Drugs to Avoid in Older Adults

The following article was written by Brown Medicine’s Marco DelBove, Pharm.D, and published in the June-July 2019 issue of the Brown Medicine Geriatrics Department newsletter:

The American Geriatrics Society recommends avoiding certain medications in older adults to reduce the chance of reactions and side effects. It is important to be aware that some of these drugs are available over-the-counter (OTC).  The following highlights two types of drug classes that should be avoided.

Non-Steroidal Anti-Inflammatory Drugs (NSAID)
Non-steroidal anti-inflammatory drugs, or NSAIDs, are used to reduce pain and inflammation.  They are available OTC and include drugs such as ibuprofen (Advil) or naproxen (Aleve).  NSAIDs can increase the risk of bleeding ulcers, increase blood pressure, affect your kidneys, or worsen heart failure.  People taking steroids or blood-thinning medications are at a higher risk of developing bleeding problems if NSAIDs are used.  Discuss pain relief options with your doctor before taking any of these medications.  Acetaminophen (Tylenol) is not an NSAID.  If effective, it is safe when taken below the maximum dose on the package. Patients with liver disease should avoid acetaminophen.

These medications can be used for allergies, cough/cold or as a sleep aid.  Examples of these medications include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), or doxylamine (NiteTime Sleep-Aid).  Be cautious of combination pain relievers or cold remedies that may include an antihistamine, like Tylenol PM.  Antihistamines can cause drowsiness, confusion, constipation, or problems urinating.  Read the product label carefully and speak to your doctor before taking any of these products.  There are usually safer alternatives that can help treat these conditions.  These include drugs like loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra). Do not take the versions of these drugs that have decongestants added. They usually end with a “D” (such as Claritin D). Also, OTC saline nasal sprays or cortisone-like sprays such as fluticasone (Flonase) can be effective. Avoid decongestant nose sprays, such as oxymetazoline (Afrin). They cause more inflammation when used more than just a day or two.