| Amiodarone (Cordarone) | Increases risk of QT interval prolongation and torsade de pointes |
| Amitriptyline (Elavil)* | Strong anticholinergic and sedating properties; safer antidepressants exist |
| Amphetamines and anorexics | Potentially increase risk of hypertension, angina, and myocardial infarction; cause dependence |
| Anticholinergics and antihistamines (i.e., chlorpheniramine [ChlorTrimeton], diphenhydramine [Benadryl], hydroxyzine [Vistaril], cyproheptadine [Periactin],* promethazine [Phenergan], tripelennamine [Vaginex],* and dexchlorpheniramine [Polaramine]*) | Nonanticholinergic antihistamines are preferred for allergic reactions |
| Barbiturates (except phenobarbital) | Higher incidence of adverse effects than other sedatives and hypnotics; addictive |
| Benzodiazepines, long-acting (chlordiazepoxide [Librium], diazepam [Valium], flurazepam [Dalmane]) | Prolonged sedation, increased risk of falls, and fractures |
| Benzodiazepines, short-acting (lorazepam [Ativan], > 3 mg; oxazepam [Serax],* > 60 mg; alprazolam [Xanax], > 2 mg; temazepam [Restoril], > 15 mg; triazolam [Halcion], > 0.25 mg) | Smaller doses are safer |
| Chlorpropamide (Diabinese) | Prolonged half-life in older patients, which can cause prolonged hypoglycemia |
| Desiccated thyroid (Armour) | May have cardiac adverse effects |
| Digoxin in dosages > 0.125 mg per day | Increased serum levels in older patients because of decreased renal excretion |
| Disopyramide (Norpace) | Strongly anticholinergic, decreases cardiac output and can cause heart failure |
| Doxepin | Strongly anticholinergic and sedating; safer antidepressants exist |
| Fluoxetine (Prozac) | Longer half-life increases CNS stimulation, sleep disturbances, and agitation; safer antidepressants exist |
| GI antispasmodics (dicyclomine [Bentyl], hyoscyamine [Levsin], clidinium†) | Highly anticholinergic at effective doses in older patients |
| Guanadrel (Hylorel)† | May produce orthostatic hypotension |
| Guanethidine (Ismelin)† | May produce orthostatic hypotension |
| Indomethacin (Indocin) | Produces more CNS adverse effects than other NSAIDs |
| Ketorolac* | Produces GI adverse effects |
| Laxatives (bisacodyl [Correctol], cascara sagrada [Nature's Remedy]†, castor oil [Purge]) | Stimulant laxatives may worsen bowel function |
| Meperidine (Demerol) | Not an effective oral analgesic; metabolite can accumulate and cause seizures |
| Meprobamate (Miltown) | Highly addictive and sedating |
| Mesoridazine (Serentil)* | May cause CNS and extrapyramidal symptoms |
| Methyldopa (Aldomet)* | Can cause bradycardia and worsen depression |
| Methyltestosterone (Android) | May worsen prostatic hypertrophy and cardiac problems |
| Muscle relaxants (methocarbamol [Robaxin], carisoprodol [Soma], chlorzoxazone [Relax DS], metaxalone [Skelaxin], cyclobenzaprine [Amrix], oxybutynin [Ditropan]) | Effectiveness is questionable; can cause anticholinergic adverse effects, weakness, and sedation |
| Nifedipine (Procardia) | May cause hypotension and constipation |
| Nitrofurantoin (Macrobid) | May worsen renal impairment |
| NSAIDs, long half-life (naproxen [Naprosyn], oxaprozin [Daypro], piroxicam [Feldene]) | Long-term use increases risk of GI bleeds, hypertension, heart failure, and renal failure |
| Orphenadrine (Norflex) | Strongly anticholinergic and sedating |
| Pentazocine (Talwin) | Causes more CNS adverse effects than other narcotics, including confusion and hallucinations |
| Thioridazine (Mellaril)* | May cause CNS and extrapyramidal symptoms |
| Trimethobenzamide (Tigan) | Less effective than other antiemetics; causes extrapyramidal adverse effects |