Table 2. PRISCUS 2.0, short version.
| Substance/class | Possible alternatives depending on indication (expert opinion) |
| Drugs for acid-related diseases | |
| Antacids containing magnesium > 4 weeks | Antacids containing alginate PPI < 8 weeks |
| Compounds containing aluminum | Antacids containing alginate PPI < 8 weeks |
| Cimetidine, ranitidine*1 | PPI < 8 weeks when indicated, famotidine |
| Proton pump inhibitors > 8 weeks | PPI < 8 weeks when indicated, famotidine |
| Drugs for functional gastrointestinal disorders | |
| Mebeverine | E.g., psyllium, non-pharmacological |
| Metoclopramide, domperidone | E.g., setrons, herbal preparations |
| Alizapride | |
| Antiemetics and drugs for nausea | |
| Dimenhydrinate | E.g., setrons, herbal preparations |
| Scopolamine | E.g., corticosteroids, setrons |
| Drugs for constipation | |
| Liquid paraffin | E.g., macrogol, psyllium |
| Sennosides > 1 week | E.g., sennosides < 1 week, macrogol |
| Sodium picosulfate > 1 week | E.g., sodium picosulfate < 1 week, macrogol |
| Antipropulsives | |
| Loperamide > 3 d, > 12 mg/d | E.g., loperamide < 3 d, < 12 mg/d, racecadotril |
| Antidiabetic drugs | |
| Glibenclamide, gliquidone, gliclazide, glimepiride | E.g., metformin, DPP-4 inhibitors |
| Acarbose | E.g., metformin, DPP-4 inhibitors |
| Pioglitazone | E.g., metformin, DPP-4 inhibitors |
| Antithrombotic drugs | |
| Ticlopidine, prasugrel | E.g., clopidogrel, ASA |
| Cardiac treatment | |
| Digoxin and derivatives | E.g., beta-blockers, digitoxin |
| Lidocaine | E.g., beta-blockers, when indicated amiodarone |
| Propafenone as long-term medication | E.g., beta-blockers, when indicated amiodarone |
| Flecainide | Beta-blockers, when indicated amiodarone |
| Dronedarone | E.g., beta-blockers, when indicated amiodarone |
| Antihypertensives | |
| Methyldopa, clonidine, moxonidine | E.g., ACE inhibitors, other antihypertensives |
| Doxazosin | E.g., ACE inhibitors, other antihypertensives |
| Terazosin as antihypertensive | ACE inhibitors, other antihypertensives |
| Dihydralazine, hydralazine*2 | E.g., ACE inhibitors, other antihypertensives |
| Minoxidil | E.g., ACE inhibitors, other antihypertensives |
| Potassium-sparing drugs | |
| Spironolactone > 25 mg/d | E.g., spironolactone ≤ 25 mg/d |
| Peripheral vasodilators | |
| Pentoxifylline | E.g., memantine, ASA, memory/walking training |
| Naftidrofuryl, cilostazol | E.g., walking training, ASA |
| Beta-adrenoceptor antagonists | |
| Pindolol, propranolol, sotalol | Others (selective beta-blockers) |
| Calcium-channel blockers | |
| Non-slow-release nifedipine | E.g., long-acting calcium antagonists |
| Drugs acting on the renin–angiotensin system | |
| Aliskiren | ACE inhibitors, sartans |
| Sexual hormones and modulators of the genital system | |
| Testosterone | |
| Oral estrogens | Vaginal estrogens, black cohosh |
| Urologics | |
| Flavoxate | E.g., pelvic floor training, bladder training |
| Oxybutynin, propiverine, tolterodine, solifenacin, trospium, darifenacin, fesoterodine, desfesoterodine | Non-pharmacological |
| Mirabegron | Non-pharmacological |
| Hypophyseal and hypothalamic hormones and analogs | |
| Desmopressin | Tamsulosin, vaginal estrogens |
| Antibiotics for systemic use | |
| Fluoroquinolones | Depending on antibiogram |
| Endocrine treatment | |
| Medroxyprogesterone | Tamoxifen, fulvestrant, vaginal estrogens |
| Non-steroidal anti-inflammatory and antirheumatic drugs | |
| Phenylbutazone | E.g., topical agents, paracetamol |
| Indomethacin, diclofenac, acemetacin, proglumetacin, aceclofenac | E.g., topical agents, paracetamol |
| Piroxicam, meloxicam | E.g., topical agents, paracetamol |
| Ibuprofen > 3 × 400 mg/d, > 1 week or > 3 × 400 mg/d, with PPI > 8 weeks | E.g., ibuprofen ≤ 3 × 400 mg/d, ≤ 1 week, with PPI ≤ 8 weeks |
| Naproxen > 2 × 250 mg/d, > 1 week or > 2 × 250 mg/d, with PPI > 8 weeks | E.g., naproxen ≤ 2 × 250 mg/d, ≤ 1 week, with PPI ≤ 8 weeks |
| Ketoprofen, dexketoprofen | E.g., topical agents, paracetamol |
| Etofenamate | E.g., topical agents, paracetamol |
| Coxibs | E.g., topical agents, paracetamol |
| Nabumetone | E.g., topical agents, paracetamol |
| Muscle relaxants | |
| Methocarbamol, orphenadrine (citrate), baclofen, tizanidine | E.g., Paracetamol, tilidine |
| Pridinol | |
| Tolperisone | Paracetamol, metamizole |
| Other drugs for disorders of the musculoskeletal system | |
| Quinine | E.g., stretching exercises, magnesium < 4 weeks |
| Analgesics | |
| Dihydrocodeine, codeine as analgesic | |
| Pethidine, tapentadol, tramadol | E.g., tilidine, other opioids |
| Methadone, levomethadone | Other opioids |
| Acetylsalicylic acid as analgesic | E.g., paracetamol |
| Phenazone, propyphenazone | E.g., paracetamol |
| Ergotamine | Triptans, paracetamol |
| Antiepileptics | |
| Phenobarbital, primidone, phenytoin, carbamazepine | E.g., lamotrigine, valproate |
| Drugs for Parkinson’s disease | |
| Trihexyphenidyl, biperiden, procyclidine, bornaprine | E.g., levodopa, ropinirole |
| Amantadine | E.g., levodopa, ropinirole |
| Pramipexole, piribedil | E.g., levodopa, ropinirole |
| Dopaminergic ergot alkaloids (e.g., pergolide) | E.g., levodopa, ropinirole |
| Monoaminoxidase-B inhibitors (e.g., selegiline) | E.g., levodopa, ropinirole |
| Tolcapone | Entacapone, when indicated opicapone |
| Antipsychotics | |
| Levomepromazine, perazine, thioridazine, chlorprothixene, zuclopenthixol, prothipendyl | E.g., risperidone < 6 weeks |
| Fluphenazine, perphenazine, haloperidol, benperidol, bromperidol, flupentixol, fluspirilene, pimozide | E.g., risperidone < 6 weeks |
| Melperone > 100 mg/d, > 6 weeks | E.g., melperone < 100 mg/d, < 6 weeks |
| Pipamperone > 120 mg/d, > 6 weeks | E.g., pipamperone < 120 mg/d, < 6 weeks |
| Ziprasidone, clozapine, olanzapine, sulpiride, amisulpride, tiapride, aripiprazole, sertindole, paliperidone, cariprazine | E.g., risperidone < 6 weeks |
| Quetiapine > 100 mg/d, > 6 weeks | E.g., quetiapine < 100 mg/d, < 6 weeks |
| Risperidone > 6 weeks | E.g., risperidone < 6 weeks |
| Anxiolytics, hypnotics, and sedatives | |
| Hydroxyzine | E.g., melatonin, mirtazapine |
| Long-acting benzodiazepines (e.g., diazepam) | E.g., melatonin, mirtazapine |
| Lorazepam | E.g., melatonin, mirtazapine, valerian |
| Moderately long-acting benzodiazepines (e.g., oxazepam) | E.g., melatonin, mirtazapine, valerian |
| Short-acting benzodiazepines (e.g., triazolam) | E.g., melatonin, mirtazapine, valerian |
| Chloral hydrate | E.g., melatonin, mirtazapine, valerian |
| Zopiclone, zolpidem | E.g., melatonin, mirtazapine, valerian |
| Clomethiazole | E.g., melatonin, mirtazapine |
| Doxylamine | E.g., melatonin, mirtazapine, valerian |
| Promethazine | E.g., melatonin, mirtazapine, valerian |
| Antidepressants | |
| Tricyclics (e.g., amitriptyline), nortriptyline*3 | E.g., citalopram, mirtazapine |
| Opipramol | E.g., citalopram, mirtazapine |
| Doxepin | E.g., citalopram, mirtazapine |
| Maprotiline, mianserin | E.g., citalopram, mirtazapine |
| Fluoxetine, paroxetine, fluvoxamine | E.g., citalopram, mirtazapine |
| Sertraline > 100 mg/d | E.g., sertraline < 100 mg/d |
| Tranylcypromine, moclobemide | E.g., citalopram, mirtazapine |
| St John’s wort | E.g., citalopram, mirtazapine |
| Bupropion | E.g., citalopram, mirtazapine |
| Tianeptine | E.g., citalopram, mirtazapine |
| Agomelatine | E.g., citalopram, mirtazapine |
| Psychostimulants | |
| Methylphenidate | |
| Pyritinol | E.g., memantine |
| Piracetam | E.g., memantine |
| Anti-dementia drugs | |
| Ginkgo leaf | E.g., memantine |
| Nicergoline | E.g., memantine |
| Nimodipine | E.g., memantine, amlodipine |
| Drugs for vertigo | |
| Betahistine | See long version |
| Cinnarizine*4, flunarizine | See long version |
| Drugs for obstructive respiratory tract diseases | |
| Sympathomimetics for systemic use, no inhalation (e.g., salbumatol) | Inhaled sympathomimetics |
| Theophylline, aminophylline | Inhaled salbutamol LABA, LAMA, ICS |
| Cough and cold remedies | |
| Codeine, dihydrocodeine as antitussive | E.g., phytopharmaceuticals, DMP |
| Antihistamines for systemic use | |
| First generation | |
| Diphenhydramine, clemastine, dimetindene, cyproheptadine, ketotifen | E.g., cetirizine, topical agents |
| Second generation | |
| Ebastine, rupatadine | E.g., cetirizine, loratadine |
ACE, Angiotensin-converting enzyme; ASA, acetylsalicylic acid; DMP, dextromethorphan; DPP-4, dipeptidyl peptidase-4; ICS, inhaled corticosteroids; LABA, long-acting beta-2 sympathomimetics; LAMA long-acting muscarine antagonists; PPI, Proton pump inhibitors
*1 License suspended since January 2021 owing to nitrosamine contamination
*2 In Germany: only as a compound with atenolol and chlorthalidone
*3 According to comments, nortriptyline is tolerated better than other tricyclics; therefore, it was evaluated in its own right in the second round of the Delphi process
*4 In Germany: only as a compound with dimenhydrinate