| Antihistamines (chlorpheniramine [Extendryl], diphenhydramine [Benadryl], hydroxyzine [Atarax], cyproheptadine [Periactin], dexchlorpheniramine [Polaramine], promethazine [Phenergan], tripelennamine [PBZ]) | Many of these are over-the-counter drugs used to treat the common cold with potent anticholinergic effects; many elderly persons use these drugs to induce sleep; if using to treat seasonal allergies, use lowest effective dose. |
| Blood products/modifiers/volume expanders (dipyridamole [Persantine], ticlopidine [Ticlid]) | Platelet aggregation inhibitors are used to prevent blood from clotting in persons who have had strokes or myocardial infarction; ticlopidine has been shown to be no better than aspirin, and it is more toxic; dipyridamole is beneficial in patients with artifical valves. |
| Antihypertensives (methyldopa [Aldomet], reserpine [Serpasil]) | Methyldopa can slow heart rate and exacerbate depression; reserpine causes depression, erectile dysfunction, sedation, and light-headedness. |
| Peripheral vasodilators (cyclandelate [Cyclospasmol], ergot mesyloids [Hydergine]) | Used to treat dementia and migraines; not shown to be effective for either in doses studied |
| Antiarrhythmics (disopyramide [Norpace]) | Potent negative inotrope, may induce heart failure; strongly anticholinergic |
| Narcotics (meperidine [Demerol], pentazocine [Talwin], propoxyphene [Darvon]) | Meperidine is not an effective oral agent for pain and has many disadvantages over other narcotics; pentazocine causes more central nervous system effects, including confusion and hallucinations; propoxyphene offers no advantages over acetaminophen but has same side effects as other narcotic drugs. |
| Barbiturates (except phenobarbital) (butalbital [Fiorinal], pentobarbital [Nembutal], secobarbital [Seconal]) | Highly addictive and cause more side effects than other sedative hypnotics; should not be started as new therapy except to treat seizures |
| Benzodiazepines (chlordiazepoxide [Librium],diazepam [Valium], flurazepam [Dalmane], triazolam [Halcion]) | Long half-life benzodiazepines produce prolonged sedation and increase risk for falls and fractures; triazolam may cause cognitive and behavioral abnormalities. |
| Meprobamate (Miltown, Equanil) | Used to treat anxiety; highly addictive and sedating |
| Antidepressants (amitriptyline [Elavil], doxepin [Sinequan], imipramine [Tofranil], combination antidepressant/antipsychotics | Highly anticholinergic and sedating; amitriptyline is rarely the antidepressant of choice in the elderly. |
| Methylphenidate (Ritalin) | May cause agitation, stimulation of the central nervous system, and seizures. |
| Antiemetic (trimethobenzamide [Tigan]) | Least effective, can cause extrapyramidal side effects |
| Gastrointestinal antispasmodics (Donnatal with belladonna, clidinium [Quarzan], dicyclomine [Bentyl], hyoscyamine [Levsin], propantheline [Pro-Banthine]) | All are highly anticholinergic and generally produce substantial toxic effects; best avoided in the elderly; not for long-term use. |
| Antidiarrheals (diphenoxylate [Lomotil]) | Drowsiness, cognitive impairment, and dependence; long-term use is not recommended. |
| Genitourinary-antispasmodic (oxybutynin [Ditropan]) | Anticholinergic effects; use lowest effective dose. |
| Hypoglycemic agents (chlorpropamide [Diabinese]) | Prolonged half-life with prolonged and serious hypoglycemia; can cause syndrome of inappropriate antidiuretic hormone. |
| NSAIDs (indomethacin [Indocin], phenylbutazone [Butazolidine], ketorolac [Toradol], mefenamic acid [Ponstel], piroxicam [Feldene]) | Indomethacin produces serious central nervous system effects; phenylbutazone produces serious hematologic effects (bone marrow suppression); ketorolac, mefenamic acid, and piroxicam have greater risk of upper gastrointestinal bleeding than other NSAIDs. |
| Skeletal muscle relaxants (all) | Effectiveness questionable; anticholinergic effects, sedation, and weakness |