Related topics: •  Medicine Tips for Seniors •  Risky Supplements (Overview)

Senior citizens need more medications than any other sector of the population, and the drugs can take a toll. By some estimates, one-third of their prescriptions trigger serious consequences. While some of the risk is unavoidable, you can provide some protection for yourself and loved ones by staying informed.

Many thousands of dangerous reactions could be prevented if more doctors -- and their patients -- realized that some drugs aren't fit for older patients. A consensus panel of experts in geriatric medicine recently singled out more than 20 medications that are unsafe or ineffective for people over 65, but not every doctor has heard the message. A study by researchers at South Dakota State University found that nearly one in 20 hospital visits by senior citizens resulted in prescriptions for inappropriate drugs. Nationwide, that translates to about 320,000 questionable prescriptions every year.

Five drugs account for 85 percent of all problem prescriptions in the elderly, and all of them can be replaced with safer alternatives. Here are the most common medications that senior citizens should avoid:

•Diazepam (Valium). This sedative, often used to treat insomnia and anxiety, is involved in nearly one-third of all inappropriate prescriptions for the elderly. Diazepam is known as a long-half-life drug, with an active ingredient that's fat soluble and distributed in body fat; there, it's released slowly into the bloodstream, thus prolonging its effect. In older patients, the drug greatly increases the risk of falls, broken bones, and confusion. It can also cause addiction and withdrawal symptoms.

•Chlordiazepoxide (Librium). Another long-half-life sedative, this drug carries the same risks as diazepam. The new drug buspirone (BuSpar) is a safer choice for treating anxiety than either diazepam or chlordiazepoxide. If you suffer from insomnia, try non-drug treatments such as relaxation therapy or ask your doctor about sedatives with less potential for addiction, such as zolpidem (Ambien).

•Propoxyphene (Darvon). This analgesic is often prescribed to older people, despite the fact that it does little to ease their pain and can damage the heart and central nervous system. Common over-the-counter painkillers such as ibuprofen will provide more relief with fewer side effects.

•Dipyridamole (Persantine). This blood-thinner is supposed to prevent blood clots, but the drug is ineffective in the vast majority of older patients. (Only those with artificial heart valves and who are also taking the blood-thinner warfarin will see any benefit.) Low-dose aspirin therapy is a much more reliable way to prevent blood clots.

•Amitriptyline (brand names include Elavil, Etrafon, Limbitrol, and Triavil). This antidepressant, which can cause dangerously low blood pressure in the elderly, can be easily replaced with nortriptyline or selective serotonin reuptake inhibitor drugs (SSRIs) such as fluoxetine (Prozac).

While some medications are always poor choices for older patients, others are dangerous only in certain circumstances. An expert panel of Canadian physicians recently warned doctors everywhere that the following "safe" drugs can sometimes turn risky:

•Beta blockers. These drugs, including penbutolol (Levatol) and metoprolol (Lopressor) are useful for treating high blood pressure and angina, but in some cases they can intensify the symptoms of emphysema, asthma, or heart failure. A doctor might want to prescribe a different class of hypertension drugs such as ACE inhibitors (such as quinapril) or diuretics (such as furosemide), although beta blockers may be preferable in some instances. Nitrates or calcium-channel blockers are generally good alternatives for treating angina, although calcium-channel blockers shouldn't be taken by patients with heart failure (see below).

•Calcium-channel blockers. This class of blood pressure medications can make heart failure worse. ACE inhibitors or diuretics would be a safer choice.

•Tricyclic antidepressants. This class of drugs, which includes imipramine and amoxapine, may aggravate glaucoma, stop the flow of urine in men with benign prostatic hyperplasia (enlarged prostate glands), and worsen heart blockages. Some patients with these conditions might be better off with fluoxetine (Prozac) or another SSRI antidepressant. But although tricylic antidepressants may no longer be the first drug of choice, they can be very effective, and some preparation have fewer of the unwanted side effects. (If you experience any of the above symptoms, or chest pain, call your doctor for an immediate appointment.)

•Barbiturates. Long-term use of these sedatives, occasionally prescribed to treat insomnia, can cause falls, broken bones, confusion, and addiction in older patients. Like the sedatives in the first list, barbiturates should generally be avoided in favor of non-drug treatments such as relaxation therapy or less addicting sedatives, such as zolpidem.

•NSAIDS, or nonsteroidal anti-inflammatory drugs. These common painkillers, including aspirin and ibuprofen, should not be the sole treatment for patients with osteoarthritis. In large doses, these drugs can greatly increase the risk of stomach ulcers, and they can be particularly dangerous for patients with a history of chronic kidney failure, heart failure, or hypertension. Acetaminophen is a safe alternative for treatment of osteoarthritis, but the Arthritis Foundation recommends that you not take it for more than ten days unless you check with your doctor.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

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First published July 25, 2000
Last updated September 29, 2006
Copyright © 2000 Consumer Health Interactive

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