Table II.
Prevalence of inappropriate drug prescriptions (Rx) issued for patients ≥70 years by 454 Norwegian general practitioners.
| Drugs or combinations of drugs to be avoided for elderly patients for reasons of safety | Mean (95% CI) Rx/100 patients ≥70 years |
| Tricyclic antidepressants | 2.2 (2.0–2.3) |
| (amitryptiline, doxepin, trimipramine, clomipramine) | |
| Anticholinergic effects, better alternatives exist | |
| First-generation (low potency) antipsychotics | 2.6 (2.4–2.8) |
| (chlorpromazine, chlorprotixene, levoprometazine, prochlorperazine) | |
| Anticholinergic effects, extrapyramidal effects, risk of falls and cognitive impairment | |
| Long-acting benzodiazepines | 4.6 (4.3–4.9) |
| (nitrazepam, flunitrazepam) | |
| Risk of accumulation, prolonged sedation, falls and fractures | |
| Strong analgesics | 1.1 (1.0–1.2) |
| (propoxyphene, pethidine, opioids with spasmolytics) | |
| Poorly tolerated by elderly, propoxyphene has narrow therapeutic width | |
| Risk of sedation, confusion, falls and fractures | |
| First-generation antihistamines | 2.5 (2.3–2.6) |
| (dexchlorphenamine, promethazine, alimemazine, hydroxycin) | |
| Anticholinergic effects, risk of “hangover” | |
| Long time oral use of theophylline | 0.5 (0.5–0.6) |
| Risk of cardiac arrhythmias | |
| No documented effect on COPD or asthma in the elderly, better alternatives exist | |
| Carisoprodol (muscle relaxant) | 1.0 (0.9–1.1) |
| Anticholinergic effects, poorly tolerated by elderly, risk of muscle weakness, falls and fractures | |
| Beta blocking agent + unselective calcium channel blocker | 0.6 (0.5–0.6) |
| May lead to AV block and myocardial depression | |
| NSAID + warfarin (any concomitant use) | 0.3 (0.3–0.4) |
| Risk of gastrointestinal bleeding due to impaired platelet function | |
| NSAID + ACE inhibitor or A2-blocker (any concomitant use) | 3.4 (3.2–3.6) |
| Risk of drug induced renal failure | |
| NSAID + SSRI (any concomitant use) | 0.8 (0.7–0.9) |
| Increased risk of gastrointestinal bleeding | |
| NSAID + diuretic (any concomitant use) | 2.4 (2.2–2.5) |
| Reduced effect of diuretics | |
| Three or more psychotropic drugs (analgesics containing opioids, psycholeptics, hypnotics, antidepressants) for ≥3 months | 2.8 (2.6–3.0) |
| Total | 24.7 (23.7–25.6) |