Table 1.
Comparison of the Most Common Explicit Measures for Drugs to Avoid in Older Adults
| Therapeutic Class/Medication | Beers 2003 | Beers 2012 | STOPP 2006 |
|---|---|---|---|
| Central Nervous System and Psychotropic Drugs | |||
| Amphetamines and anorexic agents | X | -- | -- |
| Anticholinergics to treat extrapyramidal side effects of neuroleptic medications (e.g., benztropine, trihexyphenidyl) | -- | X | X |
| Antihistamines, 1st generation (select agents in Beers 2003; all agents in Beers 2012; select agents in STOPP 2006) | X | X | X |
| Antipsychotics, first (conventional) and second (atypical) generation (for behavioral problems of dementia) | -- | X | -- |
| Barbiturates (all agents except phenobarbital for seizure control in Beers 2003; all agents in Beers 2012) | X | X | -- |
| Benzodiazepines, short- and intermediate-acting (dose limits in Beers 2003; all doses in Beers 2012) | X | X | -- |
| Chloral hydrate | -- | X | -- |
| Dementia treatments, older (i.e., ergot mesylates and isoxsuprine in Beers 2003 and Beers 2012; cyclandelate in Beers 2003) | X | X | -- |
| Fluoxetine, daily | X | -- | -- |
| Long-acting benzodiazepines (e.g., clonazepam, diazepam, flurazepam) | X | X | X |
| Long-term neuroleptics for insomnia | -- | -- | X |
| Meprobamate | X | X | -- |
| Mesoridazine | X | X | -- |
| Nonbenzodiazepine (“Z”) hypnotics (i.e., eszoplicone, zaleplon, zolpidem) | -- | X | -- |
| Tertiary TCAs, alone or in combination (amitriptyline and doxepin in Beers 2003; all in Beers 2012) | X | X | -- |
| Thioridazine | X | X | -- |
| Cardiovascular | |||
| α-acting and central-acting agents for treatment of hypertension (clonidine, doxazosin, guanethidine, guanadrel, methyldopa, and reserpine in Beers 2003; clonidine, doxazosin, guanabenz, guanfacine, methyldopa, prazosin, terazosin, and reserpine in Beers 2012) | X | X | -- |
| Antiarrhythmic drugs (amiodarone and disopyramide in Beers 2003; Class Ia, Class Ic, and Class III drugs in Beers 2012) for atrial fibrillation | X | X | -- |
| Aspirin for primary prevention (to be used with caution in adults ≥80 years old for primary prevention of cardiac events in Beers 2012; to be avoided in those with no history of coronary, cerebral or peripheral vascular symptoms or occlusive events in STOPP 2006) | -- | X | X |
| Aspirin to treat dizziness not clearly attributable to cerebrovascular disease | -- | -- | X |
| Digoxin > 0.125 mg/day | X | X | X |
| Dipyridamole IR as monotherapy | X | X | X |
| Ethacrynic acid | X | -- | -- |
| Loop diuretic for ankle edema (i.e., no clinical signs of heart failure) or as 1st line monotherapy for hypertension | -- | -- | X |
| Nifedipine IR | X | X | -- |
| Spironolactone > 25 mg/day | -- | X | -- |
| Ticlopidine | X | X | -- |
| Endocrine | |||
| Androgens (methyltestosterone in both Beers 2003 and Beers 2012; testosterone in Beers 2012) | X | X | -- |
| Chlorpropamide | X | X | X |
| Dessicated thyroid | X | X | -- |
| Estrogen (estrogens only in Beers 2003; estrogen with or without progestins in Beers 2012; estrogen without progestin in patients with intact uterus in STOPP 2006) | X | X | X |
| Glyburide/glibenclamide (European generic name) | -- | X | X |
| Growth hormone | -- | X | -- |
| Megesterol | -- | X | -- |
| Sliding scale insulin | -- | X | -- |
| Gastrointestinal | |||
| GI antispasmodics (e.g., dicyclomine, hyoscyamine) | X | X | -- |
| Cimetidine | X | -- | -- |
| Diphenoxylate, loperamide or codeine for treatment of diarrhea of unknown cause or severe infective gastroenteritis | -- | -- | X |
| Long-term use of stimulant laxatives (i.e., bisacodyl, cascara sagrada, and neoloid except in the presence of opioid use) | X | -- | -- |
| Metoclopramide | -- | X | -- |
| Mineral oil (given orally) | X | X | -- |
| Trimethobenzamide | X | X | -- |
| Miscellaneous | |||
| Ferrous sulfate > 325 mg/d | X | -- | -- |
| Nitrofurantoin | X | X | -- |
| Skeletal muscle relaxants (e.g., carisoprodol, cyclobenzaprine, orphenadrine) | X | X | -- |
| Musculoskeletal | |||
| Chronic non-COX-selective NSAIDs (naproxen, oxaprozin, and piroxicam in Beers 2003; all agents in Beers 2012 and STOPP 2006) | X | X | X |
| Indomethacin | X | X | -- |
| Ketorolac | X | X | -- |
| Long-term corticosteroids as monotherapy for RA or OA | -- | -- | X |
| Long-term colchicine for chronic treatment of gout where there is no contraindication to allopurinol | -- | -- | X |
| Powerful opiates (e.g., morphine or fentanyl) as first-line therapy for for mild/moderate pain | -- | -- | X |
| Meperidine | X | X | -- |
| Pentazocine (Talwin) | X | X | -- |
| Propoxyphene (Darvon) and combination products | X | -- | -- |
| Respiratory | |||
| Systemic corticosteroids instead of inhaled corticosteroids for maintenance therapy in moderate-to-severe COPD | -- | -- | X |
| Theophylline monotherapy for COPD | -- | -- | X |
Abbreviations: COPD, chronic obstructive pulmonary disease; COX, cyclooxygenase; GI, gastrointestinal; IR, immediate release; NSAID, non-steroidal anti-inflammatory drugs; OA, osteoarthritis; TCA, tricyclic antidepressants; RA, rheumatoid arthritis; SR, sustained release