Table 1.

2002 Beers’ criteria for potentially inappropriate medication use with a high severity rating in older adults: Independent of diagnosis or condition³⁶

Drug	Concern
Amitriptyline, chlordiazepoxide-amitriptyline, perphenazine-amitriptyline	Exhibits strong anticholinergic and sedation properties.
Amphetamines and anorexic drugs	Use is associated with dependence, hypertension, angina, and myocardial infarction;
	Amphetamines other than methylphenidate and anorexic drugs can also cause CNS side effects.
Amiodarone	Associated with QT interval prolongation, may provoke torsades de pointes, and lacks efficacy in the elderly.
Antipsychotic medications: mesoridazine, thioridazine	Have CNS and extrapyramidal side effects.
Antihistamines and anticholinergic medications: chlorpheniramine, diphenhydramine, hydroxyzine, cyproheptadine, promethazine, tripelennamine, dexchlorpheniramine	Has potent anticholinergic properties and can cause sedation and confusion.
Barbiturates: all barbituratesa except phenobarbital	Are highly addictive and cause more adverse effects than most sedative or hypnotic drugs.
Benzodiazepines (long-acting): chlordiazepoxide, chlordiazepoxide-amitriptyline, clidinium-chlordiazepoxide, diazepam, quzepam, halazepam, chlorazepate	Exhibits long half-life, producing sedation and increasing incidence of falls and factures.
Benzodiazepines (short-acting): Lorazepam (doses exceeding 3 mg), oxazepam (doses exceeding 60 mg), alprazolam (doses exceeding 2 mg), temazpam (doses exceeding 15 mg), triazolam (doses exceeding 0.125 mg)	Increased sensitivity at higher doses.
Chlorpropramide	Has a long half-life leading to possible prolonged hypoglycemia and can cause SIADH.
Desiccated thyroid	Has cardiac side effects concerns.
Disopyramide	Has the most potent negative inotropic properties compared to other antiarrhythmic drugs and exhibits significant anticholinergic side effects.
Fluoxetine (daily use)	Exhibits a long half-life and risk of producing excessive CNS stimulation, sleep disturbances, and agitation.
Flurazepam	Exhibits long half-life, producing sedation and increasing incidence of falls and factures.
Gastrointestinal antispasmodic drugs: dicyclomine, hyoscyamine, propantheline, clidinium-chlordiazepoxide	Have strong anticholinergic side effects and questionable efficacy.
Guanethidine	Can cause orthostatic hypotension.
Guanadrel	Can cause orthostatic hypotension.
Indomethacin	Exhibits greatest CNS side effects compared to other NSAIDs.
Ketorolac	Immediate and long-term use should be avoided as older adults have a higher incidence of asymptomatic GI pathologic conditions.
Meperidine	May cause confusion and may lack effectiveness in doses commonly used.
Meprobamate	Exhibits highly addictive and sedating properties.
Methyldopa and methyldopa-hydrochlorothiazide	May cause bradycardia and exacerbate depression.
Mineral oil	Has potential for aspiration side effects.
Muscle relaxants and antispasmodics: methocarbamol, carisoprodol, chlorzoxazone, metaxalone, cyclobenzaprine, oxybutynin (not XL formulation)	Are poorly tolerated by elderly patients, exhibit anticholinergic side effects, sedation, and weakness; questionable effectiveness at doses tolerated by the elderly.
Nifedipine (short acting only)	Causes hypotension and constipation.
Nitrofurantoin	Has potential for renal impairment.
NSAIDS (long-term use, longer half-life, non-COX selective): naproxen, oxaprozin, piroxicam	Have the potential for produce GI bleeding, renal failure, high blood pressure, and heart failure.
Orphenadrine	Causes more sedation and anticholinergic side effects than safer alternatives.
Pentazocine	Causes more CNS side effects more commonly than other narcotic drugs.
Stimulant laxatives (long-term use only): bisacodyl, cascara sagrada and neoloidb	May exacerbate bowel dysfunction.
Ticlopidine	No more effective than aspirin and may be considerably more toxic.
Trimethobenzamide	One of the lest effective antiemetic drugs and exhibits extrapyramidal side effects.

Abbreviations: COX, cyclooxygenase; CNS, central nervous system; GI, gastrointestinal; NSAIDs, nonsteroidal anti-inflammatory drugs; SIADH, syndrome of inappropriate antidiuretic hormone secretion; XL, extended release; except when treating atrial arrhythmias.

Notes:

^aExcept when used to control seizures;

^bExcept in the presence of opiate analgesic use.