These medicines have been shown to have more harmful side effects and medication interactions when taken by older adults. The American Geriatrics Society recommends avoiding these medicines if possible. If you are taking any of these medicines, have a conversation with your doctor about the risk and benefits, and work together to create a plan that works best for you. 

Sedating antihistamines

Sedating antihistamines such as diphenhydramine (Benadryl) and doxylamine (active ingredient in Nyquil) are often used to treat allergies or as an over-the-counter sleep aid. They are highly anticholinergic, meaning they block the normal function of a neurotransmitter called Acetylcholine. As a result, they can cause dry mouth, constipation, urinary retention, and confusion. This group of medicines should particularly be avoided in people with dementia as they can cause worsening confusion and delirium. These medicines are often added to over-the-counter medicines for sleep, cough, and cold, so be sure to avoid taking medicines that have “PM” or “Nighttime” in their names. 

Antispasmodics

This family of medicines prevents spasms of the bladder, intestines, or stomach. They are used to treat overactive bladder, irritable bowel syndrome, and motion sickness. Examples of antispasmodics are dicyclomine (Bentyl), hyoscyamine (Levsin), and scopolamine (Transdermscop). Like antihistamines, this class of medicines are also highly anticholinergic, meaning they can cause dry mouth, constipation, urinary retention, and confusion. They should especially be avoided in people with dementia or urination issues like enlarged prostate. 

Alpha blocker antihypertensives

This family of medications, including doxazosin (Cardura) and prazosin (Minipress), are used to treat high blood pressure. They work by dilating the blood vessels. However, as they dilate blood vessels, they often also cause dizziness, low blood pressure, and even fainting. Usually, there are other safer alternatives than can be used to treat high blood pressure in older adults. 

Antipsychotics in dementia

Antipsychotic medications such as haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). This class of medication is associated with increased risk of stroke, faster cognitive decline, and death when used in people with dementia. These medications can be used to control behavioral problems of dementia, but should only be used if other safer options have failed AND if the patient is at risk of harming themselves or others. A risk vs. benefit discussion is highly recommended before starting. 

Benzodiazepine anxiety medications

Benzodiazepines, such as alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril),  and clonazepam (Klonopin) are used to treat insomnia and anxiety. Older adults are much more sensitive to the harmful side effects of these medicines. They increase risk of dementia, delirium, falls, fractures, and car accidents in older adults. In addition, when used regularly, they can be habit-forming. 

“Z-drug” sleeping medications

Drugs like zolpidem (Ambien) and eszopiclone (Lunesta) are hypnotics that are often used to treat insomnia. Similar to benzodiazepines, they increase risk of delirium, falls, fractures, emergency room visits, hospitalizations, and car accidents when used in older adults. Furthermore, research shows that they produce only minimal improvement in sleep. Talk to your doctor about safer alternatives to help you sleep. 

NSAID pain medications in high risk patients

NSAID pain medications such as ibuprofen (Advil, Motrin), meloxicam (Mobic), and naproxen (Aleve) should be used with caution in older adults. When used on a regular basis, they increase the risk of stomach ulcers and stomach bleeding in people who are over 75 or are taking other medications that increase risk of stomach bleeding such as steroids and blood thinners. In addition, NSAIDs can increase blood pressure, cause kidney injury and increase the risk of heart attacks. Talk to your doctor before taking NSAIDs.