Author's details
Reviewer's details
Medications to be Avoided in Elderly
According to WHO, old age starts at 65. Life expectancy is increasing even in low—and middle-income countries, which means many elderly people live nowadays. Aging is a risk factor for many diseases that require medication management.
During the aging process, metabolism and organ function, especially the kidneys and liver, are diminished, severely affecting drug metabolism. The kidneys and liver that are majorly responsible for drug metabolism. It is thus important to have appropriate knowledge about geriatric pharmacology. Certain medications are inappropriate, they are term inappropriate medications for the elderly due to the undesirable side effects they cause. However, there are alternative medications that are safer for them to take. It is important to always ask about over-the-counter and traditional medications. When managing older adults, use the anticholinergic burden calculator (ACB calculator) and the STOPP-START v.3 [Screening Tool of Older People’s Prescription (STOPP) and Screening Tool to Alert to Right Treatment (START)] for i.e. when reviewing their medication list or contemplating on starting a new medication. ACB calculator where a score >3 increases the risk of anticholinergic adverse drug reactions like impaired cognition and death.
Keywords: side effects, medications in elderly, prescription cascades, polypharmacy, geriatrics pharmacology in sub-Saharan Africa.
Elderly patients are particularly vulnerable to adverse drug reactions due to multimorbidity which leads to taking many medications at the same time (Polypharmacy) therefore, Knowledge about these drugs helps in reducing morbidity and mortality. The tables below highlight different medications that should be avoided and their alternatives.
https://www.researchgate.net/publication/328481220/figure/tbl3/AS:685256071970826@1540389187681/Potentially-inappropriate-medications-in-older-adults-with-specific-conditions.png
| Medications with side effects in in the elderly | Avoid these medications | Replace with these medications | |
| Antihistamines | Brompheniramine, carbinoxamine, chlorpheniramine, clemastine, cyproheptadine, dimenhydrinate, doxepin, hydroxyzine, meclizine | Desloratadine, loratadine, Cetirizine, levocetirizine, fexofenadine | |
| Antiparkinsonian | Benztropine, trihexyphenidy | Levodopa, Pramipexole | |
| Antimuscarinic overactive bladder | Darifenacin, fesoterodine, flavoxate, oxybutynin, solifenacin, tolterodine, trospium | Conservative treatment of urge incontinence in form of bladder retraining, urge suppression. | |
| Antimuscarinic spasmolytic | Atropine, hyoscamine, glycopyrrolate | ||
| Antimuscarinic inhaled bronchodilator | Ipatropium, tiotropium | Formoterol, Salmeterol | |
| Psychotropic | |||
| Lower seizure threshold, fall risk, extra pyramidal effects | Chlorpromazine, fluphenazine, loxapine, clozapine
Tricyclic antidepressants: amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline |
Risperidone, haloperidol | |
| Obesity by increasing appetite | Olanzapine, clozapine, Quetiapine | Risperidone, haloperidol | |
| Antihypertensives | |||
| Hypotension, incontinence dry mouth | Alpha-blockers doxazosin, terazosin, prazosin | ACE-inhibitor, calcium channel blocker, beta-blocker, thiazides | |
| Orthostatic hypotension | Clonidine | ACE-inhibitor, calcium channel blocker, beta-blocker, thiazides | |
| Bumetanide, furosemide | |||
| Orthostatic hypotension, depression | Guanethidine | ACE inhibitor, thiazide, calcium-channel blocker beta-blocker | |
| Hypotension,
constipation |
Short acting Nifedipine | Long acting nifedipine or other calcium channel blocker | |
| Increased risk of gout in patients with gout | Thiazide | ACE-inhibitor, calcium channel blocker, beta-blocker. | |
| Antiplatelets | |||
| Ineffective, cause orthostastic hypotension | Dipyridamole
Ticlopidine |
Clopidogrel, low-dose aspirin | |
| Drugs with increased gastrointestinal bleeding | |||
| NSAID | Acetylsalicylic acid, Diclofenac, Ketorolac. | Ibuprofen under a short duration. Paracetamol under a short duration
Celecoxib with proton pump inhibitor within a short period Use of topical analgesics |
|
| Long half-life, insomnia and agitation | Fluoxetine | Fluoxetine | SSRI with short half-life like escitalopram and sertraline. |
| Low glomerular filtration rate | |||
| Sleep disorders | |||
| Dependence, tiredness during the day | Long-acting benzodiazepine like diazepam, quazepam, clorazepate | Conservative treatment with good sleeping hygiene. Melatonin, low-dose Mirtazapin
Short term medication with Zolpidem. |
|
In sub-Saharan African settings, medications that should be avoided in the elderly require careful consideration due to resource constraints, varying healthcare access, and the unique health challenges faced by aging populations. Medications with high risks of adverse effects, such as sedatives, anticholinergics, and NSAIDs, should be prescribed with caution, especially where monitoring may be limited. Emphasizing non-pharmacological treatments, conducting regular medication reviews, and promoting the use of safer alternatives are critical to reducing harm. A tailored, patient-centered approach that considers local healthcare realities is vital to optimizing medication safety for the elderly in this region.
Mr. J, an 85-year-old man with hypertension, insomnia, and chronic back pain, presents with drowsiness, confusion, and difficulty walking. His medications include diazepam for insomnia, lisinopril for hypertension, and ibuprofen for pain. Over time, his memory and mobility have worsened, with an increased risk of falls. The use of diazepam, a benzodiazepine, is contributing to confusion and falls, while ibuprofen increases the risk of gastrointestinal bleeding and kidney impairment. The physician decides to discontinue these medications and replace them with safer alternatives, aiming to improve his cognitive and physical function.
1. Velkoff VA, Kowal PR. Aging in Sub-Saharan Africa: The Changing Demography of the Region. In: National Research Council (US) Committee on Population; Cohen B, Menken J, editors. Aging in Sub-Saharan Africa: Recommendation for Furthering Research. Washington (DC): National Academies Press (US); 2006. 2. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20301/
2. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023; 71(7): 2052-2081. doi:10.1111/jgs.18372
3. Hanlon JT, Semla TP, Schmader KE. Alternative Medications for Medications in the Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly Quality Measures. J Am Geriatr Soc. 2015 Dec;63(12):e8-e18.
4. O’Mahony D et al, STOPP-START v.3. 16 June 2023. Available at: 2a1cfa_94280508e6014f3db06594abd0193994.pdf Accessed 17 January 2025.
5. O’Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023 Aug;14(4):625-632. doi: 10.1007/s41999-023-00777-y. Epub 2023 May 31. Erratum in: Eur Geriatr Med. 2023 Aug;14(4):633. doi: 10.1007/s41999-023-00812-y. PMID: 37256475; PMCID: PMC10447584.
6. Dr Rebecca King & Steve Rabino. ACB Calculator. https://www.acbcalc.com/ Accessed 18 January 2025.
7. Matera MG, Hanania NA, Maniscalco M, Cazzola M. Pharmacotherapies in Older Adults with COPD: Challenges and Opportunities. Drugs Aging. 2023 Jul;40(7):605-619. doi: 10.1007/s40266-023-01038-0. Epub 2023 Jun 14. PMID: 37316689; PMCID: PMC10300166.
8. Nadia Mouchaileh BPharm, GradCertPharmPrac, Andrew J. Hughes MBBS, FRACP, MD. Pharmacological management of Parkinson’s disease in older people. 01 October 2020 https://doi.org/10.1002/jppr.1683
9. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. J Clin Sleep Med. 2008 Oct 15;4(5):487-504.
10. Rogers NL, Dinges DF, Kennaway DJ, et al. Potential Action of Melatonin in Insomnia. Sleep 2003;26(8)1058-9.
11. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014 Dec 2;130(23):2071-104.
12. Kim, Moo-Young & Etherton-Beer, Christopher & Kim, Chae-Bong & Yoon, Jong Lull & Ga, Hyuk & Kim, Hyun & Song, Jung & Kim, Kwang-il & Won, Chang. (2018). Development of a Consensus List of Potentially Inappropriate Medications for Korean Older Adults. Annals of Geriatric Medicine and Research. 22. 121-129. 10.4235/agmr.2018.22.3.121.
13. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239.
14. Procardia XL [package insert]. New York, NY: Pfizer Laboratories Div Pfizer Inc; 2015.
15. Qaseem A, Snow V, Denberg T, et al. Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2008;149(10):725-733.
16. Baldwin DS, Waldman S, Allqulander C. Evidence-Based Pharmacological Treatment of Generalized Anxiety Disorder. Int J Neuropsychopharmacol. 2011 Jun;14(5):697-710.
17. Bielski RJ, Bose A, Chang CC. A Double-Blind Comparison of Escitalopram and Paroxetine in the Long-Term Treatment of Generalized Anxiety Disorder. Ann Clin Psychiatry. 2005 Apr-Jun;17(2):65-9.
18. Dworkin RH, O’Connor AB, Audette J, et al. Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update. May Clin Proc. 2010 Mar;85(3 Suppl):S3-S14.
19. Estemalik E, Tepper S. Preventive Treatment in Migraine and the New US Guidelines. Neuropsychiatr Dis Treat. 2013;9:709-720.
20. American Diabetes Association. Standards of Medical Care in Diabetes-2016. Diabetes Care. 2016;39(suppl 1):S1-119.
21. Christian JB, Vanhaaren A, Cameron KA, et al. Alternatives for Potentially Inappropriate Medications in the Elderly Population: Treatment Algorithms for Use in the Fleetwood Phase III Study. Consult Pharm. 2014;19:1011-28.
22. Gaddey HL, Holder K. Unintentional Weight Loss in Older Adults. Am Fam Physician. 2014 May 1;89(9):718-22.
23. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015 Nov;100(11):3975-4011.
24. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359-2381
25. Monteiro C, Silvestre S, Duarte AP, Alves G. Safety of Non-Steroidal Anti-Inflammatory Drugs in the Elderly: An Analysis of Published Literature and Reports Sent to the Portuguese Pharmacovigilance System. Int J Environ Res Public Health. 2022 Mar 16;19(6):3541. doi: 10.3390/ijerph19063541. PMID: 35329224; PMCID: PMC8949212.
26. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis. 2018 Feb 1;9(1):143-150. doi: 10.14336/AD.2017.0306. PMID: 29392089; PMCID: PMC5772852.
27. Bill H. McCarberg, NSAIDs in the Older Patient: Balancing Benefits and Harms, Pain Medicine, Volume 14, Issue suppl_1, December 2013, Pages S43–S44, https://doi.org/10.1111/pme.12253
28. Wuraola Akande-Sholabi, Princess C. Agha, Olufemi O. Olowookere,1 and Lawrence A. Adebusoye1 Evaluation of Prescription Pattern of Analgesic Use among Ambulatory Elderly in South-Western Nigeria. Ann Afr Med. 2020 Apr-Jun; 19(2): 131–136. Published online 2020 Jun 3. doi: 10.4103/aam.aam_57_19 PMCID:
PMC7453942 PMID: 32499470
Author's details
Reviewer's details
Medications to be Avoided in Elderly
According to WHO, old age starts at 65. Life expectancy is increasing even in low—and middle-income countries, which means many elderly people live nowadays. Aging is a risk factor for many diseases that require medication management.
During the aging process, metabolism and organ function, especially the kidneys and liver, are diminished, severely affecting drug metabolism. The kidneys and liver that are majorly responsible for drug metabolism. It is thus important to have appropriate knowledge about geriatric pharmacology. Certain medications are inappropriate, they are term inappropriate medications for the elderly due to the undesirable side effects they cause. However, there are alternative medications that are safer for them to take. It is important to always ask about over-the-counter and traditional medications. When managing older adults, use the anticholinergic burden calculator (ACB calculator) and the STOPP-START v.3 [Screening Tool of Older People’s Prescription (STOPP) and Screening Tool to Alert to Right Treatment (START)] for i.e. when reviewing their medication list or contemplating on starting a new medication. ACB calculator where a score >3 increases the risk of anticholinergic adverse drug reactions like impaired cognition and death.
Keywords: side effects, medications in elderly, prescription cascades, polypharmacy, geriatrics pharmacology in sub-Saharan Africa.
1. Velkoff VA, Kowal PR. Aging in Sub-Saharan Africa: The Changing Demography of the Region. In: National Research Council (US) Committee on Population; Cohen B, Menken J, editors. Aging in Sub-Saharan Africa: Recommendation for Furthering Research. Washington (DC): National Academies Press (US); 2006. 2. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20301/
2. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023; 71(7): 2052-2081. doi:10.1111/jgs.18372
3. Hanlon JT, Semla TP, Schmader KE. Alternative Medications for Medications in the Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly Quality Measures. J Am Geriatr Soc. 2015 Dec;63(12):e8-e18.
4. O’Mahony D et al, STOPP-START v.3. 16 June 2023. Available at: 2a1cfa_94280508e6014f3db06594abd0193994.pdf Accessed 17 January 2025.
5. O’Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023 Aug;14(4):625-632. doi: 10.1007/s41999-023-00777-y. Epub 2023 May 31. Erratum in: Eur Geriatr Med. 2023 Aug;14(4):633. doi: 10.1007/s41999-023-00812-y. PMID: 37256475; PMCID: PMC10447584.
6. Dr Rebecca King & Steve Rabino. ACB Calculator. https://www.acbcalc.com/ Accessed 18 January 2025.
7. Matera MG, Hanania NA, Maniscalco M, Cazzola M. Pharmacotherapies in Older Adults with COPD: Challenges and Opportunities. Drugs Aging. 2023 Jul;40(7):605-619. doi: 10.1007/s40266-023-01038-0. Epub 2023 Jun 14. PMID: 37316689; PMCID: PMC10300166.
8. Nadia Mouchaileh BPharm, GradCertPharmPrac, Andrew J. Hughes MBBS, FRACP, MD. Pharmacological management of Parkinson’s disease in older people. 01 October 2020 https://doi.org/10.1002/jppr.1683
9. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. J Clin Sleep Med. 2008 Oct 15;4(5):487-504.
10. Rogers NL, Dinges DF, Kennaway DJ, et al. Potential Action of Melatonin in Insomnia. Sleep 2003;26(8)1058-9.
11. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014 Dec 2;130(23):2071-104.
12. Kim, Moo-Young & Etherton-Beer, Christopher & Kim, Chae-Bong & Yoon, Jong Lull & Ga, Hyuk & Kim, Hyun & Song, Jung & Kim, Kwang-il & Won, Chang. (2018). Development of a Consensus List of Potentially Inappropriate Medications for Korean Older Adults. Annals of Geriatric Medicine and Research. 22. 121-129. 10.4235/agmr.2018.22.3.121.
13. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239.
14. Procardia XL [package insert]. New York, NY: Pfizer Laboratories Div Pfizer Inc; 2015.
15. Qaseem A, Snow V, Denberg T, et al. Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2008;149(10):725-733.
16. Baldwin DS, Waldman S, Allqulander C. Evidence-Based Pharmacological Treatment of Generalized Anxiety Disorder. Int J Neuropsychopharmacol. 2011 Jun;14(5):697-710.
17. Bielski RJ, Bose A, Chang CC. A Double-Blind Comparison of Escitalopram and Paroxetine in the Long-Term Treatment of Generalized Anxiety Disorder. Ann Clin Psychiatry. 2005 Apr-Jun;17(2):65-9.
18. Dworkin RH, O’Connor AB, Audette J, et al. Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update. May Clin Proc. 2010 Mar;85(3 Suppl):S3-S14.
19. Estemalik E, Tepper S. Preventive Treatment in Migraine and the New US Guidelines. Neuropsychiatr Dis Treat. 2013;9:709-720.
20. American Diabetes Association. Standards of Medical Care in Diabetes-2016. Diabetes Care. 2016;39(suppl 1):S1-119.
21. Christian JB, Vanhaaren A, Cameron KA, et al. Alternatives for Potentially Inappropriate Medications in the Elderly Population: Treatment Algorithms for Use in the Fleetwood Phase III Study. Consult Pharm. 2014;19:1011-28.
22. Gaddey HL, Holder K. Unintentional Weight Loss in Older Adults. Am Fam Physician. 2014 May 1;89(9):718-22.
23. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015 Nov;100(11):3975-4011.
24. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359-2381
25. Monteiro C, Silvestre S, Duarte AP, Alves G. Safety of Non-Steroidal Anti-Inflammatory Drugs in the Elderly: An Analysis of Published Literature and Reports Sent to the Portuguese Pharmacovigilance System. Int J Environ Res Public Health. 2022 Mar 16;19(6):3541. doi: 10.3390/ijerph19063541. PMID: 35329224; PMCID: PMC8949212.
26. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis. 2018 Feb 1;9(1):143-150. doi: 10.14336/AD.2017.0306. PMID: 29392089; PMCID: PMC5772852.
27. Bill H. McCarberg, NSAIDs in the Older Patient: Balancing Benefits and Harms, Pain Medicine, Volume 14, Issue suppl_1, December 2013, Pages S43–S44, https://doi.org/10.1111/pme.12253
28. Wuraola Akande-Sholabi, Princess C. Agha, Olufemi O. Olowookere,1 and Lawrence A. Adebusoye1 Evaluation of Prescription Pattern of Analgesic Use among Ambulatory Elderly in South-Western Nigeria. Ann Afr Med. 2020 Apr-Jun; 19(2): 131–136. Published online 2020 Jun 3. doi: 10.4103/aam.aam_57_19 PMCID:
PMC7453942 PMID: 32499470
Content
Author's details
Reviewer's details
Medications to be Avoided in Elderly
Background
According to WHO, old age starts at 65. Life expectancy is increasing even in low—and middle-income countries, which means many elderly people live nowadays. Aging is a risk factor for many diseases that require medication management.
During the aging process, metabolism and organ function, especially the kidneys and liver, are diminished, severely affecting drug metabolism. The kidneys and liver that are majorly responsible for drug metabolism. It is thus important to have appropriate knowledge about geriatric pharmacology. Certain medications are inappropriate, they are term inappropriate medications for the elderly due to the undesirable side effects they cause. However, there are alternative medications that are safer for them to take. It is important to always ask about over-the-counter and traditional medications. When managing older adults, use the anticholinergic burden calculator (ACB calculator) and the STOPP-START v.3 [Screening Tool of Older People’s Prescription (STOPP) and Screening Tool to Alert to Right Treatment (START)] for i.e. when reviewing their medication list or contemplating on starting a new medication. ACB calculator where a score >3 increases the risk of anticholinergic adverse drug reactions like impaired cognition and death.
Keywords: side effects, medications in elderly, prescription cascades, polypharmacy, geriatrics pharmacology in sub-Saharan Africa.
Further readings
1. Velkoff VA, Kowal PR. Aging in Sub-Saharan Africa: The Changing Demography of the Region. In: National Research Council (US) Committee on Population; Cohen B, Menken J, editors. Aging in Sub-Saharan Africa: Recommendation for Furthering Research. Washington (DC): National Academies Press (US); 2006. 2. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20301/
2. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023; 71(7): 2052-2081. doi:10.1111/jgs.18372
3. Hanlon JT, Semla TP, Schmader KE. Alternative Medications for Medications in the Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly Quality Measures. J Am Geriatr Soc. 2015 Dec;63(12):e8-e18.
4. O’Mahony D et al, STOPP-START v.3. 16 June 2023. Available at: 2a1cfa_94280508e6014f3db06594abd0193994.pdf Accessed 17 January 2025.
5. O’Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023 Aug;14(4):625-632. doi: 10.1007/s41999-023-00777-y. Epub 2023 May 31. Erratum in: Eur Geriatr Med. 2023 Aug;14(4):633. doi: 10.1007/s41999-023-00812-y. PMID: 37256475; PMCID: PMC10447584.
6. Dr Rebecca King & Steve Rabino. ACB Calculator. https://www.acbcalc.com/ Accessed 18 January 2025.
7. Matera MG, Hanania NA, Maniscalco M, Cazzola M. Pharmacotherapies in Older Adults with COPD: Challenges and Opportunities. Drugs Aging. 2023 Jul;40(7):605-619. doi: 10.1007/s40266-023-01038-0. Epub 2023 Jun 14. PMID: 37316689; PMCID: PMC10300166.
8. Nadia Mouchaileh BPharm, GradCertPharmPrac, Andrew J. Hughes MBBS, FRACP, MD. Pharmacological management of Parkinson’s disease in older people. 01 October 2020 https://doi.org/10.1002/jppr.1683
9. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. J Clin Sleep Med. 2008 Oct 15;4(5):487-504.
10. Rogers NL, Dinges DF, Kennaway DJ, et al. Potential Action of Melatonin in Insomnia. Sleep 2003;26(8)1058-9.
11. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014 Dec 2;130(23):2071-104.
12. Kim, Moo-Young & Etherton-Beer, Christopher & Kim, Chae-Bong & Yoon, Jong Lull & Ga, Hyuk & Kim, Hyun & Song, Jung & Kim, Kwang-il & Won, Chang. (2018). Development of a Consensus List of Potentially Inappropriate Medications for Korean Older Adults. Annals of Geriatric Medicine and Research. 22. 121-129. 10.4235/agmr.2018.22.3.121.
13. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239.
14. Procardia XL [package insert]. New York, NY: Pfizer Laboratories Div Pfizer Inc; 2015.
15. Qaseem A, Snow V, Denberg T, et al. Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2008;149(10):725-733.
16. Baldwin DS, Waldman S, Allqulander C. Evidence-Based Pharmacological Treatment of Generalized Anxiety Disorder. Int J Neuropsychopharmacol. 2011 Jun;14(5):697-710.
17. Bielski RJ, Bose A, Chang CC. A Double-Blind Comparison of Escitalopram and Paroxetine in the Long-Term Treatment of Generalized Anxiety Disorder. Ann Clin Psychiatry. 2005 Apr-Jun;17(2):65-9.
18. Dworkin RH, O’Connor AB, Audette J, et al. Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update. May Clin Proc. 2010 Mar;85(3 Suppl):S3-S14.
19. Estemalik E, Tepper S. Preventive Treatment in Migraine and the New US Guidelines. Neuropsychiatr Dis Treat. 2013;9:709-720.
20. American Diabetes Association. Standards of Medical Care in Diabetes-2016. Diabetes Care. 2016;39(suppl 1):S1-119.
21. Christian JB, Vanhaaren A, Cameron KA, et al. Alternatives for Potentially Inappropriate Medications in the Elderly Population: Treatment Algorithms for Use in the Fleetwood Phase III Study. Consult Pharm. 2014;19:1011-28.
22. Gaddey HL, Holder K. Unintentional Weight Loss in Older Adults. Am Fam Physician. 2014 May 1;89(9):718-22.
23. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015 Nov;100(11):3975-4011.
24. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359-2381
25. Monteiro C, Silvestre S, Duarte AP, Alves G. Safety of Non-Steroidal Anti-Inflammatory Drugs in the Elderly: An Analysis of Published Literature and Reports Sent to the Portuguese Pharmacovigilance System. Int J Environ Res Public Health. 2022 Mar 16;19(6):3541. doi: 10.3390/ijerph19063541. PMID: 35329224; PMCID: PMC8949212.
26. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis. 2018 Feb 1;9(1):143-150. doi: 10.14336/AD.2017.0306. PMID: 29392089; PMCID: PMC5772852.
27. Bill H. McCarberg, NSAIDs in the Older Patient: Balancing Benefits and Harms, Pain Medicine, Volume 14, Issue suppl_1, December 2013, Pages S43–S44, https://doi.org/10.1111/pme.12253
28. Wuraola Akande-Sholabi, Princess C. Agha, Olufemi O. Olowookere,1 and Lawrence A. Adebusoye1 Evaluation of Prescription Pattern of Analgesic Use among Ambulatory Elderly in South-Western Nigeria. Ann Afr Med. 2020 Apr-Jun; 19(2): 131–136. Published online 2020 Jun 3. doi: 10.4103/aam.aam_57_19 PMCID:
PMC7453942 PMID: 32499470
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