As described in see Table: Potentially Inappropriate Drugs in the Elderly (Based on the American Geriatrics Society 2012 Beers Criteria Update), short-, intermediate-, and long-acting benzodiazepines are associated with increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in the elderly and should be avoided for the treatment of insomnia.Benzodiazepines may be appropriate for treatment of anxiety or panic attacks in the elderly.β-blockers should be reserved for 2nd-line therapy.Short-acting dihydropyridines (eg, ) may increase mortality risk and should not be used.Patients should also be monitored for Doses of antihyperglycemics should be titrated carefully in patients with diabetes mellitus.Risk of hypoglycemia due to sulfonylureas may increase with age.Sitting and standing BP can be monitored, particularly when multiple antihypertensives are used, to check for orthostatic hypotension, which may increase risk of falls and fractures.
Linnebur, Pharm D, BCPS, BCGP, Professor of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences In patients with heart failure, risk of hyperkalemia especially if also taking an NSAID, ACE inhibitor, angiotensin receptor blocker, or K supplement; avoid in heart failure or if creatinine clearance May be appropriate for seizure disorders, rapid eye movement sleep disorders, benzodiazepine withdrawal, ethanol withdrawal, severe generalized anxiety disorder, periprocedural anesthesia, end-of-life care Serious adverse effects include peptic ulceration and upper GI bleeding; risk is increased when an NSAID is begun and when dose is increased.
Risk of lactic acidosis, a rare but serious complication, increases with degree of renal impairment and with patient age. In many elderly patients, lower starting doses of antihypertensives may be necessary to reduce risk of adverse effects; however, for most elderly patients with hypertension, achieving BP goals requires standard doses and multidrug therapy.
Initial treatment of hypertension in the elderly typically involves a thiazide-type diuretic, ACE inhibitor, angiotensin II receptor blocker, or dihydropyridine Ca channel blocker, depending on comorbidities.
Therefore, elderly patients should be given a lower starting dose of levodopa and carefully monitored for adverse effects (see Parkinson Disease : Levodopa).
Patients who become confused while taking levodopa may also not tolerate Antipsychotics should be used only for psychosis.