Medication or class	Concern
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