Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
Disclaimer for the 2019 American Geriatrics Society Updated Beers Criteria Guideline Summary
Drug-Disease or Drug-Syndrome Interactions That May Exacerbate the Disease or Syndrome
Drug-Drug Interactions That Should Be Avoided in Older Adults
Medications/Criterion Added, Removed or Modified Since 2015
Select Highlights for Medications to Avoid, Adjust Dosage for or Use with Caution
Medication | Comments |
---|---|
Alprazolam | Avoid |
Amiloride | Avoid if CrCl <30 mL/min |
Amiodarone | Avoid as first-line therapy for atrial fibrillation for most patients |
Amitriptyline | Avoid; has strong anticholinergic properties |
Amobarbital | Avoid |
Amoxapine | Avoid; has strong anticholinergic properties |
Androgens | Avoid unless indicated for symptomatic hypogonadism |
Apixaban | Avoid if CrCl <25 mL/min |
Aripiprazole | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Asenapine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Aspirin | Use with caution for primary prevention of cardiovascular disease and colorectal cancer; Use with caution in adults ≥70 years; Avoid in most patients with history of gastric or duodenal ulcers; avoid chronic use with >325 mg/day |
Atropine (excludes ophthalmic) | Avoid; has strong anticholinergic properties |
Belladonna alkaloids | Avoid; has strong anticholinergic properties |
Benztropine (oral) | Avoid; has strong anticholinergic properties |
Brexpiprazole | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Brompheniramine | Avoid; has strong anticholinergic properties |
Butabarbital | Avoid |
Butalbital | Avoid |
Carbamazepine | Use with caution |
Carbinoxamine | Avoid; has strong anticholinergic properties |
Cariprazine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Carisoprodol | Avoid |
Chlordiazepoxide (alone or in combination with amitriptyline or clidinium) | Avoid |
Chlorpheniramine | Avoid; has strong anticholinergic properties |
Chlorpromazine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties |
Chlorpropamide | Avoid |
Chlorzoxazone | Avoid |
Cilostazol | Avoid for most patients; Use with caution in patients with heart failure |
Cimetidine | Reduce dose if CrCl <50 mL/min; avoid in patients with delirium |
Ciprofloxacin | Reduce dose if CrCl <30 mL/min |
Citalopram | Use with caution |
Clemastine | Avoid; has strong anticholinergic properties |
Clidinium-chlordiazepoxide | Avoid; has strong anticholinergic properties |
Clomipramine | Avoid; has strong anticholinergic properties |
Clonazepam | Avoid |
Clonidine for first-line treatment | Avoid as an antihypertensive |
Clorazepate | Avoid |
Clozapine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties |
Colchicine | Reduce dose if CrCl <30 mL/min and monitor |
Cyclobenzaprine | Avoid; has strong anticholinergic properties |
Cyproheptadine | Avoid; has strong anticholinergic properties |
Dabigatran | Use with caution for treatment of VTE or atrial fibrillation in adults ≥75 years; Avoid; dose adjustment advised when CrCl >30 mL/min in the presence of drug-drug interactions |
Darifenacin | Has strong anticholinergic properties |
Desiccated thyroid | Avoid |
Desipramine | Avoid; has strong anticholinergic properties |
Desmopressin | Avoid for nocturia or nocturnal polyuria |
Desvenlafaxine | Use with caution |
Dexbrompheniramine | Avoid; has strong anticholinergic properties |
Dexchlorpheniramine | Avoid; has strong anticholinergic properties |
Dexlansoprazole | Avoid scheduled use for >8 weeks for most patients |
Dextromethorphan/quinidine | Use with caution |
Diazepam | Avoid |
Diclofenac | Avoid chronic use |
Dicyclomine | Has strong anticholinergic properties; Avoid in men with lower urinary tract symptoms, benign prostatic hyperplasia |
Dicyclomine Homatropine (excludes opthalmic) | Avoid |
Diflunisal | Avoid chronic use |
Digoxin | Avoid as first line therapy for atrial fibrillation and for heart failure; if used for atrial fibrillation or heart failure, avoid dosages >0.125 mg/day |
Diltiazem | Avoid for most patients; Use with caution in patients with heart failure |
Dimenhydrinate | Avoid; has strong anticholinergic properties |
Diphenhydramine (oral) | Avoid; has strong anticholinergic properties |
Dipyridamole, oral short acting | Avoid |
Disopyramide | Avoid; has strong anticholinergic properties |
Diuretics | Use with caution |
Dofetilide | Reduce dose if CrCl 20-59 mL/min; Avoid if CrCl <20 mL/min |
Doxazosin | Avoid use as an antihypertensive; Avoid in patients with syncope and in females with urinary incontinence |
Doxepin (>6 mg / day) | Avoid; has strong anticholinergic properties |
Doxylamine | Avoid; has strong anticholinergic properties |
Dronedarone | Avoid in individuals with permanent atrial fibrillation or some types of heart failure |
Duloxetine | Use with caution; Avoid if CrCl <30 mL/min |
Edoxaban | Reduce dose if CrCl 15-50 mL/min; Avoid if CrCl <15 or >95 mL/min |
Enoxaparin | Reduce dose if CrCl <30 mL/min |
Ergoloid mesylates (dehydrogenated ergot alkaloids) | Avoid |
Escitalopram | Use with caution |
Esomeprazole | Avoid scheduled use for >8 weeks for most patients |
Estazolam | Avoid |
Estrogens with or without progestins | Avoid systemic estrogen. Vaginal cream or vaginal tablets: acceptable to use low-dose intravaginal estrogen for some patients |
Eszopiclone | Avoid |
Etodolac | Avoid chronic use |
Famotidine | Reduce dose if CrCl <50 mL/min; Avoid in patients with delirium |
Fenoprofen | Avoid chronic use |
Fesoterodine | Has strong anticholinergic properties |
Flavoxate | Has strong anticholinergic properties |
Fluoxetine | Use with caution |
Fluphenazine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Flurazepam | Avoid |
Fluvoxamine | Use with caution |
Fondaparinux | Avoid if CrCl <30 mL/min |
Gabapentin | Reduce if CrCl <60 mL/min |
Glimepiride | Avoid |
Glyburide (also known as glibenclamide) | Avoid |
Growth hormone | Avoid, except for some patients with growth hormone deficiency |
Guanabenz | Avoid other CNS alpha-agonists as listed |
Guanfacine | Avoid other CNS alpha-agonists as listed |
Haloperidol | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Homatropine (excludes ophthalmic) | Has strong anticholinergic properties; Avoid in men with lower urinary tract symptoms, benign prostatic hyperplasia |
Hydroxyzine | Avoid; has strong anticholinergic properties |
Hyoscyamine | Avoid; has strong anticholinergic properties |
Ibuprofen | Avoid chronic use |
Iloperidone | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Imipramine | Avoid; has strong anticholinergic properties |
Indomethacin | Avoid |
Insulin, sliding scale | Avoid |
Isoxsuprine | Avoid |
Ketoprofen | Avoid chronic use |
Ketorolac, includes parenteral | Avoid |
Lansoprazole | Avoid scheduled use for >8 weeks for most patients |
Levetiracetam | Reduce dose if CrCl ≤80 mL/min |
Levomilnacipran | Use with caution |
Lorazepam | Avoid |
Loxapine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties |
Lumateperone | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Lurasidone | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Meclizine | Avoid |
Meclofenamate | Avoid chronic use |
Mefenamic acid | Avoid chronic use |
Megestrol | Avoid |
Meloxicam | Avoid chronic use |
Meperidine | Avoid |
Mephobarbital | Avoid |
Meprobamate | Avoid |
Mesoridazine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Metaxalone | Avoid |
Methocarbamol | Avoid |
Methscopolamine | Avoid; has strong anticholinergic properties |
Methyldopa | Avoid other CNS alpha-agonists as listed |
Methyltestosterone | Avoid unless indicated for symptomatic hypogonadism |
Metoclopramide | Avoid, unless for gastroparesis use less than 12 weeks for most cases; Avoid in patients with Parkinson Disease |
Milnacipran | Use with caution |
Mineral oil, given orally | Avoid |
Mirtazapine | Use with caution |
Molindone | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Nabumetone | Avoid chronic use |
Naproxen | Avoid chronic use |
Nifedipine, immediate release | Avoid |
Nitrofurantoin | Avoid in individuals with creatinine clearance <30 mL/min or for long-term suppression |
Nizatidine | Reduce dose if CrCl <50 mL/min; Avoid in patients with delirium |
Nortriptyline | Avoid; has strong anticholinergic properties |
Olanzapine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties |
Omeprazole | Avoid scheduled use for >8 weeks for most patients |
Omeprazole / sodium bicarbonate | Avoid scheduled use for >8 weeks for most patients |
Orphenadrine | Avoid; has strong anticholinergic properties |
Other 1st and 2nd Generation Antipsychotics | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Other PPIs | Avoid scheduled use for >8 weeks for most patients |
Other SNRIs | Use with caution |
Other SSRIs | Use with caution |
Other TCAs | Use with caution |
Oxaprozin | Avoid chronic use |
Oxazepam | Avoid |
Oxcarbazepine | Use with caution |
Oxybutynin | Has strong anticholinergic properties |
Paliperidone | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Pantoprazole | Avoid scheduled use for >8 weeks for most patients |
Paroxetine | Avoid; has strong anticholinergic properties |
Pentobarbital | Avoid |
Perphenazine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties |
Phenobarbital | Avoid |
Pimavanserin | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Pioglitazone | Avoid for most patients; Use with caution in patients with heart failure |
Piroxicam | Avoid chronic use |
Prasugrel | Use with caution in adults ≥75 years |
Prazosin | Avoid use as an antihypertensive; Avoid in patients with syncope and in females with urinary incontinence |
Pregabalin | Reduce if CrCl <60 mL/min |
Probenecid | Avoid if CrCl <30 mL/min |
Prochlorperazine | Avoid in patients with Parkinson Disease |
Prochlorperazine | Has strong anticholinergic properties; Avoid in men with lower urinary tract symptoms, benign prostatic hyperplasia |
Promethazine | Avoid; has strong anticholinergic properties |
Propantheline | Avoid; has strong anticholinergic properties |
Protriptyline | Avoid; has strong anticholinergic properties |
Pyrilamine | Avoid; has strong anticholinergic properties |
Quazepam | Avoid; has strong anticholinergic properties |
Quetiapine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Rabeprazole | Avoid scheduled use for >8 weeks for most patients |
Ranitidine | Reduce dose if CrCl <50 mL/min; Avoid in patients with delirium |
Reserpine (>0.1 mg/day) | Avoid other CNS alpha-agonists as listed |
Risperidone | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Rivaroxaban | Use with caution for treatment of VTE or atrial fibrillation in adults ≥75 years; Nonvalvular Afib reduce dose if CrCl 15-50 mL/min; avoid if CrCl <15 mL/min; for VTE avoid if CrCl <30 mL/min |
Rosiglitazone | Avoid for most patients; Use with caution in patients with heart failure |
Scopolamine (excludes ophthalmic) | Avoid; has strong anticholinergic properties |
Secobarbital | Avoid |
Sertraline | Use with caution |
Solifenacin | Has strong anticholinergic properties |
Spironolactone | Avoid if CrCl <30 mL/min |
Sulindac | Avoid chronic use |
Temazepam | Avoid |
Terazosin | Avoid use as an antihypertensive; Avoid in patients with syncope and in females with urinary incontinence |
Testosterone | Avoid unless indicated for symptomatic hypogonadism |
Thioridazine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties |
Thiothixene | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Tolmetin | Avoid chronic use |
Tolterodine | Has strong anticholinergic properties |
Tramadol | Use with caution; If CrCl <30 mL/min, may require reduction with immediate release or avoid with extended release |
Triamterene | Avoid if CrCl <30 mL/min |
Triazolam | Avoid |
Trifluoperazine | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties |
Trihexyphenidyl | Avoid; has strong anticholinergic properties |
Trimethoprimsulfamethoxazole | Use with caution in patients on ACEI or ARB and decreased creatinine clearance; Reduce dose if CrCl <30 mL/min; Avoid if CrCl <15 mL/min |
Trimipramine | Avoid; has strong anticholinergic properties |
Triprolidine | Avoid; has strong anticholinergic properties |
Trospium | Has strong anticholinergic properties |
Venlafaxine | Use with caution |
Verapamil | Avoid for most patients; Use with caution in patients with heart failure |
Zaleplon | Avoid |
Ziprasidone | Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy) |
Zolpidem | Avoid |
This table is not intended as a replacement for or comprehensive summary of the whole or of any part of the AGS 2019 Beers Criteria. For a full and complete listing of medications, along with recommendations, rationale and grading, please refer to the full text Beers Criteria guideline here.
Recommendation Grading
Overview
Title
AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
Authoring Organization
American Geriatrics Society
Publication Month/Year
January 25, 2019
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
With more than 90% of older people using at least one prescription and more than 66% using three or more in any given month, the AGS Beers Criteria® plays a vital role in helping health professionals, older adults, and caregivers work together to ensure medications are appropriate.
Target Patient Population
Older adults taking one or more medications
Target Provider Population
All healthcare providers that care for older patients
Inclusion Criteria
Male, Female, Older adult
Health Care Settings
Ambulatory, Home health, Hospital, Long term care, Outpatient
Intended Users
Healthcare business administration, nurse, nurse practitioner, community pharmacist, health systems pharmacist, pharmacy technician, physician, physician assistant
Scope
Treatment, Management, Prevention
Diseases/Conditions (MeSH)
D008508 - Medication Errors, D000067561 - Potentially Inappropriate Medication List, D054539 - Medication Therapy Management
Keywords
Beers Criteria, beers, Beer's, Beer's Criteria, beers list, medication use, beer criteria
Source Citation
By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019 Apr;67(4):674-694. doi: 10.1111/jgs.15767. Epub 2019 Jan 29. PMID: 30693946.