High Risk Medications List - 2017 (Page 5 of 7) in pdf

High risk medications

pdated May 2017

Alternatives When Diagnosis is NOT KNOWN

Classification

Drug name

Risk

If diagnosis is known - refer to FER Alternatives document

CNS (other)

chloral hydrate (SOMNOTE)

Avoid in older adults with or at high risk of delirium because of

For anxiety:

the potential of inducing or worsening delirium. Avoid

buspirone

meprobamate (MILTOWN)

(generic for Buspar)

antipsychotics for behavioral problems of dementia or delirium

SSRI's

unless nonpharmacological options (e.g., behavioral

citalopram (generic for Celexa)

interventions) have failed or are not possible and the older

escitalopram (generic for Lexapro)

adult is threatening substantial harm to self or others.

fluoxetine (generic for Prozac)

Antipsychotics are associated with greater risk of

fluoxetine delayed-release (generic for Prozac Weekly)

cerebrovascular accident (stroke) and mortality in persons with

sertraline (generic for Zoloft)

dementia.

VIIBRYD

SNRI's

Meprobamate has a high rate of physical dependence and is

desvenlafaxine ER

very sedating.

duloxetine (generic for Cymbalta)

FETZIMA

PRISTIQ

venlafaxine (generic for Effexor)

venlafaxine ER (generic for Effexor XR)

Nonbenzodiazepine

Risk of: delirium, falls, and fractures; increased emergency

None recommended by The American Geriatrics Society;

eszopiclone (LUNESTA)

hypnotics

department visits and hospitalizations; and motor vehicle

however, may consider the following:

crashes.

zolpidem (AMBIEN, AMBIEN CR)

ROZEREM

zaleplon (SONATA)

These drugs produce minimal improvement in sleep latency

trazodone

and duration.

temazepam

BEERS

Included in CMS's 5-star measure with two or more fills

BEERS

Not recommended by The American Geriatrics Society because of increased risk for

with 90 or more cumulative days of any combination of

cognitive impairment, delirium, falls, fractures, and motor vehicle accidents.

these drugs.

Vasodilators for

Lack of efficacy

ergoloid mesylates (HYDERGINE)

donepezil (generic for Aricept)

dementia

isoxsuprine (VASODILAN)

galantamine (generic for Razadyne)

rivastigmine (generic for Exelon)

memantine (generic for Namenda)

NAMENDA XR

Endocrine

desiccated thyroid (ARMOUR THYROID, NP THYROID)

There are concerns about cardiac effects with desiccated

levothyroxine (generic for Levoxyl, Synthroid, Unithroid)

thyroid and safer alternatives are available.

liothyronine (generic for Cytomel)

THYROLAR (levothyroxine/liothyronine)

TIROSINT (levothyroxine capsule)

estrogens

There is evidence of potential breast and endometrium cancer.

For dyspareunia and vulvovaginitis:

There is a lack of cardioprotective effect and cognitive

CONJUGATED ESTROGEN

ESTRING

protection in older women.

CENESTIN, ENJUVIA, PREMARIN

ESTRACE VAGINAL CREAM

* 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

High Risk Medications List - 2017 Page 5

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