20 Drugs Seniors Should Not Take — The Beers Criteria Explained for Families

Your mother's been on the same sleep medication for eight years. Her doctor prescribed it when she was 62 and recovering from surgery. She's 74 now, and nobody's revisited whether she still needs it — or whether it's appropriate for someone her age.

This happens more than you'd expect. Medications that are perfectly safe for a 50-year-old can become dangerous for a 75-year-old. The body changes: kidneys filter more slowly, the liver metabolizes drugs differently, the brain becomes more sensitive to sedation, and the balance system becomes more fragile. A drug that caused mild drowsiness at 55 can cause a fall and a hip fracture at 78.

The American Geriatrics Society (AGS) maintains a list called the Beers Criteria — a regularly updated catalogue of medications that are "potentially inappropriate" for adults 65 and older. The list was created by Dr. Mark Beers in 1991 and has been updated by the AGS every three years since. It's used by geriatricians, pharmacists, and hospitals worldwide, including in the UK, Canada, Australia, and New Zealand (which have their own complementary lists like STOPP/START).

This is not medical advice. You should never stop or change a medication without talking to the prescribing doctor. But you should know about these drugs — because your parent's doctor may not have reviewed the full list recently, and you are often the only person with the complete picture of what your parent actually takes.

Here are 20 of the most commonly prescribed medications that appear on the Beers Criteria.

Anticholinergics

These drugs block the neurotransmitter acetylcholine. In older adults, they can cause confusion, memory problems, constipation, urinary retention, dry mouth, and blurred vision. Long-term use has been linked to increased dementia risk.

1. Diphenhydramine (Benadryl)

Widely used for allergies and sleep. Available over the counter, which means many seniors take it without a prescription. In older adults, it causes significant sedation, confusion, and fall risk. It's the active ingredient in many OTC sleep aids (Tylenol PM, Advil PM, ZzzQuil).

Ask the doctor about: Non-sedating alternatives like cetirizine (Zyrtec) or loratadine (Claritin) for allergies. For sleep, discuss sleep hygiene strategies or melatonin.

2. Hydroxyzine (Vistaril, Atarax)

Prescribed for anxiety and itching. Strong anticholinergic effects. Often prescribed years ago and never revisited.

3. Oxybutynin (Ditropan)

Prescribed for overactive bladder. One of the strongest anticholinergics in common use. Associated with cognitive decline in older adults. Alternatives with fewer cognitive effects exist, such as mirabegron (Myrbetriq).

4. Chlorpheniramine (Chlor-Trimeton)

An older antihistamine found in many cold and flu combination products. Highly sedating.

Benzodiazepines

Benzodiazepines increase fall risk, cause cognitive impairment, and can lead to dependence. In seniors, they are a major contributor to hip fractures.

5. Diazepam (Valium)

Long-acting benzodiazepine. It stays in the body for days, not hours, in older adults — accumulating and increasing sedation over time.

6. Lorazepam (Ativan)

Shorter-acting than diazepam but still carries significant fall and confusion risk in older adults. Commonly prescribed in hospitals and continued after discharge without a clear end date.

7. Alprazolam (Xanax)

Prescribed for anxiety. Highly addictive and difficult to taper off in older adults.

8. Temazepam (Restoril)

Prescribed for insomnia. Fall risk and next-day sedation are the primary concerns.

Certain NSAIDs

Non-steroidal anti-inflammatory drugs are risky in older adults due to increased gastrointestinal bleeding, kidney damage, and cardiovascular risk — especially when combined with blood thinners or blood pressure medications.

9. Indomethacin (Indocin)

The highest-risk NSAID for older adults. More GI side effects than alternatives. Rarely justified when other options exist.

10. Ketorolac (Toradol)

A powerful injectable NSAID sometimes given in the ER. Should be used for only five days maximum, but some patients end up on longer courses.

11. Long-term ibuprofen or naproxen use

Short-term use for acute pain may be appropriate, but chronic daily NSAID use in seniors increases the risk of GI bleeding (especially when combined with aspirin or warfarin), kidney damage, and heart failure exacerbation.

Muscle relaxants

12. Cyclobenzaprine (Flexeril)

Prescribed for muscle spasms. Poorly tolerated in older adults due to sedation, dizziness, and anticholinergic effects. Limited evidence that it's effective for chronic pain.

13. Methocarbamol (Robaxin)

Similar concerns: sedation and fall risk outweigh the modest pain relief.

14. Carisoprodol (Soma)

Highly sedating and metabolized to meprobamate, a drug with abuse potential. No role in geriatric care.

Certain diabetes medications

15. Glyburide (Glynase, DiaBeta)

A sulfonylurea that causes prolonged hypoglycemia (dangerously low blood sugar) in older adults. Glipizide or glimepiride are preferred alternatives in the same drug class.

16. Sliding-scale insulin (as sole management)

Using only short-acting insulin on a reactive sliding scale — without a basal insulin — causes blood sugar swings that increase fall and confusion risk.

Other commonly flagged medications

17. Metoclopramide (Reglan)

Prescribed for nausea and gastroparesis. Can cause irreversible movement disorders (tardive dyskinesia) with long-term use. Should not be used for more than 12 weeks.

18. Megestrol (Megace)

Sometimes prescribed as an appetite stimulant in frail elderly patients. Increases blood clot risk and has minimal evidence of benefit. Weight loss in the elderly is often a symptom of something else — treating the symptom with megestrol doesn't fix the underlying cause.

19. Nitrofurantoin (Macrobid)

Used for urinary tract infections. In seniors with reduced kidney function (GFR below 30), it doesn't reach effective concentrations in the urine and can cause lung and liver toxicity.

20. Proton pump inhibitors (long-term)

Omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid). Appropriate for short-term use (4-8 weeks for ulcers or severe reflux), but long-term daily use in seniors is associated with increased fracture risk, magnesium deficiency, kidney disease, and C. difficile infection. Many seniors have been on a PPI for years without reassessment.

What to do with this list

Do not stop any of these medications on your own. Some of them — particularly benzodiazepines and PPIs — must be tapered gradually under medical supervision. Abruptly stopping them can be dangerous.

Do bring this list to your parent's next doctor appointment. Say: "I've been reading about medications that may not be appropriate for older adults. Can we review whether any of Mom's medications should be reconsidered?"

The concept is called deprescribing — systematically reducing medications that may no longer be necessary or that carry more risk than benefit. It's becoming standard practice in geriatric medicine, but it requires the doctor to know the complete medication list, including supplements and OTC drugs.

If you don't have a complete, current list of everything your parent takes — prescriptions, supplements, OTC drugs, and as-needed medications — that's the first step. The drug interaction checklist in the Medication Management Kit is designed for exactly this: a plain-English reference that helps you flag potential problems before the doctor visit, so you walk in with specific questions instead of vague concerns.

The bigger picture

The Beers Criteria isn't a blacklist — it's a conversation starter. Some medications on this list may still be appropriate for your parent if the benefits outweigh the risks and the doctor has made a deliberate decision to continue them. The problem isn't that these drugs exist. The problem is that they're often prescribed, never revisited, and continued for years on autopilot while the patient's body changes around them.

You don't need a medical degree to ask the question. You just need the list — and the complete medication tracking system to make sure nothing falls through the cracks.