High-Risk Medications to Avoid for Geriatric Patients at ED Discharge[1]
| Therapeutic Class
|
Alternatives
|
Exclusions^
|
| Barbiturates
|
- 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]).
|
- Seizures disorders, benzodiazepine or ethanol withdrawal, barbiturates are acceptable to use.
|
| Benzodiazepines
|
- 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]).
|
- Seizure disorders: benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, and end of life, benzodiazepines are acceptable to use.
|
| First-generation antihistamines
|
- 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.
|
- For allergic reactions, first-generation antihistamines are acceptable to use.
|
| Metoclopramide
|
- For nausea, use ondansetron.
|
- For gastroparesis, metoclopramide is acceptable to use.
|
| First-generation antipsychotics
|
- Second-generation antipsychotics (eg, olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone).
|
|
| Nonbenzodiazepine, Benzodiazepine Receptor Agonist Hypnotics (Z-drugs)
|
- Insomnia: use melatonin, ramelteon, doxepin (<=3 mg).
- Anxiety: use mirtazapine, buspirone, serotonin–norepinephrine reuptake inhibitor (serotonin and norepinephrine reuptake inhibitor, eg, duloxetine, venlafaxine, desvenlafaxine).
|
|
| Skeletal muscle relaxants
|
- Treat musculoskeletal pain first with nonpharmacologic agents (eg, heat, ice, massage) then with Tylenol, short-course NSAIDs, lidocaine patch, diclofenac gel.
|
|
| Sulfonylureas
|
Metformin, long-acting insulin (eg, glargine).
|
|
^Exclusion criteria: valid indications to prescribe potentially inappropriate medications at ED discharge for older adults.
See Also
