Specific PIMs | Frequency (%) | Beers recommendation | Reason (s) |
---|---|---|---|
Amitriptyline | 2 (1.0) | Avoid | Highly anticholinergic, sedating, and cause orthostatic hypotension |
Aspirin | 1 (0.5) | Use with caution in patients ≥ 70 years | Aspirin for primary prevention of cardiovascular disease |
Warfarin and Aspirin | 3 (1.5) | Avoid when possible; if used together, monitor INR closely | Increased risk of bleeding |
Cimetidine | 14 (7.2) | Reduce dose if CrCl is < 50 | Mental status changes |
Warfarin and Ciprofloxacin | 2 (1.0) | Avoid when possible; if used together, monitor INR closely | Increased risk of bleeding |
Dexamethasone and NSAID | 1 (0.5) | Avoid; if not possible, provide gastrointestinal protection | Increased risk of peptic ulcer disease or gastrointestinal bleeding |
Digoxin | 4 (2.1) | Avoid this rate control agent as first line therapy for atrial fibrillation | Should not be used as a first-line agent in atrial fibrillation, because there are safer and more effective alternatives for rate control |
Furosemide | 83 (43) | Use with caution | May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults |
Hydrochlorothiazide | 4 (2.1) | Use with caution | May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults |
Metoclopramide | 9 (4.7) | Avoid, unless for gastroparesis with duration of use not to exceed 12Â weeks except in rare cases | Can cause extrapyramidal effects, including tardive dyskinesia; risk may be greater in frail older adults |
Ranitidine | 17 (8.8) | Reduce dose if CrCl is < 50 | Mental status changes |
Sliding-scale regular Insulin alone | 2 (1.0) | Avoid | Insulin regimens that include only short- or rapid acting insulin increases the risk of hypoglycemia without improvement in hyperglycemia management regardless of care setting |
Risperidone | 1 (0.5) | Avoid | Avoid in older adults with or at high risk of delirium because of potential of inducing or worsening delirium |
Spironolactone | 22 (11.4) | Avoid in patients with CrCl < 30 = 2 | Increased potassium |
Use with caution = 20 | May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults | ||
Tramadol | 26 (14.5) | Avoid if CrCl < 30 = 1 | CNS adverse effect |
Use with caution = 25 | May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults |