The 2015 Beers criteria: Selected drugs to avoid in older adults
| Drug class (example) | Recommendation | Rationale | Quality of evidence | Strength of recommendation |
|---|---|---|---|---|
| First-generation antihistamines (diphenhydramine) | Avoid | Highly anticholinergic | Moderate | Strong |
| Antiparkinsonian agents (benztropine) | Avoid | Not recommended for prevention of extrapyramidal symptoms with antipsychotics; more-effective agents available for treatment of Parkinson disease | Moderate | Strong |
| Antispasmodics (hyoscyamine) | Avoid | Highly anticholinergic | Moderate | Strong |
| Antidepressants (amitriptyline) | Avoid | Highly anticholinergic | High | Strong |
| Antipsychotics (conventional or atypical) | Avoid except for schizophrenia, bipolar disorder, or short-term use as antiemetic during chemotherapy | Increased risk of stroke and death in persons with dementia | Moderate | Strong |
| Skeletal muscle relaxants (methocarbamol) | Avoid | Most muscle relaxants are poorly tolerated by older adults | Moderate | Strong |
| Benzodiazepine (lorazepam) | Avoid | All benzodiazepines increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults | Moderate | Strong |
| Nonbenzodiazepine and benzodiazepine hypnotics (zolpidem) | Avoid | Adverse events similar to those of benzodiazepines in older adults | Moderate | Strong |
| Proton pump inhibitors | Avoid using for > 8 weeks unless for high-risk patients | Risk of Clostridium difficile infection, bone loss, and fractures | High | Strong |
Based on information in reference 58.