Last updated September 23, 2022

Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Disclaimer for the 2019 American Geriatrics Society Updated Beers Criteria Guideline Summary

The guideline summary for the 2019 American Geriatrics Society Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults has been removed upon request from the American Geriatrics Society. To purchase access to the 2019 Beers Criteria, visit this link provided by the AGS.

Drug-Disease or Drug-Syndrome Interactions That May Exacerbate the Disease or Syndrome

For 2019 Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults Due to Drug-Disease or Drug-Syndrome Interactions That May Exacerbate the Disease or Syndrome, please refer to the full text guideline here.

Drug-Drug Interactions That Should Be Avoided in Older Adults

For 2019 Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults Drug-Drug Interactions That Should Be Avoided in Older Adults, please refer to the full text guideline here.

Medications/Criterion Added, Removed or Modified Since 2015

For Medications/Criterion Added, Removed or Modified Since 2015 American Geriatrics Society Beers Criteria®, please refer to the full text guideline here.

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 unless patient has heart failure or substantial left ventricular hypertrophy
Amitriptyline Avoid; has strong anticholinergic properties
Amobarbital Avoid
Amoxapine Avoid; has strong anticholinergic properties
Androgens Avoid unless indicated for confirmed hypogonadism with clinical symptoms
Apixaban Avoid if CrCl <25 mL/min
Aripiprazole Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Asenapine Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Aspirin For >325 mg/day, avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol); Use with caution for primary prevention of cardiovascular disease and colorectal cancer use with caution in adults ≥70 years; Avoid in patients with history of gastric or duodenal ulcers unless other alternatives are not effective and patient can take gastroprotective agent (ie, proton-pump inhibitor or misoprostol)
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 schizophrenia or bipolar disorder, or for short-term use as antiemetic during 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 schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Carisoprodol Avoid
Chlordiazepoxide (alone or in combination with amitriptyline or clidinium) Avoid
Chlorpheniramine Avoid; has strong anticholinergic properties
Chlorpromazine Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy; has strong anticholinergic properties
Chlorpropamide Avoid
Chlorzoxazone Avoid
Cilostazol Avoid or 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 use as an antihypertensive
Clorazepate Avoid
Clozapine Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy; has strong anticholinergic properties
Colchicine Reduce dose if CrCl <30 mL/min; monitor for adverse effects
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 treatment of 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 unless for high-risk patients (eg, oral corticosteroids or chronic NSAID use), erosive esophagitis, Barrett esophagitis, pathological hypersecretory condition, or demonstrated need for maintenance treatment (eg, because of failure of drug discontinuation trial or H2-receptor antagonists)
Dextromethorphan/quinidine Use with caution
Diazepam Avoid
Diclofenac Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
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, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Digoxin Avoid this rate control agent as firstline therapy for atrial fibrillation; Avoid as first-line therapy for heart failure; if used for atrial fibrillation or heart failure, avoid dosages >0.125 mg/day
Diltiazem Avoid or 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; Avoid in female patients 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 severe or recently decompensated 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 unless for high-risk patients (eg, oral corticosteroids or chronic NSAID use), erosive esophagitis, Barrett esophagitis, pathological hypersecretory condition, or demonstrated need for maintenance treatment (eg, because of failure of drug discontinuation trial or H2-receptor antagonists)
Estazolam Avoid
Estrogens with or without progestins Avoid systemic estrogen (eg, oral and topical patch). Vaginal cream or vaginal tablets: acceptable to use low-dose intravaginal estrogen for management of dyspareunia, recurrent lower urinary tract infections, and other vaginal symptoms
Eszopiclone Avoid
Etodolac Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Famotidine Reduce dose if CrCl <50 mL/min; Avoid in patients with delirium
Fenoprofen Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Fesoterodine Has strong anticholinergic properties
Flavoxate Has strong anticholinergic properties
Fluoxetine Use with caution
Fluphenazine Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during 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 patients rigorously diagnosed by evidence-based criteria with growth hormone deficiency due to an established etiology
Guanabenz Avoid other CNS alpha-agonists as listed
Guanfacine Avoid other CNS alpha-agonists as listed
Haloperidol Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during 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, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Iloperidone Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Imipramine Avoid; has strong anticholinergic properties
Indomethacin Avoid
Insulin, sliding scale (insulin regimens containing only short- or rapid-acting insulin dosed according to current blood glucose levels without concurrent use of basal or long-acting insulin) Avoid
Isoxsuprine Avoid
Ketoprofen Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Ketorolac, includes parenteral Avoid
Lansoprazole Avoid scheduled use for >8 weeks unless for high-risk patients (eg, oral corticosteroids or chronic NSAID use), erosive esophagitis, Barrett esophagitis, pathological hypersecretory condition, or demonstrated need for maintenance treatment (eg, because of failure of drug discontinuation trial or H2-receptor antagonists)
Levetiracetam Reduce dose if CrCl ≤80 mL/min
Levomilnacipran Use with caution
Lorazepam Avoid
Loxapine Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy; has strong anticholinergic properties
Lumateperone Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Lurasidone Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Meclizine Avoid
Meclofenamate Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Mefenamic acid Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Megestrol Avoid
Meloxicam Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Meperidine Avoid
Mephobarbital Avoid
Meprobamate Avoid
Mesoridazine Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Metaxalone Avoid
Methocarbamol Avoid
Methscopolamine Avoid; has strong anticholinergic properties
Methyldopa Avoid other CNS alpha-agonists as listed
Methyltestosterone Avoid unless indicated for confirmed hypogonadism with clinical symptoms
Metoclopramide Avoid, unless for gastroparesis with duration of use not to exceed 12 weeks except in rare cases; Avoid in patients with Parkinson Disease
Milnacipran Use with caution
Mineral oil, given orally Avoid
Mirtazapine Use with caution
Molindone Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Nabumetone Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Naproxen Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
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 schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy; has strong anticholinergic properties
Omeprazole Avoid scheduled use for >8 weeks unless for high-risk patients (eg, oral corticosteroids or chronic NSAID use), erosive esophagitis, Barrett esophagitis, pathological hypersecretory condition, or demonstrated need for maintenance treatment (eg, because of failure of drug discontinuation trial or H2-receptor antagonists)
Omeprazole / sodium bicarbonate Avoid scheduled use for >8 weeks unless for high-risk patients (eg, oral corticosteroids or chronic NSAID use), erosive esophagitis, Barrett esophagitis, pathological hypersecretory condition, or demonstrated need for maintenance treatment (eg, because of failure of drug discontinuation trial or H2-receptor antagonists)
Orphenadrine Avoid; has strong anticholinergic properties
Other 1st and 2nd Generation Antipsychotics Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Other PPIs Avoid scheduled use for >8 weeks unless for high-risk patients (eg, oral corticosteroids or chronic NSAID use), erosive esophagitis, Barrett esophagitis, pathological hypersecretory condition, or demonstrated need for maintenance treatment (eg, because of failure of drug discontinuation trial or H2-receptor antagonists)
Other SNRIs Use with caution
Other SSRIs Use with caution
Other TCAs Use with caution
Oxaprozin Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Oxazepam Avoid
Oxcarbazepine Use with caution
Oxybutynin Has strong anticholinergic properties
Paliperidone Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Pantoprazole Avoid scheduled use for >8 weeks unless for high-risk patients (eg, oral corticosteroids or chronic NSAID use), erosive esophagitis, Barrett esophagitis, pathological hypersecretory condition, or demonstrated need for maintenance treatment (eg, because of failure of drug discontinuation trial or H2-receptor antagonists)
Paroxetine Avoid; has strong anticholinergic properties
Pentobarbital Avoid
Perphenazine Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy; has strong anticholinergic properties
Phenobarbital Avoid
Pimavanserin Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Pioglitazone Avoid or use with caution in patients with heart failure
Piroxicam Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Prasugrel Use with caution in adults ≥75 years
Prazosin Avoid use as an antihypertensive; Avoid in patients with syncope; Avoid in female patients 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 schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Rabeprazole Avoid scheduled use for >8 weeks unless for high-risk patients (eg, oral corticosteroids or chronic NSAID use), erosive esophagitis, Barrett esophagitis, pathological hypersecretory condition, or demonstrated need for maintenance treatment (eg, because of failure of drug discontinuation trial or H2-receptor antagonists)
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 schizophrenia or bipolar disorder, or for short-term use as antiemetic during 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 or 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, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
Temazepam Avoid
Terazosin Avoid use as an antihypertensive; Avoid in patients with syncope; Avoid in female patients with urinary incontinence
Testosterone Avoid unless indicated for confirmed hypogonadism with clinical symptoms
Thioridazine Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy; has strong anticholinergic properties
Thiothixene Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Tolmetin Avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent (proton-pump inhibitor or misoprostol)
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 schizophrenia or bipolar disorder, or for short-term use as antiemetic during 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 or use with caution in patients with heart failure
Zaleplon Avoid
Ziprasidone Avoid, except in schizophrenia or bipolar disorder, or for short-term use as antiemetic during chemotherapy
Zolpidem Avoid

Recommendation Grading

Overview

Title

AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Authoring Organization

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.