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"Medications to be Used in the Elderly"
A Statewide Clinical Recommendation on Potentially Inappropriate Medications
Medication Detail: Flur - Or
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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flurazepam (DALMANE®)
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Benzodiazepines, Long-Acting
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Long half-life, sedative effects, increased risk of falls |
(Algorithm I) Insomnia: sleep hygiene, trazodone, temazepam, zolpidem, zaleplon, eszopiclone, ramelteon5,6,7 |
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guanethidine (ISMELIN®)
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Antihypertensive Agents |
Orthostatic hypotension
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(Algorithm H) Hypertension: lifestyle modifications, thiazide (chlorthalidone), ACE inhibitor, ARB, CCB17,23 |
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haloperidol (HALDOL®)
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Antipsychotic Agents, Typical
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Increased risk of falls, extrapyramidal symptoms, Boxed Warning: increased mortality risk in elderly dementia related patients on typical or atypical antipsychotics
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Agitation: treat underlying causes, psychiatry consult, (haloperidol may be used in hospice patients); (Algorithm N/V) Nausea and Vomiting: ondansetron, granisetron, dolasetron, palonosetron15 |
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hydroxyzine (VISTARIL®, ATARAX®)
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Antihistamines, H1 Receptor Antagonist
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Anticholinergic effects
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Pruritis/Dermatitis: non-drug treatment, topical corticosteroid, dermatology consult; (Algorithm N/V) Nausea and Vomiting: ondansetron, granisetron, dolasetron, palonosetron15; (Algorithm A) Anxiety: buspirone5
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hyoscyamine (LEVBID®, LEVSIN®, LEVSINEX®)
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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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indomethacin (INDOCIN®, INDOCIN SR®)
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Analgesics, NSAID
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CNS adverse effects, renal failure, GI bleeding, hypertension, heart failure, Boxed Warning: cardiovascular risk, GI risk
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(Algorithm P) Mild Pain, Non-Neuropathic: APAP, NSAID+PPI, COX II inhibitor, topical (capsaicin, menthol)9; Moderate to Severe Pain, Non-Neuropathic: APAP, NSAID+PPI, hydrocodone/APAP (do not exceed max APAP dose recommendations), morphine, oxycodone, fentanyl patch9
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isoxsuprine (VASODILAN®)
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Antihypertensive Agents,Vasodilator
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Uncertain effectiveness
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(Algorithm H) Hypertension: lifestyle modifications, thiazide (chlorthalidone), ACE inhibitor, ARB, CCB17,23
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ketorolac (TORADOL®)
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Analgesics, NSAID
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GI bleeding, renal failure, hypertension, heart failure, Boxed Warning: GI risk, cardiovascular risk, renal and bleeding risk, hypersensitivity reactions
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(Algorithm P) Mild Pain, Non-Neuropathic: APAP, NSAID+PPI, COX II inhibitor, topical (capsaicin, menthol)9; Moderate to Severe Pain, Non-Neuropathic: APAP, NSAID+PPI, hydrocodone/APAP (do not exceed max APAP dose recommendations), morphine, oxycodone, fentanyl patch9
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lorazepam doses >3mg (ATIVAN®)
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Benzodiazepines, Short-Acting
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Due to sensitivity in elderly populations, total daily doses should not exceed the suggested maximum dose of 3mg
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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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meperidine (DEMEROL®)
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Analgesics, Opiate Agonist
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Dependency, sedative effects, uncertain effectiveness
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(Algorithm P) Mild Pain, Non-Neuropathic: APAP, NSAID+PPI, COX II inhibitor, topical (capsaicin, menthol)9; Moderate to Severe Pain, Non-Neuropathic: APAP, NSAID+PPI, hydrocodone/APAP (do not exceed max APAP dose recommendations), morphine, oxycodone, fentanyl patch9
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meprobamate (MILTOWN®)
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Anxiolytics
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Dependency, sedative effects
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(Algorithm A) Anxiety: buspirone, lorazepam <3mg/day, oxazepam <60mg/day5
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metaxalone (SKELAXIN®)
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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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methocarbamol (ROBAXIN®)
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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, baclofen, tizanidine13 |
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methyldopa (ALDOMET®)
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Antihypertensive Agents, Central-Acting Adrenergic
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Bradycardia, depression
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(Algorithm H) Hypertension: lifestyle modifications, thiazide (chlorthalidone), ACE inhibitor, ARB, CCB, (methyldopa may be used in hypertensive urgency/ emergency or hospice patients)17,23
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methyldopa-hydrochlorothiazide (ALDORIL®)
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Antihypertensive Agents, Central-acting Adrenergic, Diuretics, Thiazide
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Bradycardia, depression
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(Algorithm H) Hypertension: lifestyle modifications, thiazide (chlorthalidone), ACE inhibitor, ARB, CCB17,23
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methyltestosterone (ANDROID®, TESTRED®, VIRILON®)
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Hormones, Androgen
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Prostatic hypertrophy, cardiac problems
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Hypogonadism/Erectile Dysfunction: topical, transdermal, IM, SQ, or buccal testosterone, (methyltestosterone may be used in documented hypogonadism)21 |
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naproxen (ALEVE®, ANAPROX®, NAPROSYN®)
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Analgesics, NSAID
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GI bleeding, renal failure, hypertension, heart failure, Boxed Warning: cardiovascular risk, GI risk
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(Algorithm P) Mild Pain, Non-Neuropathic: APAP, NSAID+PPI, COX II inhibitor, topical (capsaicin, menthol)9; Moderate to Severe Pain, Non-Neuropathic: APAP, NSAID+PPI, hydrocodone/APAP (do not exceed max APAP dose recommendations), morphine, oxycodone, fentanyl patch9
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(NEOLOID®)
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Laxatives, Stimulant
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Bowel dysfunction exacerbation
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(Algorithm C) Constipation: increase fluids and fiber intake, psyllium, polyethylene glycol, stool softener (docusate), glycerin suppository, (stimulant laxatives may be used in elderly or hospice patients taking medications that may cause constipation and have failed alternative suggestions)12
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nifedipine, immediate release (ADALAT®, PROCARDIA®)
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Antihypertensive Agents, CCB, Short-Acting
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Hypotension, constipation
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(Algorithm H) Hypertension: lifestyle modifications, thiazide (chlorthalidone), ACE inhibitor, ARB, CCB17,23
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nitrofurantoin (MACROBID®, MACRODANTIN®)
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Anti-Infective Agents, Urinary
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Pulmonary fibrosis
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Anti-infective: organism dependent, sulfamethoxazole/trimethoprim, quinolone |
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orphenadrine (NORFLEX®)
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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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