2019 Beers Criteria for Potentially Inappropriate Medications for Older Adults

This is a must have resource for all geriatric nurses and prescribers. Highlights of Changes in 2019 Beers Criteria include:

1. H2-receptor antagonists were removed from the “avoid” list among adults with dementia or cognitive impairment. The degree of evidence that these drugs cause negative cognitive effects is weak. However, H2-receptor antagonists should still be avoided among patients with delirium.
2. Glimepiride was added to the list of sulfonylureas, which can increase the risk for severe prolonged hypoglycemia.
3. Serotonin-norepinephrine reuptake inhibitors were added to the list of drugs to avoid among adults with a history of falls or fractures.
4. Although most antipsychotic medications should be avoided among patients with Parkinson disease, quetiapine, clozapine, and pimavanserin may be preferred in this setting.
5. Nondihydropyridine calcium channel blockers should not be used among patients with heart failure. Nonsteroidal anti-inflammatory drugs and thiazolidinediones should be used with caution in cases of heart failure.
6. The age limit for the safe use of aspirin as primary prophylaxis against cardiovascular disease and colorectal cancer was lowered from 80 to 70 years.
7. Rivaroxaban was added to dabigatran as increasing the risk for gastrointestinal bleeding compared with warfarin and other direct oral anticoagulants among adults at age 75 years and older.
8. Dextromethorphan/quinidine is deemed inappropriate in the treatment of the behavioral symptoms of dementia. This drug has limited evidence of efficacy and may increase the risk for falls and drug interactions. This recommendation did not apply to the treatment of pseudobulbar affect.
9. Multiple drugs should be avoided because of their associated risk for hyponatremia and syndrome of inappropriate diuretic hormone, including carbamazepine, diuretics, tramadol, and multiple forms of antidepressants.
10. Trimethoprim-sulfamethoxazole was cited for its associated risk for hyperkalemia when used with a renin-angiotensin inhibitor in the setting of reduced creatinine clearance. Trimethoprim-sulfamethoxazole can also increase the risk for phenytoin toxicity and bleeding among patients treated with warfarin. Finally, trimethoprim-sulfamethoxazole was added to the warning list among older adults with renal dysfunction.
11. Nonsteroidal anti-inflammatory drugs should be avoided if possible among older adults, especially for prolonged periods of treatment. The authors note that indomethacin is associated with the highest rate of adverse effects of all nonsteroidal anti-inflammatory drugs.
12. Ciprofloxacin can cause neurological adverse effects among adults with reduced renal function, and it can promote a higher risk for tendon rupture among these patients.