ANALGESICSKetorolac Gi bleedingMeperidine Not effective at commonly used

oral doses; confusion, falls, factures, dependency, withdrawal

Pentazocine More CNS effects (e.g., confusion, hallucinations) than other opioids; ceiling to analgesic effect

Propoxyphene No better than acetaminophen, but has narcotic AE

ANTIDEPRESSANTSAmitriptyline & doxepin Anticholinergic AE, sedation,

urinary retention or incontinence, constipation, arrhythmias, falls

Bupropion, seizure disorder May cause seizure

Fluoxetine used dailyLong half-life; agitation, insomnia, anorexia

Tricyclic for depression in patient with postural hypotension, BPH, glaucoma, heart block

Fall risk; urinary retention; worsening glaucoma, heart block

Tricyclic in patient with stress incontinence or bladder outflow obstruction

Urinary retention or incontinence

SSRIs in patient with SIADH May cause or worsen SIADH

Antihistamines, anticholinergic:Chlorpheniramine Cyproheptadine Dexchlorpheniramine (Polaramine), Diphenhydramine (Benadryl, etc), Hydroxyzine (Vistaril, Atarax),Promethazine (Phenergan, etc)

Anticholinergic AE, urine retention, confusion, sedation

Antihypertensives

Alpha-blockers (doxazosin, prazosin, terazosin)Hypotension, dry mouth, incontinence

Clonidine Orthostatic hypotension, CNS AE

Ethacrynic acidHypotension; fluid, electrolyte imbalances

Guanethidine Orthostatic hypotension,

depression

Methyldopa Bradycardia; depression

Nifedipine, short- acting Hypotension, constipation

Reserpine >0.25mg

Depression, impotence, sedation, orthostatic hypotension, extrapyramidal effects

ANTIPLATELET

Dipyridamole, short- actingIneffective for stroke prevention & dementia; orthostatic hypotension

TiclopidineNot more effective than aspirin, but more toxic

ANTIPSYCHOTICS

Mesoridazine

Thioridazine

CNS AE, seizures, extrapyramidal effects

Clozapine in patient with seizures Lower seizure threshold

Olanzapine (Zyprexa), obesity Increased appetite, weight gain

Thiothixene (Navane), in patient with seizure disorder Lower seizure threshold

Anxiolytics

Long-acting benzodiazepines:clorazepate, chlordiazepoxide, diazepam, quazepam

Dependence, depression, prolonged sedation, confusion, falls, fractures, respiratory depression in COPD, incontinence

Short-acting benzodiazepines, daily doses greater than : alprazolam (Xanax) 2 mg, lorazepam (Ativan) 3 mg, oxazepam (Serax) 60 mg

Falls

Meprobamate Dependence, sedation

Cardiac Drugs

AmiodaroneQT prolongation, torsades de pointes, lack of efficacy in elderly

Beta-blockers in patient with asthma, COPD, or Raynaud’s disease

Worsening disease

Calcium channel blocker in patient with systolic heart failure (C) or chronic constipation

Worsening heart failure; constipation

Digoxin doses >0.125 mg/d except for atrial arrhythmias

Toxicity due to reduced renal clearance

DisopyramideNegative inotrope; anticholinergic; sudden death

Diabetes Drugs

Chlorpropamide Prolonged hypoglycemia; SIADH

Gastrointestinal Drugs

Antispasmodics, long- term use belladonna alkaloids

Clindinium

Dicyclomine

Hyoscyamine

Propantheline

Anticholinergic AE; worsened cognition & behavioral problems in dementia; urinary retention or incontinence; questionable efficacy

CimetidineConfusion, other CNS AE, interaction with warfarin

DiphenoxylateDependence, sedation, cognitive impairment

Metoclopramide in patient with Parkinson’s disease Antidopaminergic effect

Mineral oil Aspiration

Stimulant laxatives (e.g., bisacodyl [Dulcolax, etc]), long- term use, except with opiates

May worsen bowel function

Trimethobenzamide) Poor efficacy; extrapyramidal AE

Hormones

Estrogens (oral)Breast, endometrial cancer; not cardioprotective

MethyltestosteroneProstatic hyperplasia, cardiac AE

Thyroid, desiccated Cardiac AE

Hypnotics

Barbiturates, except phenobarbital for seizures

Dependence; higher risk of AE (falls, fractures, confusion, cognitive impairment) than other hypnotics

Long-acting benzodiazepines See entry under Anxiolytics.

Diphenhydramine (Benadryl, etc)Confusion, sedation, anticholinergic effects

Flurazepam (Dalmane) Sedation, falls, accumulation

Triazolam (Halcion)Cognitive/behavioral disturbances

NSAIDs

Aspirin for pain in patient on warfarin Bleeding

NSAIDs, longer half- life, full dose, long durationGI bleeding, renal failure, hypertension, heart failure

Indomethacin (Indocin) CNS AE, GI effects, fluid retention

NSAID in patient with history of peptic ulcer New ulcers; bleeding risk

Respiratory Drugs

Corticosteroids, oral, long-term for COPD, patient with diabetes

Worsening glucose control

Pseudoephedrine in patient with hypertension or bladder outflow obstruction

Increased blood pressure; incontinence

Theophylline, patient with insomnia May contribute to insomnia

Stimulant Drugs

Amphetamines, anorexics Dependence, hypertension, myocardial ischemia, CNS

Muscle Relaxants

Muscle relaxants: Carisoprodol, Chlorzoxazone, Cyclobenzaprine (Flexeril),Metaxalone (Skelaxin), Methocarbamol (Robaxin) Orphenadrine (Norflex)

Anticholinergic effects, sedation, cognitive impairment, weakness, urine retention; questionable efficacy at lower doses

stimulation (agitation, insomnia)

Any stimulant in patient with anorexia/malnutrition Appetite suppression

Methylphenidate for depressionCNS stimulation, agitation, seizures

Urinary Drugs

Nitrofurantoin Nephrotoxicity

Oxybutynin, in patient with bladder outflow

obstruction

Urine retention, confusion, hallucinations, sedation

Tolterodinein patient with bladder outflow obstructionUrinary retention, confusion, hallucinations, sedation

Miscellaneous

Ergot mesylates Unproven efficacy

Ferrous sulfate>325 mg per dayConstipation, without increased iron absorption

Isoxsuprine Lack of efficacy

Sodium containing drugs in heart failure Worsening heart failure