Drugs to approach with care

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The medicines below should be avoided or used cautiously because older adults are sensitive to their side effects. If you see a drug that you are taking on the list below*, check with your physician. Do not stop taking any medication without first talking to your doctor. You can find additional information and a full list of medications to avoid or use with caution through the Health in AgingKaiser Permanente is not responsible for the content or policies of external Internet sites, or mobile apps. website.


Non-steroidal anti-inflammatory drugs (NSAIDs)

  • Long-acting NSAIDs like indomethacin (Indocin) and piroxicam (Feldene)
  • Shorter-acting NSAIDs like ibuprofen (Advil, Motrin) and salsalate (Disalcid) are better choices

NSAIDs can increase the risk of indigestion, ulcers, and bleeding in your stomach or colon. They can also increase blood pressure, affect your kidneys, and make heart failure worse.

Digoxin (Lanoxin) in doses greater than 0.125 mg.It can be toxic in older adults and people whose kidneys do not work well.

Certain diabetes drugs

  • Glyburide (Diabeta, Micronase)
  • Chlorpropamide (Diabinese)
  • Glimepiride (Amaryl)
These can cause severe low blood sugar.

Muscle relaxants

  • Cyclobenzaprine (Flexeril)
  • Methocarbamol (Robaxin)
  • Carisoprodol (Soma), and similar medications.
They can leave you feeling groggy and confused, increase your risk of falls, and cause constipation, dry mouth, and problems urinating. Plus, there is little evidence that they work well.

Certain medications used for anxiety and/or insomnia

  • Benzodiazepines
  • Diazepam (Valium)
  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)

Sleeping pills such as

  • Zaleplon (Sonata)
  • Zolpidem (Ambien)
They can increase your risk of falls, as well as cause confusion. Because it takes your body a long time to get rid of these drugs, you could feel groggy and sleepy for a long time.

Certain anticholinergic drugs

  • Antidepressants amitriptyline (Elavil) and imipramine (Tofranil)
  • Anti-Parkinson's drug trihexyphenidyl (Artane)
  • Irritable bowel syndrome drug dicyclomine (Bentyl)
  • Overactive bladder drug oxybutynin (Ditropan)

They can cause confusion, constipation, problems urinating, blurry vision, and low blood pressure. Men with an enlarged prostate should be particularly cautious.

Pain Reliever meperidine (Demerol)It can increase the risk of seizures and can cause confusion.

Certain over-the-counter products

  • products that contain the antihistamines diphenhydramine (Benadryl) and chlorpheniramine (AllerChlor, Chlor-Trimeton), particularly in men with an enlarged prostate
  • over-the-counter sleep products, like Tylenol PM, which contain diphenhydramine
Although these medications are sold without a prescription, they are not risk free. They can cause confusion, blurred vision, constipation, problems urinating, and dry mouth.

If you are not being treated for psychosis, avoid using antipsychotics

  • Haloperidol (Haldol)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
They can increase the risk of stroke or even death. They can also cause tremors and other side effects, as well as increase your risk of falls. 

Estrogen pills and patches

  • Premarin
  • Ogen
  • Menest
They can increase your risk of breast cancer, blood clots, and even dementia.

*Used with permission from the American Geriatrics Society: AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (2012). See the full list of medicationsKaiser Permanente is not responsible for the content or policies of external Internet sites, or mobile apps. at the American Geriatrics Society website.

Reviewed by Tracy Lippard, MD, July 2019