You have javascript disabled. We recommend that you turn it on for the best experience on our site.

Medicare AssuredSM Drug Safety Information

Drug Safety Warnings

Gateway HealthSM is dedicated to providing our physicians with access to the most up-to-date medication safety information.  Drug safety updates can occur on a daily basis due to new research or to the Food and Drug Administration’s (FDA) Adverse Event Reporting Program.  In order to provide you with the latest information, Gateway has posted the following links to the FDA website.  The FDA Safety Alerts for Human Medical Products link will provide the latest ongoing safety reviews and recalls with medication specific links.  The FDA Drug Safety Newsletter is published quarterly to provide post-marketing information to healthcare professionals, in addition to summarizing the drug safety advisories that are issued by the FDA during that quarter.

FDA Safety Alerts for Human Medical Products:
www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm091428.htm

FDA Drug Safety Newsletter:
www.fda.gov/Drugs/DrugSafety/DrugSafetyNewsletter/default.htm

 

Drugs to Avoid in the Elderly

Gateway HealthSM has initiated a quality improvement activity to evaluate the medication profiles of our Medicare AssuredSM members who are at least 65 years old and are taking at least one of the most frequently used drugs that are deemed to be potentially harmful to an elderly patient according to the Beers List. The Beers List criteria are based on expert consensus developed through an extensive literature review with a bibliography and questionnaire evaluated by nationally recognized experts in geriatric care, clinical pharmacology, and psychopharmacology.

Network physicians may receive a letter informing them that a Gateway HealthSM patient under his or her care is receiving a potentially harmful medication based upon the above criteria.  We ask that the physician evaluate this therapy to determine if there are safer alternatives considering the member's age and medical condition.

A copy of the Beers List can be obtained at http://www.dcri.duke.edu/ccge/curtis/beers.html.  Please take some time to review any opportunities to apply the Beers List criteria to applicable patients as this may decrease the possibility of potential drug related adverse reactions in the elderly.

The following list provides the rationale why specific medications are on the Beers List and alternative medications that can be prescribed.

 

Beers List Alternatives

Frequently Used Medications on the Beers List Beers Rationale Alternative Medication Recommendations
Propoxyphene Containing Products Offers few analgesic advantages over Acetaminophen, yet exhibits adverse effects of other narcotic drugs, including fall risk Acetaminophen w/o Codeine, Morphine
Meperidine Not an effective oral analgesic in doses commonly used. May cause confusion and is highly recognized for possibility of seizures Morphine, Codeine and Fentanyl patches
Indomethacin
Naproxen
Piroxicam
Ketorolac
Of all the NSAID's available, these cause the most CNS adverse effects Ibuprofen, Diclofenac
Amitriptyline
Doxepin
Fluoxetine
Its strong anticholinergic and sedation properties make this a poor choice of antidepressants for the elderly Remeron, Celexa, Zoloft, or other TCA's such as Desipramine or Nortriptyline.
Flurazepam*
Diazepam*
Clorazepate*
Chlordiazepoxide*
These drugs have reduced clearance and therefore longer half lives. Sedation and increased risk of falls are problematic in the elderly. Shorter acting benzodiazepines are preferred Lorazepam*, Temazepam*, Clonazepam*
Fluoxetine Long half life of near 2 weeks produces excessive CNS stimulation, sleep disturbances and increased agitation Shorter acting SSRI's: Citalopram, Paroxetine, Sertraline
Clonidine Potential for orthostatic hypotension and CNS side effects Dependent on clinical scenario and comorbidities but may include: ACE-inhibitors, Ca++ channel blockers, Beta-blockers and ARB's
Short Acting Nifedipine Potential for hypotension and constipation Longer acting Nifedipine, Felodipine or Amlodipine
Hydroxyzine
Diphenhydramine
Cyproheptadine
Dexchlorpheniramine
Promethazine
Nonprescription and many prescription antihistamines have potent anticholinergic properties Fexofenadine, Loratadine
Digoxin Decreased renal clearance leads to toxic effects and narrow therapeutic window Periodic Digoxin Serum levels to ensure appropriateness of dose. Also specific renal testing as a monitoring tool.
Ticlopidine Has been shown to be no better then aspirin in preventing clotting and may be considerably more toxic ASA, Clopidogrel
Cimetidine CNS effects including confusion Ranitidine*
Desiccated Thyroid Concerns about cardiac effects Levothyroxine without T3 component
Meprobamate Highly addictive and sedating Buspirone
Thioridazine Greater potential for CNS and extrapyramidal side effects Abilify, Geodon, Zyprexa, Prolixin
Amphetamines Potential for dependence, angina, hypertension, and MI Strattera
All barbituates except Phenobarbital Highly addictive and causes more adverse effects than most sedatives or hypnotic drugs Phenobarbital*
Dicyclomine, Propantheline Highly anticholinergic, uncertain effectiveness No preferred agents
Atropine, Hyoscyamine, Scopolamine Strongly anticholinergic Paregoric
Soma, Flexeril, Skelaxin, Robaxin, Norflex Poorly tolerated in elderly, anticholinergic effects, sedation and weakness Baclofen, Dantrium
Oral estradiol, estrogen No cardioprotective effect. Risk of breast/endometrial cancer No preferred agents
Chlorpropamide Prolonged half life in elderly, prolonged hypoglycemia. Glyburide, Glipizide
Dipyridamole, Isoxsuprine, Cyclandelate May cause orthostatic hypotension Hydralazine, minoxidil
Nitrofurantoin May cause renal impairment Trimethoprim, Methenamine mandalate
Methyltestosterones Potential for prostatic hypertrophy and cardiac problems Danazol

* Not Covered under Medicare Part D

References:

Fick DM et al. Updating the Beers criteria for potentially inappropriate use in older adults: Results of a consensus panel of experts. Archives of internal medicine. 2003 Dec 8-22;163(22):2716-24, American Medical Association.
http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf