Medication class | Rationale |
---|---|
All benzodiazepines as well as non-benzodiazepine hypnotics | • Associated with: |
  ○ A 5-fold increased risk of cognitive events [36–39] | |
  ○ A 30 % to 2-fold increased risk of falls [40–42], a 50 % increased risk of hip fractures [42–46] | |
  ○ A 25 % to 2-fold increased risk of motor vehicle accidents [47–49] | |
  ○ Increased risk of Alzheimer’s disease by up to 80 % [50] | |
• Similar evidence of harm exists for non-benzodiazepine hypnotics [9] | |
• Hypnotics are associated with a greater than 3-fold increased risk of death even when prescribed < 18 pills/year [51] | |
Anticholinergic agents including first-generation antihistamines (as single agents or as part of combination products) | • Can cause cognitive impairment [39] |
• Have been associated with an increased risk of [52–57]: | |
  ○ Confusion | |
  ○ Dry mouth | |
  ○ Constipation | |
  ○ Functional decline | |
Long-acting sulfonylurea oral hypoglycemic agents chlorpropamide or glyburide used for the treatment of diabetes | • Estimated to be responsible for 11 % of emergency hospitalizations for adverse drug events in older adults [58] |
• Glyburide is associated with a 52 % greater risk of experiencing at least one episode of hypoglycemia compared with other secretagogues and with 83 % greater risk compared with other sulfonylureas [59, 60] | |
• Chlorpropramide has potential to cause SIADH (syndrome of inappropriate antidiuretic hormone secretion) [61] | |
• Glyburide was a new addition to the Beers list in 2012 [9, 62] | |
Chronic non-COX-selective non-steroidal anti-inflammatory drug (NSAIDs) | • Increased risk of gastro-intestinal bleeding/peptic ulcer disease in older adults |
• Ulcers, bleeding, or perforation caused by NSAIDs occur in approximately 1 % of patients treated for 3–6 months, and in about 2–4 % of patients treated for 1 year with trends continuing with longer duration of use [63–65] | |
• Use of misoprostol or a proton pump inhibitor reduces this risk, it does not eliminate it |