treatment, topical corticosteroid, dermatology consult
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dexchlorpheniramine(POLARAMINE®)
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Antihistamines, H1 Receptor Antagonist
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Anticholinergic effects
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(Algorithm A/R) Allergic Rhinitis: nasal corticosteroid, opthalmic antihistamine, fexofenadine, loratadine, desloratadine, cetirizine, levocetirizine5,14
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diazepam (VALIUM®)
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Benzodiazepines, Long-Acting
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Long half-life, anticholinergic effects, sedative effects
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(Algorithm A) Anxiety: taper off benzodiazepine and add buspirone, lorazepam <3mg/day, oxazepam <60mg/day5; (Algorithm I) Insomnia: sleep hygiene, trazodone, temazepam, zolpidem, zaleplon, eszopiclone, ramelteon5,6,7
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dicyclomine (BENTYL®)
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Autonomic Agents, Antimuscarinic
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Anticholinergic effects, uncertain effectiveness
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Pain, IBS/GI: APAP, fiber (psyllium), simethicone9,12; (Algorithm C) Constipation: increase fluids and fiber intake, psyllium, polyethylene glycol, stool softener (docusate), glycerin suppository12; Diarrhea: loperamide, cholestyramine12 |
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digoxin (LANOXIN®)
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Anti-Arrhythmic Agents, Cardiac Glycoside
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Decreased renal clearance may lead to increased risk of digitalis toxicity
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(Algorithm A/F) Atrial Fibrillation, Rate Control; LVEF <40%: metoprolol (extended release), carvedilol, bisoprolol, (digoxin may be used if alternative suggestions have failed)8,22; Atrial Fibrillation, Rate Control; LVEF > 40%: atenolol, metoprolol, propranolol, non-dihydropyridine CCB (diltiazem, verapamil), (digoxin may be used if alternative suggestions have failed)8,22; Heart Failure: metoprolol (extended release), carvedilol, bisoprolol with ACE inhibitor and loop diuretic, (spironolactone or low dose digoxin,125mcg/day or 125mcg/every other day, may be used if patient remains symptomatic)8,22
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diphenhydramine (BENADRYL®)
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Antihistamines, H1 Receptor Antagonist
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Anticholinergic effects, sedative effects, CNS adverse effects
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Pruritis: non-drug treatment, topical corticosteroid, dermatology consult; (Algorithm A/R) Allergic Rhinitis: nasal corticosteroid, opthalmic antihistamine, fexofenadine, loratadine, desloratadine, cetirizine, levocetirizine5,14,28; (Algorithm I) Insomnia: sleep hygiene, trazodone, temazepam, zolpidem, zaleplon, eszopiclone, ramelteon5,6,7 |
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dipyridamole (PERSANTINE®)
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Hematological Agents, Platelet Inhibitor
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Orthostatic hypotension, potential bleeding
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Thromboembolic Complication: low-dose aspirin, clopidogrel, aspirin/dipyridamole8 |
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disopyramide (NORPACE®, NORPACE CR®)
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Anti-Arrhythmic Agents, Class IA
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May induce heart failure, anticholinergic effects, hypotension
Boxed Warning: increased mortality; restrict use to life-threatening ventricular arrhythmias, no survival benefit in patients without life-threatening arrhythmias
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Arrhythmia: should be started by cardiologist only |
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doxazosin (CARDURA®)
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Autonomic Agents, Alpha-Blocker
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Hypotension, anticholinergic effects
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Benign Prostatic Hypertrophy: tamsulosin, prazosin, terazosin, finasteride, dutasteride, alfuzosin, surgical consult; (Algorithm H) Hypertension: lifestyle modifications, thiazide (chlorthalidone), ACE inhibitor, ARB, CCB17,23 |
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doxepin (SINEQUAN®)
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Antidepressants, Tricyclic
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Anticholinergic effects, sedative effects
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Dermatitis/Eczema: non-drug treatment, topical corticosteroid, dermatology consult; Depression: psychotherapy, SSRI, SNRI, bupropion, mirtazapine10; (Algorithm A) Anxiety: buspirone, lorazepam <3mg/day, oxazepam <60mg/day5 |
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ergot mesyloids (HYDERGINE®)
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Autonomic Agents, Ergot Alkaloid
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Uncertain effectiveness
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(Algorithm M) Pain, Migraine: lifestyle modifications, APAP, NSAID+PPI20
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estrogens, oral (ESTRADIOL®)
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Hormones, Estrogen
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Carcinogenic effects, endometrial hyperplasia Boxed Warning: endometrial cancer risk, cardiovascular risk
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Menopausal Symptoms: non-drug treatment, lifestyle modifications, SSRI; Osteoporosis Prophylaxis: weight bearing exercises, calcium w/ vitamin D, bisphosphonate; Vaginitis: topical |
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ethacrynic acid (EDECRIN®)
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Antihypertensive Agents, Loop Diuretic
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Hypotension, fluid/electrolyte imbalances, ototoxicity
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Diuresis: furosemide, bumetanide, (ethacrynic acid may be used if allergic to other diuretic classes or if recommended by nephrology)17,23 |
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iron >325mg/day
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Supplement, Iron
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Doses >325mg/day do not dramatically increase the amount absorbed, but increase potential for constipation
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Iron Deficiency: iron <325mg/day, (higher doses of iron may be used in documented iron deficiency) |
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fluoxetine, daily dosing (PROZAC®)
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Antidepressants, SSRI
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Long half-life, excessive CNS stimulation, sleep disturbances, agitation
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Depression: psychotherapy, citalopram, escitalopram, sertraline, SNRI, bupropion, mirtazapine (fluoxetine daily dosing may be used by psychiatrist in patients that have failed other SSRI alternative suggestions)10,11 |
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