Medication Safety for the Elderly

 Medication Safety for the Elderly

If you are taking care of an elderly parent or a practitioner taking care of geriatric patients, please read this for safe medication administration.

Polypharmacy, typically described as the use of five or more medications, is more prevalent among older adults than other age groups. This practice often leads to adverse drug reactions due to errors associated with polypharmacy and frequently results in emergency department visits by older adults. 

The Beers Criteria is a tool designed to identify medications that pose a high risk to older adults, aiming to discontinue those that may cause adverse drug events. This approach promotes better medication selection and quality of care while reducing unnecessary drug costs. 

The American Geriatrics Society updates the Beers Criteria list every three years. Below is a summary of the 2023 Beers Criteria updates: 

DOACs- direct-acting oral anticoagulants such as dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa), and betrixaban (Bevyxxa).

Sulfonylureas are oral type 2 anti diabetic pills that help to lower blood sugar levels by stimulating the pancreas to create more insulin. Examples are glipizide, glimepiride, and glyburide.

Examples of proton pump inhibitor are esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid) and omeprazole (Prilosec).

HFrEF means Heart failure with reduced ejection fraction.

Sodium-Glucose Transport Protein 2 inhibitors (SGLT2i) examples are Dapagliflozin (Forxiga), Empagliflozin (Jardiance), and Ertugliflozin (Steglatro).

Prasugrel is a platelet inhibitor used to prevent formation of blood clots. 

Trimethoprim-Sulfamethoxazole or Bactrim is an antibiotic used to treat ear infections, urinary tract infections, bronchitis, and pneumonia. 

ARNI (angiotensin receptor/neprilysin inhibitor) are medications used to treat heart failure. Sacubitril/valsartan is the only ARNI drug available now in the US.

                                          

Some examples of anticholinergic agents are atropine, scopolamine, ipatropium, tiotropium.

Due to their potential to cause central nervous system (CNS) depression, skeletal muscle relaxants included on the Beers list are carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine.

ARBs or angiotensin receptor blockers are antihypertensive drugs like losartan, valsartan, candesartan, olmesartan.

SSRI or selective serotonin reuptake inhibitors are antidepressants such as Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), Sertraline (Zoloft).

Baclofen is a muscle relaxant that may cause drowsiness or dizziness. People with low eGFR or glomerular filtration rate or with kidney disorders should avoid use.

NSAIDs or non-steroidal anti-inflammatory drugs are added to the medications to be avoided for renal patients or use renal or lower dose.

Note: Please consult your doctor before discontinuing any medications. 

Source: Beers Criteria Updates Handout (ashp.org)

American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults (sbgg.org.br)

What are Direct-Acting Oral Anticoagulants (DOACs)? (heart.org)