High Risk Medications List - 2017
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7High risk medications
U
pdated May 2017
*
Alternatives When Diagnosis is NOT KNOWN
Classification
Drug name
Risk
If diagnosis is known - refer to FER Alternatives document
First-generation
brompheniramine
Highly anticholinergic (risk of confusion, dry mouth,
second-generation antihistamines
antihistamines
constipation, blurred vision, drowsiness, hallucinations,
1
carbinoxamine
cetirizine (generic for Zyrtec)
OTC
difficulty urinating)
1
chlorpheniramine
fexofenadine (generic for Allegra)
OTC
1
clemastine
loratadine (generic for Claritin)
OTC
Clearance reduced with advanced age (risk of toxicity)
cyproheptadine
CLARINEX SYRUP
(PERIACTIN)
dexbrompheniramine
desloratadine (generic for Clarinex)
Tolerance develops when used as a hypnotic
dexchlorpheniramine
desloratadine ODT (generic for Clarinex RediTab)
diphenhydramine
levocetirizine (generic for Xyzal)
(oral) (BENADRYL)
doxylamine
intranasal steroids
1
hydroxyzine
FLONASE ALLERGY
(ATARAX, VISTARIL)
OTC
1
promethazine
NASACORT ALLERGY
(PHENERGAN)
OTC
1
triprolidine
RHINOCORT ALLERGY
OTC
triamcinolone nasal spray (generic for Nasacort AQ)
fluticasone nasal spray (generic for Flonase)
mometasone nasal spray (generic for Nasonex)
azelastine nasal spray
flunisolide nasal spray
OMNARIS
QNASAL
BECONASE AQ
Parkinson disease
1
benztropine
diphenhydramine
(oral) (COGENTIN)
OTC
Not recommended for prevention of extrapyramidal symptoms
trihexyphenidyl
with antipsychotics
amantadine
(ARTANE)
carbidopa/levodopa ODT (generic for Parcopa)
More effective agents available for treatment of Parkinson
carbidopa/levodopa (generic for Sinemet)
disease
carbidopa/levodopa ER (generic for Sinemet CR)
Antiplatelets
Dipyridamole immediate-release may cause orthostatic
dipyridamole
aspirin/dipyridamole (generic for Aggrenox)
(PERSANTINE)
hypotension
clopidogrel (generic for Plavix)
ticlopidine
Ticlodipine - Safer, effective alternatives available
EFFIENT
(TICLID)
BRILINTA
Anti-infective
nitrofurantoin
Potential for pulmonary toxicity, hepatotoxicity, and peripheral
None recommended by The American Geriatrics Society; however,
(MACROBID, MACRODANTIN)
neuropathy, especially with long-term use
Nitrofurantoin is included in CMS's 5-star measure if beneficiary
may consider the following:
has two or more fills and receives 90 or more cumulative days of
ciprofloxacin (generic for Cipro)
treatment in a calendar year.
MONUROL
trimethoprim (generic for Proloprim)
trimethoprim/sulfamethoxazole (generic for Bactrim)
trimethoprim/sulfamethoxazole DS (generic for Bactrim DS)
Alpha blockers
guanfacine (TENEX)
High risk of adverse CNS effects (may cause bradycardia and
Thiazide-type diuretics
(central)
orthostatic hypotension)
methyldopa (ALDOMET)
reserpine (>0.1 mg/day)*
chlorthalidone (generic for Thalitone)
*Reserpine is included in CMS's 5 -star measure for any
hydrochlorothiazide (generic for Hydrodiuril, Microzide)
beneficiary with two or more fills in a calendar year.
indapamide (generic for Lozol)
metolazone (generic for Zaroxolyn)
* Alternatives are recommended by The American Geriatrics Society, unless otherwise noted. Alternatives are not diagnosis-specific.
¹ OTC (over-the-counter) drugs are not covered by Medicare Part D
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