Potentially Inappropriate Medication No of patients Recommendation by Beer guidelines Quality of Evidence Strength of Recommendation
Independent of diagnosis Independent of diagnosis Independent of diagnosis Independent of diagnosis Independent of diagnosis
Omeprazole 18 Avoid Scheduled use for >8 weeks unless for high- risk patients (e.g., Oral corticosteroids or chronic NSAID use), erosive esophagitis, Barrett’s esophagitis, pathological hypersecretory condition, or demonstrated need for maintenance treatment High Strong
Rabeprazole 12
Pantoprazole 40
Prazosin 4 Avoid use as an Antihypertensive Moderate Strong
Glimepiride 14 Avoid High Strong
Human insulin, according to Random Blood Sugar 52 Avoid (insulin regimens containing only short- or rapid-acting insulin dosed according to current blood glucose levels without concurrent use of basal or long-acting insulin) Moderate Strong
Nitrofurantoin 8 Avoid in individuals with creatinine clearance <30mL/min or for long- term suppression Low Strong
Chlordiazepoxide 3 Avoid Moderate Strong
Trihexyphenidyl 2 Avoid Moderate Strong
Zolpidem 3 Avoid Moderate Strong
Clonazepam 22 Avoid Moderate Strong
Digoxin 0.25mg
4
Avoid this rate control agent as first line therapy for atrial fibrillation Avoid as first- line therapy for heart failure. If used for atrial fibrillation or heart failure, avoid dosages >0.125mg/day.
Atrial fibrillation: low Heart failure: low Dosage >0.125mg/day: moderate Atrial fibrillation: strong Heart failure: strong Dosage >0.125mg/day: strong
Amiodarone 6 Avoid as first- line therapy for atrial fibrillation unless the patient has heart failure or substantial left ventricular hypertrophy High Strong
Nortriptyline 4 Avoid High Strong
Ketorolac 4 Avoid Moderate Strong
Quetiapine 8 Avoid Moderate Strong
Clonidine 3 Avoid Low Strong
Ergot mesyloids 2 Avoid High Strong
Dependent of diagnosis Dependent of diagnosis Dependent of diagnosis Dependent of diagnosis Dependent of diagnosis
Delirium
Ranitidine 3 Avoid Moderate Strong
Hydrocortisone 3 Avoid Moderate Strong
Drug-drug interaction Drug-drug interaction Drug-drug interaction Drug-drug interaction Drug-drug interaction
Prazosin + Furosemide Urinary incontinence in women 2 Avoid in older women Moderate Strong
Hydrocortisone + ketorolac increased risk of peptic ulcer or GI bleeding 2 Avoid; if not possible, provide gastrointestinal protection Moderate Strong
Drugs that should be used with caution in older adults Drugs that should be used with caution in older adults Drugs that should be used with caution in older adults Drugs that should be used with caution in older adults Drugs that should be used with caution in older adults
Aspirin for primary prevention of cardiovascular disease and colorectal cancer 12 Use with caution in adults ≥70 years Moderate Strong
Furosemide 6 Use with caution as they may exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults Moderate Strong
Torsemide 12
Metolazone 2
According to creatinine clearance of the patient According to creatinine clearance of the patient According to creatinine clearance of the patient According to creatinine clearance of the patient According to creatinine clearance of the patient
Creatinine clearance at which action required (ml/min)
Enoxaparin <30ml/min 32 Reduced dose Moderate Strong
Spironolactone <30ml/min 8 Avoid Moderate Strong
Ranitidine <50ml/min 8 Reduced dose Moderate Strong
Pregabalin<60ml/min 6 Reduced dose Moderate Strong
Gabapentin <60ml/min 2 Reduced dose Moderate Strong
Dabigatran <30ml/min 4 Avoid; dose adjustment advised when CrCl >30 mL/min Moderate Strong
Trimethoprim-sulfamethoxazole <30ml/min 3 Reduced dose if CrCl 15-29ml/min Avoid if CrCl <15ml/min Moderate Strong