The Beers criteria

The following is a compilation of medications available in Canada that seniors with certain diseases or conditions should not use, according to a study known as the Beers criteria.

DRUGS SENIORS SHOULD AVOID:

Another component of the Beers criteria outlines drugs to be avoided by seniors, regardless of conditions or diseases they might already have.

CBC News has made a Canadian version available here.

This list is the result of a U.S. study that outlines potentially inappropriate drug use in seniors. The Beers list was originally compiled in 1991, and was updated in 2003. It is based on drugs available in the U.S., some of which are not available in Canada. As such, CBC News has edited the list to reflect only those drugs available in Canada.

This page lists drugs seniors should not take if they have one of the 19 conditions or diseases identified by the Beers study.

If you're uncertain about a medical term, check the glossary.

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Disclaimer: This edited online Canadian version of the Beers list is intended solely to give you convenient access to the drug information published in "Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults." It is not a substitute for professional medical advice. If you have a medical concern, consult a qualified health professional.

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Diseases and conditions identified by Beers:

• Anorexia and malnutrition
• Arrhythmias
• Bladder outflow obstruction
• Blood clotting disorders or receiving anticoagulant therapy
• Chronic constipation
• Cognitive impairment
• COPD
• Depression
• Heart failure
• Hypertension
• Gastric or duodenal ulcers
• Insomnia
• Obesity
• Parkinson's disease
• Seizures or epilepsy
• Seizure disorder
• SIADH/hyponatremia
• Stress incontinence
• Syncope or falls

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Anorexia and malnutrition (Top)

Drug(s) you shouldn't use:
Central nervous system stimulants: DextroAmphetamine (Adderall), methylphenidate (Ritalin), and fluoxetine (Prozac)

Beers Concern:
Concern due to appetite-suppressing effects.

Beers Severity Rating:
High

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Arrhythmias (Top)

Drug(s) you shouldn't use:
Tricyclic antidepressants (imipramine hydrochloride, doxepin hydrochloride, and amitriptyline hydrochloride)

Beers Concern:
Concern due to proarrhythmic effects and ability to produce QT interval changes.

Beers Severity Rating:
High

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Bladder outflow obstruction (Top)

Drug(s) you shouldn't use:
Anticholinergics and antihistamines, gastrointestinal antispasmodics, muscle relaxants, oxybutynin (Ditropan), flavoxate (Urispas), anticholinergics, antidepressants, decongestants, and tolterodine (Detrol)

Beers Concern:
May decrease urinary flow, leading to urinary retention.

Beers Severity Rating:
High

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Blood clotting disorders or receiving anticoagulant therapy (Top)

Drug(s) you shouldn't use:
Aspirin, NSAIDs (nonsteroidal anti-inflammatory drugs), dipyridamole (Persantin, Aggrenox), ticlopidine (Ticlid), and clopidogrel (Plavix)

Beers Concern:
May prolong clotting time and elevate INR values or inhibit platelet aggregation, resulting in an increased potential for bleeding.

Beers Severity Rating:
High

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Chronic constipation (Top)

Drug(s) you shouldn't use:
Calcium channel blockers, anticholinergics, and tricyclic antidepressants (imipramine hydrochloride, doxepin hydrochloride, and amitriptyline hydrochloride)

Beers Concern:
May exacerbate constipation.

Beers Severity Rating:
Low

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Cognitive impairment (Top)

Drug(s) you shouldn't use:
Barbiturates, anticholinergics, antispasmodics, and muscle relaxants. CNS (central nervous system) stimulants: dextroAmphetamine (Adderall), and methylphenidate (Ritalin)

Beers Concern:
Concern due to CNS-altering effects.

Beers Severity Rating:
High

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COPD (chronic obstructive pulmonary disease) (Top)

Drug(s) you shouldn't use:
Long-acting benzodiazepines: chlordiazepoxide (Librium), chlordiazepoxide-amitriptyline (Limbitrol), clidinium-chlordiazepoxide (Librax), diazepam (Valium), quazepam (Doral), halazepam (Paxipam), and chlorazepate (Tranxene). Beta-blockers: propranolol

Beers Concern:
CNS adverse effects. May induce respiratory depression. May exacerbate or cause respiratory depression.

Beers Severity Rating:
High

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Depression (Top)

Drug(s) you shouldn't use:
Long-term benzodiazepine use. Sympatholytic agents: methyldopa (Dopamet, Medopa), reserpine, and guanethidine

Beers Concern:
May produce or exacerbate depression.

Beers Severity Rating:
High

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Heart failure (Top)

Drug(s) you shouldn't use:
Disopyramide (Rythmodan), and low sodium content drugs (sodium and sodium salts [alginate bicarbonate, biphosphate, citrate, phosphate, salicylate, and sulfate])

Beers Concern:
Negative inotropic effect. Potential to promote fluid retention and exacerbation of heart failure.

Beers Severity Rating:
High

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Hypertension (Top)

Drug(s) you shouldn't use:
Pseudoephedrine; diet pills, and amphetamines

Beers Concern:
May produce elevation of blood pressure secondary to sympathomimetic activity.

Beers Severity Rating:
High

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Gastric or duodenal ulcers (Top)

Drug(s) you shouldn't use:
NSAIDs and aspirin (>325 mg) (coxibs excluded)

Beers Concern:
May exacerbate existing ulcers or produce new/additional ulcers.

Beers Severity Rating:
High

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Insomnia (Top)

Drug(s) you shouldn't use:
Decongestants, theophylline (Theolair, Uniphyl, Theophyl, Pulmophylline, Apo-Theo-LA), methylphenidate (Ritalin), MAOIs (monoamine oxidase inhibitors), and amphetamines

Beers Concern:
Concern due to CNS stimulant effects.

Beers Severity Rating:
High

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Obesity (Top)

Drug(s) you shouldn't use:
Olanzapine (Zyprexa)

Beers Concern:
May stimulate appetite and increase weight gain.

Beers Severity Rating:
Low

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Parkinson's disease (Top)

Drug(s) you shouldn't use:
Metoclopramide and conventional antipsychotics

Beers Concern:
Concern due to their antidopaminergic/cholinergic effects.

Beers Severity Rating:
High

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Seizures or epilepsy (Top)

Drug(s) you shouldn't use:
Clozapine (Clozaril), chlorpromazine (Thorazine), thioridazine (Mellaril), and thiothixene (Navane)

Beers Concern:
May lower seizure thresholds.

Beers Severity Rating:
High

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Seizure disorder (Top)

Drug(s) you shouldn't use:
Bupropion (Wellbutrin)

Beers Concern:
May lower seizure threshold.

Beers Severity Rating:
High

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SIADH/hyponatremia (Top)

Drug(s) you shouldn't use:
SSRIs: fluoxetine (Prozac), citalopram (Celexa), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)

Beers Concern:
May exacerbate or cause SIADH.

Beers Severity Rating:
Low

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Stress incontinence (Top)

Drug(s) you shouldn't use:
Beta-Blockers (Doxazosin, Prazosin, and Terazosin), anticholinergics, tricyclic antidepressants (imipramine hydrochloride, doxepin hydrochloride, and amitriptyline hydrochloride), and long- acting benzodiazepines

Beers Concern:
May produce polyuria and worsening of incontinence.

Beers Severity Rating:
High

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Syncope or falls (Top)

Drug(s) you shouldn't use:
Short- to intermediate-acting benzodiazepine and tricyclic antidepressants (imipramine hydrochloride, doxepin hydrochloride, and amitriptyline hydrochloride)

Beers Concern:
May produce ataxia, impaired psychomotor function, syncope, and additional falls.

Beers Severity Rating:
High