Table 2.
Comparison of the Most Common Explicit Measures for Drug-Disease Interactions in Older Adults
| Disease – Therapeutic Class/Medication | Beers 2003 | Beers 2012 | STOPP 2006 |
|---|---|---|---|
| Anorexia and Malnutrition | |||
| CNS stimulants (e.g., dextroamphetamine, methylphenidate, methamphetamine, pemolin) | X | -- | -- |
| Bleeding Disorder * | |||
| Antithrombotics/anticoagulants (aspirin, dipyridamole, and clopidogrel in both Beers 2003 and STOPP 2006; NSAIDs and ticlopidine in Beers 2003) | X | -- | X |
| Cardiac Conduction Abnormalities | |||
| Tricyclic antidepressants | X | -- | X |
| Chronic Constipation | |||
| Anticholinergics, not listed below | -- | X | -- |
| Anticholinergic GI antispasmodic drugs (e.g., dicyclomine) | X | X | X |
| Antihistamines, 1st generation (e.g., diphenhydramine) | X | X | -- |
| Antipsychotics | -- | X | -- |
| Calcium channel blockers, nondihydropyridine (i.e., diltiazem, verapamil) | X | X | X |
| Bladder antimuscarinic drugs (e.g., oxybutynin) | -- | X | X |
| Opioids, regular (>2 weeks) and without concurrent use of laxatives | -- | -- | X |
| Tricyclic antidepressants (amitriptyline, doxepin, and imipramine in Beers 2003; all in Beers 2012 and STOPP 2006) | X | X | X |
| Chronic Kidney Disease (Stages IV and V) | |||
| NSAID, all | -- | X | X |
| Triamterene | -- | X | -- |
| COPD | |||
| β blockers, non-cardioselective (propanolol in Beers 2003; all in STOPP 2006) | X | -- | X |
| Long-acting benzodiazepines | X | -- | -- |
| Diabetes Mellitus and frequent hypoglycemic episodes (i.e., ≥ 1 episode per month) | |||
| β blockers | -- | -- | X |
| Delirium | |||
| Anticholinergics | -- | X | -- |
| Benzodiazepines | -- | X | -- |
| Chlorpromazine | -- | X | -- |
| Corticosteroids | -- | X | -- |
| H2-receptor antagonist | -- | X | -- |
| Meperidine | -- | X | -- |
| Sedative hypnotics (e.g., zolpidem) | -- | X | -- |
| Thioridazine | -- | X | -- |
| Tricyclic antidepressants, all | -- | X | -- |
| Dementia and Cognitive Impairment | |||
| Anticholinergics, not listed below | X | X | -- |
| Antipsychotics, chronic and as-needed use | -- | X | -- |
| Barbiturates | X | -- | -- |
| Benzodiazepines | -- | X | -- |
| Bladder antimuscarinic drugs | X | X | X |
| CNS stimulants (dextroamphetamine, methylphenidate, methamphetamine, pemolin) | X | -- | -- |
| GI antispasmodics (e.g., dicyclomine, hyoscyamine) | X | X | -- |
| H2-receptor antagonists | -- | X | -- |
| Muscle relaxants | X | X | -- |
| Opioids, long-term (unless indicated for palliative care or management of moderate-severe chronic pain | -- | -- | X |
| Tricyclic antidepressants, all | -- | X | X |
| Zolpidem | -- | X | -- |
| Depression | |||
| Long-term benzodiazepine use | X | -- | -- |
| Sympatholytic agents (methyldopa, reserpine, guanethidine) | X | -- | -- |
| Glaucoma | |||
| Bladder antimuscarinic drugs | -- | -- | X |
| Ipratropium, nebulized | -- | -- | X |
| Tricyclic antidepressants | -- | -- | X |
| Gout | |||
| Diuretic, thiazide | -- | -- | X |
| Heart Failure (systolic specified in Beers 2012) | |||
| Calcium channel blockers, nondihydropyridine (i.e., diltiazem, verapamil) | -- | X | X |
| Cilostazol | -- | X | -- |
| Disopyramide | X | -- | -- |
| Dronaderone | -- | X | -- |
| High sodium content drugs (sodium and sodium salts) | X | -- | -- |
| NSAID, all | -- | X | X |
| Thiazolidinediones (i.e., pioglitazone, rosiglitazone) | -- | X | -- |
| History of Breast Cancer or VTE | |||
| Estrogen | -- | -- | X |
| History of Falls/Fractures | |||
| Anticonvulsants | -- | X | -- |
| Antihistamines, 1st generation | -- | -- | X |
| Antipsychotics | -- | X | X |
| Benzodiazepines (short- to intermediate-acting in Beers 2003; all in Beers 2012 and in STOPP 2006) | X | X | X |
| Nonbenzodiazepine (“Z”) hypnotics (i.e., eszopiclone, zaleplon, zolpidem) | -- | X | -- |
| Opioids, long-term | -- | -- | X |
| SSRIs | -- | X | -- |
| Tricyclic antidepressants (amitriptyline, doxepin, and imipramine Beers 2003; all in Beers 2012) | X | X | -- |
| History of Peptic Ulcer Disease | |||
| NSAID, non-COX-2-selective, without gastroprotection (non-COX-2 NSAIDs in Beers 2003 and Beers 2012; all NSAIDs in STOPP 2006) | X | X | X |
| Hypertension | |||
| Amphetamines | X | -- | -- |
| Diet pills | X | -- | -- |
| NSAIDs (moderate to severe hypertension) | -- | -- | X |
| Phenylpropanolamine hydrochloride | X | -- | -- |
| Pseudoephedrine | X | -- | -- |
| Insomnia | |||
| Decongestants, oral (i.e., pseudoephedrine, phenylephrine) | X | X | -- |
| MAOIs | X | -- | -- |
| Stimulants (e.g., amphetamine, methylphenidate, pemoline) | X | X | -- |
| Theobromines (i.e., theophylline, caffeine) | X | X | -- |
| Lower Urinary Tract Symptoms | |||
| Anticholinergics (oral in Beers 2003; oral and inhaled in Beers 2012; bladder antispasmodic agents only in STOPP 2006) | X | X | X |
| Decongestants, oral | X | -- | -- |
| Obesity | |||
| Olanzapine | X | -- | -- |
| Parkinson's Disease | |||
| Antipsychotics (conventional antipsychotics in Beers 2003; all except for quetiapine and clozapine for Beers 2012; all for STOPP 2006) | X | X | X |
| Metoclopramide | X | X | X |
| Prochlorperazine | -- | X | X |
| Promethazine | -- | X | -- |
| Tacrine | X | -- | -- |
| Persistent Postural Hypotension | |||
| Vasodilators | -- | -- | X |
| Seizures | |||
| Antipsychotics, atypical (clozapine in Beers 2003; clozapine, olanzapine in Beers 2012) | X | X | -- |
| Antipyschotics, conventional (e.g., chlorpromazine, thioridazine, thiothixene) | X | X | X |
| Bupropion | X | X | -- |
| Maprotiline | -- | X | -- |
| Tramadol | -- | X | -- |
| SIADH/Hyponatremia † | |||
| SSRIs | X | -- | X |
| Syncope ‡ | |||
| Acetylcholinesterase inhibitors | -- | X | -- |
| α blockers, peripheral (i.e., doxazosin, prazosin, terazosin) | -- | X | -- |
| Chlorpromazine | -- | X | -- |
| Olanzapine | -- | X | -- |
| Thioridazine | -- | X | -- |
| Tricyclic antidepressants (amitriptyline, doxepin, and imipramine Beers 2003; all in Beers 2012) | X | X | -- |
| Urinary Incontinence | |||
| α blockers (stress incontinence in Beers 2003; stress or mixed urinary incontinence, avoid in women in Beers 2012; avoid in men with frequent incontinence in STOPP 2006) | X | X | X |
| Long-acting benzodiazepines (stress) | X | -- | -- |
| Estrogen oral and transdermal dosage forms only (applies to women) | X | ||
| Tricyclic antidepressants (amitriptyline, doxepin, and imipramine with stress incontinence in Beers 2003; all in both Beers 2012 and STOPP 2006) | X | X | X |
*
Beers 2012 includes aspirin for primary prevention, dabigatran, and prasugrel in the category of potentially inappropriate medications to be used with caution in older adults due to the increased risk of bleeding.
†
Beers 2012 includes antipyschotics, carbamazepine, carboplatin, cisplatin, mirtazapine, SNRIs, SSRIs, TCAs, and vincristine in the category of potentially inappropriate medications to be used with caution in older adults due to increased risk of SIADH/hyponatremia.
‡
Beers 2012 includes vasodilators in the category of potentially inappropriate medications to be used with caution in older adults due to increased risk of syncope in individuals with a history of syncope.
Abbreviations: COPD, chronic obstructive pulmonary disease; COX, cyclooxygenase; GI, gastrointestinal; H, histamine; MAOI: monoamine oxidase inhibitor; NSAID, non-steroidal anti- inflammatory drugs; SIADH, syndrome of inappropriate diuretic hormone secretion; SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitors; TCA, tricyclic antidepressants VTE, venous thromboembolism