Drug Classes To Avoid: Elderly

Selected Top 10 Drug Classes To Avoid in Elderly PLWH
Drug class Problems/alternatives
First generation antihistamines
e.g., clemastine, diphenhydramine, doxylamine, hydroxyzine
Strong anticholinergic properties, risk of impaired cognition, delirium, falls, peripheral anticholinergic adverse reactions (dry mouth, constipation, blurred vision, urinary retention).
Alternatives: cetirizine, desloratadine, loratadine
Tricyclic antidepressants
e.g., amitryptiline, clomipramine, doxepin, imipramine, trimipramine
Strong anticholinergic properties, risk of impaired cognition, delirium, falls, peripheral anticholinergic adverse reactions (dry mouth, constipation, blurred vision, urinary retention).
Alternatives: citalopram, escitalopram, mirtazapine, venlafaxine
Benzodiazepines
Long and short acting benzodiazepines e.g., clonazepam, diazepam, midazolam Non-benzodiazepines hypnotics
e.g., zolpidem, zopiclone
Elderly are more sensitive to their effect, risk of falls, fractures, delirium, cognitive impairment, drug dependency. Use with caution, at the lowest dose and for a short duration.
Alternatives: non-pharmacological treatment of sleep disturbance/sleep hygiene.
Atypical antipsychotics
e.g., clozapine, olanzapine, quetiapine
Anticholinergic adverse reactions, increased risk of stroke and mortality (all antipsychotics).
Alternatives: aripiprazole, ziprasidone
Urological spasmolytic agents
e.g., oxybutynin, solifenacin, tolterodine
Strong anticholinergic properties, risk of impaired cognition, delirium, falls, peripheral anticholinergic adverse reactions (dry mouth, constipation, blurred vision, urinary retention).
Alternatives: non-pharmacological treatment (pelvic floor exercises).
Stimulant laxatives
e.g., senna, bisacodyl
Long-term use may cause bowel dysfunction. Alternatives: fibres, hydration, osmotic laxatives
NSAIDs
e.g., diclofenac, indomethacin, ketorolac, naproxen
Avoid regular, long-term use of NSAIDs due to risk of gastrointestinal bleeding, renal failure, worsening of heart failure.
Alternatives: paracetamol, weak opioids
Digoxin
Dosage > 0.125 mg/day
Avoid doses higher than 0.125 mg/day due to risk of toxicity. Alternatives for atrial fibrillation: beta-blockers
Long acting sulfonylureas
e.g., glyburide, chlorpropamide
Can cause severe prolonged hypoglycemia. Alternatives: metformin or other antidiabetic classes
Cold medications
Most of these products contain antihistamines (e.g., diphenhydramine) and decongestants (e.g., phenylephrine, pseudoephedrine)
First generation antihistamines can cause central and peripheral anticholinergic adverse reactions as described above. Oral decongestants can increase blood pressure. Avoid

Legend

NSAID nonsteroidal anti-inflammatory drug

Reference [1]