High Risk Medications List - 2017 (Page 7 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

pentazocine

Causes CNS adverse effects more commonly than other opioid

oxycodone/acetaminophen (generic for Percocet)

(TALACEN, TALWIN, TALWIN COMPOUND, TALWIN NX)

analgesics, including confusion and hallucinations. This drug is

tramadol (generic for Ultram)

hydromorphone

also a mixed agonist and antagonist.

oxycodone

oxymorphone

hydrocodone/acetaminophen

Non-COX-selective

Increased risk of gastrointestinal bleeding, peptic ulcer

indomethacin (INDOCIN)

acetaminophen (generic for Tylenol)

OTC

NSAIDS

disease, and acute kidney injury in older adults compared to

BEERS

ketorolac (SPRIX, TORADOL)

ibuprofen

(generic for Motrin)

other NSAID's.

BEERS

naproxen

(generic for Naprosyn)

diclofenac

Skeletal muscle

carisoprodol (SOMA)

Most muscle relaxants are poorly tolerated by older adults

acetaminophen (generic for Tylenol)

OTC

relaxants

because some have anticholinergic adverse effects, sedation,

BEERS

chlorzoxazone (LORSONE, PARAFON FORTE DSC)

ibuprofen

(generic for Motrin)

and increased risk of fractures.

BEERS

cyclobenzaprine (FLEXERIL)

naproxen

(generic for Naprosyn)

metaxalone (SKELAXIN)

diclofenac

methocarbamol (ROBAXIN)

BEERS

Use only if no heart failure and estimated GFR > 30 mL/min.

BEERS

Use PPI combination if used > 7 days.

orphenadrine (NORFLEX)

The following may also be considered, but are not recommended by

the American Geriatrics Society:

baclofen

BEERS

tizanidine

BEERS

Avoid use of tizanidine in men because of urinary retention.

References

1. Pharmacy Quality Alliance. Use of High-Risk Medications in the Elderly (HRM) . Available at: , last accessed Jan. 5, 2016.

2. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults . JAGS 2015; 1-20.

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. JAGS 2015; 1-11.

4. Clinical Pharmacology . Elsevier Gold Standard. Available at: https://

9960

* 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