Drugs to Be Used With Caution in Older Adults (Based on the American Geriatrics Society 2019 Beers Criteria^® Update)

Aspirin for primary prevention of cardiovascular disease and colorectal cancer

Use with caution in patients ≥ 70 years

Risk of major bleeding from aspirin increases markedly in older age.

Dabigatran

Rivaroxaban

Use with caution for treatment if venous thromboembolism (VTE) or atrial fibrillation in patients ≥ 75 years

Greater risk of bleeding than warfarin in patients ≥ 75 year

Prasugrel

Use with caution in patients ≥ 75 years. Increased risk of bleeding; benefit may offset risk in highest-risk older adults (eg, those with previous myocardial infarction or diabetes mellitus)

Antipsychotics

Carbamazepine

Diuretics

Mirtazapine

Oxcarbazepine

Serotonin–norepinephrine reuptake inhibitors (SNRIs)

Selective serotonin reuptake inhibitors (SSRIs)

Tricyclic antidepressants (TCAs)

Tramadol

May worsen or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia

Monitor sodium level closely when starting or changing dosages

Dextromethorphan/quinidine

Limited efficacy in patients with behavioral symptoms of dementia (does not apply to treatment of pseudobulbar affect)

May increase risk of falls and concerns with clinically significant drug interactions

Trimethoprim-sulfamethoxazole

Use with caution in patients on angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) and decreased creatinine clearance; may increase risk of hyperkalemia in these patients