Skip to main content

Table 1 Targeted medication classes

From: A consumer-targeted, pharmacist-led, educational intervention to reduce inappropriate medication use in community older adults (D-PRESCRIBE trial): study protocol for a cluster randomized controlled trial

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

  1. A full list of medication associated with these drug classes is presented in Appendix 1: Table 3