Drug Classes To Avoid in Older Persons with HIV
| 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 Non-benzodiazepines hypnotics, Z-drugs e.g., zapleton, 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. |
Legend
NSAID nonsteroidal anti-inflammatory drug