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Approved Formulary
Search results for:
chlorpheniramine
chlorpheniramine
- Restricted Medications Non-Formulary
| Form | Strength |
|---|---|
| TABLET, ORAL | 4 mg |
Display First Generation Antihistamines Class:
040400
Medication comments:
| Per policy, orders for these non-formulary agents will be changed to formulary equivalents. | |
|---|---|
| Non-Formulary Agent | Formulary Equivalent |
| chlorpheniramine (Chlorphen) 4 mg Q 4-6 hr | loratadine (Claritin) 10 mg Daily |
| 2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults. | |
|---|---|
| Medication: | chlorpheniramine (Chlor-Trimeton) |
| Criteria 1: Potentially inappropriate medication use in older adults. (Table 2) | |
| Drug(s) | first-generation antihistamines |
| Rationale | Highly anticholinergic; clearance reduced with advanced age, and tolerance develops when used as hypnotic; risk of confusion, dry mouth, constipation, and other anticholinergic effects or toxicity. Cumulative exposure to anticholinergic drugs is associated with an increased risk of falls, delirium, and dementia, even in younger adults. Consider total anticholinergic burden during regular medication reviews and be cautious in "young-old" as well as "old-old" adults. |
| Recommendation | Avoid |
| Quality of evidence: Moderate, Strength of Recommendation: Strong | |
| Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3) | |
| Drug(s) ⇆ disease or syndrome | anticholinergics ⇄ Delirium |
| Rationale | Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium. |
| Recommendation | Avoid |
| Quality of evidence: Moderate, Strength of Recommendation: Strong | |
| Drug(s) ⇆ disease or syndrome | anticholinergics ⇄ Dementia or cognitive impairment |
| Rationale | Avoid because of adverse CNS effects. If used, periodic deprescribing attempts should be considered to assess ongoing need and/or the lowest effective dose. |
| Recommendation | Avoid |
| Quality of evidence: Moderate, Strength of Recommendation: Strong | |
| Drug(s) ⇆ disease or syndrome | anticholinergics ⇄ History of falls or fractures |
| Rationale | May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk. |
| Recommendation | Avoid unless safer alternatives are not available. |
| Quality of evidence: High, Strength of Recommendation: Strong | |
| Drug(s) ⇆ disease or syndrome | strongly anticholinergic drugs, except antimuscarinics for urinary incontinence ⇄ Lower urinary tract symptoms, benign prostatic hyperplasia |
| Rationale | May decrease urinary flow and cause urinary retention |
| Recommendation | Avoid in men |
| Quality of evidence: Moderate, Strength of Recommendation: Strong | |
| Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5) | |
| Interacting drug(s) or class(es) | anticholinergics ⇄ anticholinergics |
| Risk Rationale | Use of more than one medication with anticholinergic properties increases the risk of cognitive decline, delirium, and falls or fractures. |
| Recommendation | Avoid; minimize the number of anticholinergic drugs Click for list. |
| Quality of evidence: Moderate, Strength of Recommendation: Strong | |
Last updated: Sep. 22, 2025
- Therapeutic Interchange Policy loratadine (Claritin)