People age 65 and older are more than twice as likely as younger ones to be treated in emergency rooms because of adverse drug reactions. One reason: Kidney function declines with age, making it harder for the body to eliminate drugs. Moreover, nearly half of them take at least five different medications, multiplying risks.
“If you take three medications that have sedation as a possible side effect, then the compounding effect may not be 1+1+1=3, but 3x3x3=27,” says Todd Semla, Pharm.D., with the Department of Veterans Affairs. The table below lists common drugs that pose such a risk to older people that researchers included them on a list of medications to generally avoid. (Brand names are shown, but most are sold as generics, too.) If you’re over 65 and your doctor prescribes one, ask whether there’s a safer alternative for you.
| DRUG | SIDE EFFECTS | POSSIBLE ALTERNATIVES |
|---|---|---|
| Antianxiety drugs | ||
| Chlordiazepoxide (Librium, Limbitrol); diazepam (Valium); quazepam (Doral) | Confusion, dependence, depression, falls, incontinence, prolonged sedation | Low doses of short-acting benzodiazepines such as alprazolam (Xanax), lorazepam (Ativan), and oxazepam (Serax) |
| Antidepressants | ||
| Amitriptyline, doxepin (Sinequan) | Constipation, sedation, urine retention | Short-acting antidepressants such as citalopram (Celexa), paroxetine (Paxil), and sertraline (Zoloft) |
| Fluoxetine (Prozac) | Agitation, sleep disturbances | |
| Antihistamines | ||
| Chlorpheniramine (Chlor-Trimeton); diphenhydramine (Benadryl) | Confusion, sedation, urine retention | Cetirizine (Zyrtec); fexofenadine (Allegra); loratadine (Claritin) |
| High blood pressure and enlarged prostate drugs | ||
| Doxazosin (Cardura); prazosin (Minipress); terazosin (Hytrin) | Dangerously low blood pressure, incontinence | Diuretics for high blood pressure; tamsulosin (Flomax) for enlarged prostate. |
| Pain relievers | ||
| Naproxen (Aleve, Naprosyn); oxaprozin (Daypro); piroxicam (Feldene) | Gastrointestinal bleeding, kidney damage | Mild pain: acetaminophen (Tylenol); ibuprofen (Advil ); capsaicin cream (Zostrix). Moderate or severe pain: morphine |
| Meperidine (Demerol) | Confusion, falls | |
| Sleeping pills | ||
| Barbituates (Butisol, Nembutal, Seconal); diphenhydramine (Sominex); flurazepam (Dalmane) | Confusion, dependence, excessive sedation, falls | Change sleeping habits; short-acting sleeping pills such as zaleplon (Sonata) and zolpidem (Ambien) |
| Stomach drugs | ||
| Bisacodyl (Dulcolax) | Worsened bowel problems | Increased intake of fiber and fluids |
| Diphenoxylate (Lomotil) | Dependence, sedation | Change in diet; loperamide (Imodium AD) |
This article first appeared in the September 2008 issue of Consumer Reports on Health.
