Table 3 Disease-specific PIM lists

Circulatory system

Heart failure

Non-COX-2 selective NSAIDs, COX-2 selective NSAIDs, thiazolidinediones, non-dihydropyridine calcium channel blockers (diltiazem, verapamil), digoxin, tricyclic antidepressants, sildenafil, tadalafil, vardenafil

Syncope

Donepezil, rivastigmine, galantamine, non-selective alpha-blockers, tricyclic antidepressants, benzodiazepines, antipsychotics, methyldopa, venlafaxine

Bradycardia

Beta-blockers, donepezil, rivastigmine, galantamine, non-dihydropyridine calcium channel blockers

Arrythmias

Antiarrhythmics, tricyclic antidepressants, antipsychotics, donepezil, quinine

Hypertension

Loop diuretics, non-selective alpha blockers, NSAIDs, thiazides, methyldopa

Hypertension and urinary incontinence

Loop diuretics

Dependent ankle oedema

Loop diuretics, calcium channel blockers

Hypokalemia

Thiazide, digoxin, fludrocortisone, loop diuretics,

Hyponatremia

Thiazides, selective serotonin reuptake inhibitors

Hypercalcemia

Thiazides

Hyperkalemia

ACE inhibitors, ARBs, spironolactone

High bleeding risk (e.g., coagulopathy)

Antiplatelet, vitamin K antagonists, direct thrombin inhibitors, direct factor Xa inhibitors, NSAIDs

First deep vein thrombosis (without continuing risks)

Vitamin K antagonists, direct thrombin inhibitors, direct factor Xa inhibitors

Cardiac conduction abnormalities and heart block

Tricyclic antidepressants, digoxin, verapamil, amiodarone, acetylcholinesterase inhibitors (e.g., donepezil, rivastigmine), beta blockers

Orthostatic hypotension

Non-selective alpha blockers, calcium channel blockers, long-acting nitrates, chlorpromazine, tricyclic antidepressants, hydralazine, thiazide, loop diuretics, dopamine agonists (except levodopa), selegiline, antipsychotics, SGLT-2 inhibitors

Acute coronary symptoms

COX-2 selective NSAIDs, Non-COX-2 selective NSAIDS

Raynaud disease

Beta-blockers

Nervous system

Delirium, dementia or cognitive impairment

Urological spasmolytic (e.g., oxybutynin, tolterodine), first-generation antihistamines, antiparkinsonian drugs, antiemetics, muscle relaxants (e.g., orphenadrine), tricyclic antidepressants, paroxetine, antipsychotics, disopyramide, intestinal antispasmodics (e.g., atropine, scopolamine), psychostimulants (methylphenidate), barbiturates, benzodiazepines, zolpidem, deferoxamine, testosterone, corticosteroids, dopamine agonist, antiepileptics

History of falls or fractures

Antipsychotics, benzodiazepines, zolpidem, opioids, tricyclic antidepressants, antiepileptics (e.g., carbamazepine, phenytoin), first generation antihistamines, non-selective alpha blockers, non-selective beta-blockers, paroxetine, duloxetine, loop diuretics

Parkinson disease and Parkinsonism

Antipsychotics (except quetiapine, clozapine), antiemetics (e.g., prochlorperazine, promethazine, metoclopramide), benzhexol

Behavioral and psychological symptoms in dementia

Antipsychotics, anticonvulsants, benzodiazepines

Sleep disorders or insomnia

Antipsychotics, psychostimulants (e.g., methylphenidate, caffeine), theophylline, pseudoephedrine, benzodiazepines (temazepam could be considered for short-term use), barbiturates, tricyclic antidepressants, Z-hypnotics

Benign essential tremor

Levodopa and dopamine agonists, benzhexol

Depression

Centrally acting antihypertensives (e.g., methyldopa, reserpine), tricyclic antidepressant

Seizures or epilepsy

Antipsychotics, bupropion, antidepressants, beta-lactam antibiotics, theophylline, H2 antagonists, levodopa, isoniazid, opioids

Gastrointestinal system

History of gastric or duodenal ulcers

Aspirin, Non-COX-2 Selective NSAIDs, Corticosteroids

History of esophageal ulcers and dysphagia

Oral bisphosphonates

Constipation

Drugs with anticholinergics properties, verapamil, oral iron, opioids, aluminium antacids, tricyclic antidepressants, calcium supplements, diuretics

Genitourinary system

Chronic kidney disease

Non-COX-2 selective NSAIDs, COX-2 selective NSAIDs, glibenclamide, digoxin, dabigatran, metformin, oral bisphosphonates, colchicine, thiazide, factor Xa inhibitors, donepezil, memantine, cimetidine, ciprofloxacin, gabapentin, PPI, ACEI, ARBs, warfarin, allopurinol, opioids, aminoglycosides, amphotericin B, vancomycin, acyclovir, clopidogrel, ticlopidine

Benign prostatic hyperplasia

Strong anticholinergic drugs, tricyclic antidepressants, antimuscarinic bronchodilators (e.g., ipratropium, tiotropium)

Urinary incontinence

Non-selective alpha blockers, tricyclic antidepressants, diuretics

Respiratory system

Bronchial asthma

Non-selective beta blockers, benzodiazepines

Chronic obstructive pulmonary disease

Theophylline, non-selective beta-blockers, benzodiazepines

Acute or chronic respiratory failures

Benzodiazepines, opioids, alcohol, cocaine, amphetamines

Sleep apnea

Benzodiazepines

Other systems

Narrow angle glaucoma

Tricyclic antidepressants, antimuscarinic bronchodilators, strongly anticholinergic drugs, Urological spasmolytic (e.g., oxybutynin)

Osteoarthritis and osteoporosis

Systemic corticosteroids (except intra-articular), high dose calcium supplements, NSAIDs, eperisone

Pain

Opioids in chronic mild pain, long-acting opioids without short-acting opioids in breakthrough pain, benzodiazepines, tramadol

Gout

Loop diuretics, colchicine

Diabetes mellitus

Beta blockers, corticosteroids, olanzapine, quetiapine, risperidone

Breast cancer

Oestrogens

Venous thromboembolism

Oestrogens