ANALGESICS

Ketorolac
Meperidine

Gi bleeding
Not effective at commonly used
oral doses; confusion, falls,
factures, dependency,
withdrawal

Pentazocine

More CNS effects (e.g.,

confusion, hallucinations) than
other opioids; ceiling to
analgesic effect

Propoxyphene

No better than acetaminophen,

but has narcotic AE

ANTIDEPRESSANTS
Amitriptyline & doxepin

Anticholinergic AE, sedation,

urinary retention or
incontinence, constipation,
arrhythmias, falls

Bupropion, seizure disorder

May cause seizure

Fluoxetine used daily

Long half-life; agitation,

insomnia, anorexia

Tricyclic for depression in patient with postural

hypotension, BPH, glaucoma, heart block

Fall risk; urinary retention;

worsening glaucoma, heart block

Tricyclic in patient with stress incontinence or

bladder outflow obstruction

Urinary retention or
incontinence

SSRIs in patient with SIADH

May cause or worsen SIADH

Antihistamines, anticholinergic:
Chlorpheniramine Cyproheptadine
Dexchlorpheniramine (Polaramine),
Diphenhydramine (Benadryl, etc), Hydroxyzine
(Vistaril, Atarax),Promethazine (Phenergan, etc)

Anticholinergic AE, urine

retention, confusion, sedation

Antihypertensives
Alpha-blockers (doxazosin, prazosin, terazosin)

Hypotension, dry mouth,

incontinence

Clonidine

Orthostatic hypotension, CNS AE

Ethacrynic acid

Hypotension; fluid, electrolyte

imbalances

Guanethidine

Orthostatic hypotension,

depression
Methyldopa

Bradycardia; depression

Nifedipine, short- acting

Hypotension, constipation

Reserpine >0.25mg

Depression, impotence,
sedation, orthostatic
hypotension,
extrapyramidal effects

ANTIPLATELET

Dipyridamole, short- acting

Ineffective for stroke prevention

& dementia; orthostatic
hypotension

Ticlopidine

Not more effective than aspirin,

but more toxic

ANTIPSYCHOTICS
Mesoridazine
Thioridazine

CNS AE, seizures, extrapyramidal

effects

Clozapine in patient with seizures

Lower seizure threshold

Olanzapine (Zyprexa), obesity

Increased appetite, weight gain

Thiothixene (Navane), in patient with seizure disorder Lower seizure threshold

Anxiolytics

Long-acting benzodiazepines:clorazepate,
chlordiazepoxide, diazepam, quazepam

Dependence, depression,
prolonged sedation, confusion,
falls, fractures, respiratory
depression in COPD, incontinence

Short-acting benzodiazepines, daily doses greater

than : alprazolam (Xanax) 2 mg, lorazepam (Ativan) 3 Falls
mg, oxazepam (Serax) 60 mg
Meprobamate

Dependence, sedation

Cardiac Drugs
Amiodarone

QT prolongation, torsades de
pointes, lack of efficacy in elderly

Beta-blockers in patient with asthma, COPD, or

Worsening disease

Raynauds disease
Calcium channel blocker in patient with systolic heart Worsening heart failure;
failure (C) or chronic constipation
constipation
Digoxin doses >0.125 mg/d except for atrial
arrhythmias

Toxicity due to reduced renal

clearance

Disopyramide

Negative inotrope;
anticholinergic; sudden death

Diabetes Drugs
Chlorpropamide

Prolonged hypoglycemia; SIADH

Gastrointestinal Drugs
Antispasmodics, long- term use belladonna alkaloids
Clindinium
Dicyclomine
Hyoscyamine

Anticholinergic AE; worsened

cognition & behavioral problems
in dementia; urinary retention or
incontinence; questionable
efficacy

Propantheline
Cimetidine

Confusion, other CNS AE,

interaction with warfarin

Diphenoxylate

Dependence, sedation, cognitive

impairment

Metoclopramide in patient with Parkinsons disease

Antidopaminergic effect

Mineral oil

Aspiration

Stimulant laxatives (e.g., bisacodyl [Dulcolax, etc]),

long- term use, except with opiates

May worsen bowel function

Trimethobenzamide)

Poor efficacy; extrapyramidal AE

Hormones
Estrogens (oral)

Breast, endometrial cancer; not

cardioprotective

Methyltestosterone

Prostatic hyperplasia, cardiac

AE

Thyroid, desiccated

Cardiac AE

Hypnotics

Barbiturates, except phenobarbital for seizures

Dependence; higher risk of AE

(falls, fractures, confusion,
cognitive impairment) than
other hypnotics

Long-acting benzodiazepines

See entry under Anxiolytics.

Diphenhydramine (Benadryl, etc)

Confusion, sedation,
anticholinergic effects

Flurazepam (Dalmane)

Sedation, falls, accumulation

Triazolam (Halcion)

Cognitive/behavioral
disturbances

Muscle Relaxants
Muscle relaxants: Carisoprodol, Chlorzoxazone,
Cyclobenzaprine (Flexeril),Metaxalone (Skelaxin),
Methocarbamol (Robaxin) Orphenadrine (Norflex)

Anticholinergic effects, sedation,

cognitive impairment, weakness,
urine retention; questionable
efficacy at lower doses

NSAIDs
Aspirin for pain in patient on warfarin

Bleeding

NSAIDs, longer half- life, full dose, long duration

GI bleeding, renal failure,

hypertension, heart failure

Indomethacin (Indocin)

CNS AE, GI effects, fluid retention

NSAID in patient with history of peptic ulcer

New ulcers; bleeding risk

Respiratory Drugs
Corticosteroids, oral, long-term for COPD, patient
with diabetes

Worsening glucose control

Pseudoephedrine in patient with hypertension or

bladder outflow obstruction

Increased blood pressure;

incontinence

Theophylline, patient with insomnia

May contribute to insomnia

Stimulant Drugs
Amphetamines, anorexics

Dependence, hypertension,
myocardial ischemia, CNS

stimulation (agitation, insomnia)

Any stimulant in patient with anorexia/malnutrition

Appetite suppression

Methylphenidate for depression

CNS stimulation, agitation,

seizures

Urinary Drugs
Nitrofurantoin

Nephrotoxicity

,
Oxybutynin in patient with bladder outflow
obstruction

Urine retention, confusion,

hallucinations, sedation

Tolterodinein patient with bladder outflow obstruction

Urinary retention, confusion,

hallucinations, sedation

Miscellaneous
Ergot mesylates

Unproven efficacy

Ferrous sulfate>325 mg per day

Constipation, without
increased iron absorption

Isoxsuprine

Lack of efficacy

Sodium containing drugs in heart failure

Worsening heart failure