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"Medications to be Used in the Elderly"
A Statewide Clinical Recommendation on Potentially Inappropriate Medications
Medication Detail: Ox - Tri
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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oxaprozin (DAYPRO®)
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Analgesics, NSAID
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GI bleeding, renal failure, hypertension, and 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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oxazepam doses >60mg (SERAX®)
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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 60mg
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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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oxybutynin (DITROPAN®)
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Autonomic Agents, Antimuscarinic
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Anticholinergic effects, sedative effects, weakness, uncertain effectiveness
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Urinary Incontinence: behavioral modifications, oxybutynin ER, tolterodine LA, darifenacin18,19
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pentazocine (TALWIN®)
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Analgesics, Opiate Agonist/Antagonist
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CNS adverse effects, sedative effects
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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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perphenazine-amitriptyline (TRIAVIL®)
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Antidepressants, Tricyclic, Antipsychotic Agents, Typical
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Increased risk of falls, extrapyramidal symptoms, anticholinergic effects, sedative effects, Boxed Warning: increased mortality risk in elderly dementia related patients on typical or atypical antipsychotics
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Depression: psychotherapy, citalopram, escitalopram, sertraline, bupropion, mirtazapine; (Algorithm A) Anxiety: buspirone, lorazepam <3mg/day, oxazepam <60mg/day5 |
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piroxicam (FELDENE®)
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Analgesics, NSAID
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GI bleeding, renal failure, hypertension, and heart failure, Boxed Warning: cardiovascular, 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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promethazine (PHENERGAN®)
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Antihistamines, H1 Receptor Antagonist
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Anticholinergic effects, Boxed Warning: use with caution at lowest effective dose
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(Algorithm A/R) Allergic Rhinitis: nasal corticosteroid, opthalmic antihistamine, fexofenadine, loratadine, desloratadine, cetirizine, levocetirizine5,14,28; (Algorithm N/V) Nausea and Vomiting: ondansetron, granisetron, dolasetron, palonosetron15
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propantheline (PRO-BANTHINE®)
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Autonomic Agents, Antimuscarinic
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Anticholinergic effects, sedative effects, weakness, 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, cholestyramine; Urinary Incontinence: behavioral modifications, oxybutynin ER, tolterodine LA, darifenacin18,19 |
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propoxyphene (DARVON®) propoxyphene/APAP (DARVOCET-N®) propoxyphene/ASA (DARVON/ASA®)
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Analgesics, Opiate Agonist
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Dependency, sedative effects, uncertain effectiveness, Boxed Warning: death, CNS depressant effects
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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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reserpine
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Antihypertensive Agents
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Depression, sedative effects, orthostatic hypotension, impotence due to sensitivity, total daily doses should not exceed the suggested maximum of 0.25mg
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(Algorithm H) Hypertension: lifestyle modifications, thiazide (chlorthalidone), ACE inhibitor, ARB, CCB17,23
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temazepam doses >15mg (RESTORIL®)
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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 15mg
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(Algorithm I) Insomnia: sleep hygiene, trazodone, temazepam, zolpidem, zaleplon, eszopiclone, ramelteon5,6,7
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thioridazine (MELLARIL®)
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Antipsychotic Agents, Typical
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QT interval prolongation, CNS adverse effects, extrapyramidal symptoms
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Psychosis: should be started by psychiatrist only |
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thiothixene (NAVANE®)
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Antipsychotic Agents, Typical
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Lowers seizure threshold, 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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Psychosis: should be started by psychiatrist only |
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thyroid, desiccated (Armour THYROID®, NATURE-THYROID®, WESTHROID®)
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Hormones, Thyroid
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Cardiac effects, Boxed Warning: not for obesity, weight loss
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Hypothyroidism: levothyroxine, liothyronine |
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ticlopidine (TICLID®)
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Hematological Agents, Platelet Inhibitor
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Orthostatic hypotension, potential bleeding, no clinical evidence showing advantage over ASA in clot prevention, Boxed Warning: neutropenia/agranulocytosis, thrombotic thrombocytopenic purpura, aplastic anemia
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Thromboembolic Complication: low-dose aspirin, clopidogrel, aspirin/ dipyridamole7 |
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triazolam doses >0.25mg (HALCION®)
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Benzodiazepines, Short-Acting
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Due to sensitivity in elderly populations, total daily dose should not exceed the suggested maximum dose of 0.25mg
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(Algorithm I) Insomnia: sleep hygiene, trazodone, temazepam, zolpidem, zaleplon, eszopiclone, ramelteon5,6,7
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trimethobenzamide (TIGAN®)
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Antiemetics
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Anticholinergic effects, extrapyramidal symptoms
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(Algorithm N/V) Nausea and Vomiting: ondansetron, granisetron, dolasetron, palonosetron15
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