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| | ===High-Risk Medications to Avoid for Geriatric Patients at ED Discharge.== |
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Revision as of 19:55, 20 May 2026
=High-Risk Medications to Avoid for Geriatric Patients at ED Discharge.
| Therapeutic Class
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Alternatives
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Exclusions^
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| Barbiturates
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- Epilepsy: use other anticonvulsants (e.g., lamotrigine, levetiracetam).
- Agitation: treat pain first with acetaminophen then low-dose opioid.
- Severe agitation: use low-dose second-generation antipsychotic (eg, olanzapine, risperidone, quetiapine [Lewy body dementia]).
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- Seizures disorders, benzodiazepine or ethanol withdrawal, barbiturates are acceptable to use.
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| Benzodiazepines
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- Epilepsy: use other anticonvulsants (eg, lamotrigine, levetiracetam).
- Agitation: treat pain first with acetaminophen then low-dose opioid.
- Severe agitation: use nonpharmacologic approach then low-dose second-generation antipsychotic (eg, olanzapine, risperidone, quetiapine [Lewy body dementia]).
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- Seizure disorders: benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, and end of life, benzodiazepines are acceptable to use.
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| First-Generation Antihistamines
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- Allergies: use intranasal saline or steroid (eg, fluticasone, beclomethasone), topical antihistamines (eg, azelastine), or second-generation antihistamines (eg, fexofenadine, loratadine).
- Vertigo: use short-term steroids and canalith repositioning maneuvers.
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- For allergic reactions, first-generation antihistamines are acceptable to use.
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| Metoclopramide
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- For nausea, use ondansetron.
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- For gastroparesis, metoclopramide is acceptable to use.
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| First-Generation Antipsychotics
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- Second-generation antipsychotics (eg, olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone).
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| Nonbenzodiazepine, Benzodiazepine Receptor Agonist Hypnotics (Z-drugs)
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- Insomnia: use melatonin, ramelteon, doxepin (<=3 mg).
- Anxiety: use mirtazapine, buspirone, serotonin–norepinephrine reuptake inhibitor (serotonin and norepinephrine reuptake inhibitor, eg, duloxetine, venlafaxine, desvenlafaxine).
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| Skeletal Muscle Relaxants
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- Treat musculoskeletal pain first with nonpharmacologic agents (eg, heat, ice, massage) then with Tylenol, short-course NSAIDs, lidocaine patch, diclofenac gel.
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| Sulfonylureas
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Metformin, long-acting insulin (eg, glargine).
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^Exclusion criteria: valid indications to prescribe potentially inappropriate medications at ED discharge for older adults.
See Also
