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9 Types of Medication Older Adults Should Use With Caution

If you're over 65, think twice before taking these drugs

En español | As you grow older, you're more likely to develop long-term health conditions that require taking multiple medications. You're also more sensitive to many common medications, including over-the-counter (OTC) drugs.

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As a result, it's not uncommon for older adults to be overmedicated and to experience adverse reactions to the ever-lengthening list of medications they take.

To lower the chances of overmedication and dangerous drug reactions, the American Geriatrics Society Foundation for Health in Aging recommends that people age 65 and over be cautious about using the following types of drugs:

Important: If you are taking any of these medications, talk to your doctor or health care provider before stopping their use.

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Be cautious of: long-lasting NSAIDS such as piroxicam (sold under the brand-name Feldene) and indomethacin (Indocin).

The concern: NSAIDs are used to reduce pain and inflammation, but in older adults these medications can increase the risk of indigestion, ulcers and bleeding in the stomach or colon; they can also increase blood pressure, affect your kidneys and make heart failure worse. If NSAIDS are needed, better choices include the shorter-acting ibuprofen (Motrin) and salsalate (Disalcid).

Because of the increased risk of bleeding, don't use NSAIDs together with aspirin, clopidogrel (Plavix), dabigatran (Pradaxa), dipyridamole (Persantine), prasugrel (Effient), ticlopidine (Ticlid) or warfarin (Coumadin).

If you take NSAIDs regularly and have a history of ulcers, or are 75 years of age or older, you may need to protect your stomach against bleeding with a prescription medication such as misoprostol (Cytotec) or a proton pump inhibitor such as omeprazole (Prilosec).

2. Muscle relaxants

Be cautious of: cyclobenzaprine (Flexeril), methocarbamol (Robaxin), carisoprodol (Soma) and similar medications.

The concern: These medications can leave you feeling groggy and confused, increase your risk of falls, and cause constipation, dry mouth and urination problems. Plus, there's little evidence that they work well.

3. Anti-anxiety and anti-insomnia drugs

Be cautious of: benzodiazepines, such as diazepam (Valium), alprazolam (Xanax) or chlordiazepoxide (Librium, Limbitrol, Librax) as well as nonbenzodiazepine sleeping pills, such as zaleplon (Sonata) and zolpidem (Ambien).

The concern: In older adults especially, these medications can increase your risk of falls, as well as cause confusion. Because it takes your body a long time to get these drugs out of your system, you could feel groggy and sleepy for an extended period of time.

4. Anticholinergic Drugs

Be cautious of: medications including the antidepressants amitriptyline (Elavil) and imipramine (Tofranil), the anti-Parkinson's drug trihexyphenidyl (Artane), the irritable bowel syndrome drug dicyclomine (Bentyl), the overactive bladder drug oxybutynin (Ditropan) and diphenhydramine, an antihistamine (Benadryl) often included in over-the-counter sleep medicines such as Tylenol PM.

The concern: Anticholinergic drugs can cause confusion, constipation, urination problems, blurry vision and low blood pressure.

5. Heart Medications

Be cautious of: digoxin (Lanoxin) in doses greater than 0.125 mg.

The concern: Use of digoxin, which is prescribed as a treatment for heart failure and irregular heartbeat, can be toxic in older adults and people whose kidneys do not work well.

6. Diabetes Drugs

Be cautious of: glyburide (Diabeta, Micronase) and chlorpropamide (Diabinese).

The concern: They can cause severe low blood sugar in older adults.

7. Opioid pain relievers

Be cautious of: meperidine (Demerol) and pentazocine (Talwin).

The concern: These types of opioid analgesic medications, also known as narcotic analgesics, can cause confusion, falls, seizures, confusion and even hallucinations, especially in older adults.

8. Anti-psychotic drugs

Be cautious of: Unless you are being treated for schizophrenia, bipolar disorder or some forms of depression, stay away from anti-psychotics such as haloperidol (Haldol), risperidone (Risperdal) and quetiapine (Seroquel).

The concern: Anti-psychotic drugs can increase the risk of stroke or even death; they can also cause tremors and increase your risk of falls.

9. Estrogen

Be cautious of: Estrogen pills and patches, which are typically prescribed for hot flashes and other menopause-related symptoms.

The concern: Estrogen can increase your risk of breast cancer, blood clots and dementia. Estrogens can also aggravate urinary incontinence in women.

Whenever a doctor prescribes a new medication or makes a change in the dose, ask why.

For instance, if a new medication is being prescribed to ease the side effects of a drug you're already taking, ask whether it makes sense to continue taking the drug that is causing the bad reaction.

Also, ask your health care provider or pharmacist to check any new medications in a drug interaction computer database, especially if you're already taking five or more drugs.

Check Your Medication List

Once or twice a year ask your doctor or health care provider to review the medications, supplements and vitamins you're taking. Ask whether you still need to take each one at its current dose.

If possible, try to have all of your prescriptions filled at the same pharmacy. (Most pharmacies use computer systems that flag possible drug interactions.)

Also, let your health care providers know about any past allergic reactions you have had to medications.

These organizations can help you find a doctor or pharmacist who specializes in caring for older adults:

American Geriatrics Society's Foundation for Health in Aging Physician Referral Service or 212-308-1414

American Society of Consultant Pharmacists or 703-739-1300

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