Beers Criteria- Criteria 3
Beers Criteria (Criteria 3)
NAV Top A B C D E F G H I L M N O P Q R S T V Z

American Geriatrics Society 2023 updated AGS Beers Criteria®
for potentially inappropriate medication use in older adults. Reference
Criteria 3: Potentially inappropriate medications: drugs to be used with caution in older adults. (Table 4) Back to All Criteria View
 A
 acetaZOLAMIDE (Diamox)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 aMILoride (Midamor)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 amitriptyline (Elavil)
Drug(s) antidepressants (selected: TCAs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 ARIPiprazole (Abilify)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 asenapine (Saphris)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 B
 brexpiprazole (Rexulti)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 bumetanide (Bumex)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 C
 canagliflozin (Invokana)
Drug(s) sodium-glucose cotransporter-2 (SGLT2) inhibitors
Rationale Older adults may be at increased risk of urogenital infections, particularly women in the first month of treatment. An increased risk of euglycemic diabetic ketoacidosis has also been seen in older adults.
Recommendation Use with caution.
Monitor patients for urogenital infections and ketoacidosis.
 Quality of evidence: Moderate, Strength of Recommendation: Weak
 carBAMazepine (Carbatrol, TEGretol)
Drug(s) antiepileptics (selected)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 cariprazine (Vraylar)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 chlorothiazide (Diuril)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 chlorproMAZINE (Thorazine)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 chlorthalidone (Hygroton, Thalitone)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 citalopram (CeleXA)
Drug(s) antidepressants (selected: SSRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 clomiPRAMINE (Anafranil)
Drug(s) antidepressants (selected: TCAs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 cloZAPine (Clozaril)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 D
 dabigatran (Pradaxa)
Comments for long-term treatment of nonvalvular atrial fibrillation or venous thromboembolism (VTE)
When selecting among DOACs and choosing a dosage, pay special consideration to kidney function (see Table 6), indication, and body weight.
Drug(s) dabigatran
Rationale Increased risk of GI bleeding compared with warfarin (based on head-to-head clinical trials) and of GI bleeding and major bleeding compared with apixaban (based on observational studies and meta-analyses) in older adults when used for long-term treatment of nonvalvular atrial fibrillation or VTE.
Recommendation Use caution in selecting dabigatran over other DOACs (e.g., apixaban) for long-term treatment of nonvalvular atrial fibrillation or VTE.
See also criteria on warfarin and rivaroxaban (Table 2) and comment above regarding choice among DOACs.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 dapagliflozin (Farxiga)
Drug(s) sodium-glucose cotransporter-2 (SGLT2) inhibitors
Rationale Older adults may be at increased risk of urogenital infections, particularly women in the first month of treatment. An increased risk of euglycemic diabetic ketoacidosis has also been seen in older adults.
Recommendation Use with caution.
Monitor patients for urogenital infections and ketoacidosis.
 Quality of evidence: Moderate, Strength of Recommendation: Weak
 desipramine (Norpramin)
Drug(s) antidepressants (selected: TCAs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 desvenlafaxine (Pristiq)
Drug(s) antidepressants (selected: SNRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 dextromethorphan-quiNIDine (Nuedexta)
Drug(s) dextromethorphan-quiNIDine
Rationale Limited efficacy in patients with behavioral symptoms of dementia (does not apply to the treatment of pseudobulbar affect). May increase the risk of falls and concerns with clinically significant drug interactions and with use in those with heart failure (see Table 3).
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 doxepin (SINEquan)
>6 mg/day
 
Drug(s) antidepressants (selected: TCAs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 droperidol (Inapsine)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 DULoxetine (Cymbalta)
Drug(s) antidepressants (selected: SNRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 E
 emplaglifozin (Jardiance)
Drug(s) sodium-glucose cotransporter-2 (SGLT2) inhibitors
Rationale Older adults may be at increased risk of urogenital infections, particularly women in the first month of treatment. An increased risk of euglycemic diabetic ketoacidosis has also been seen in older adults.
Recommendation Use with caution.
Monitor patients for urogenital infections and ketoacidosis.
 Quality of evidence: Moderate, Strength of Recommendation: Weak
 eplerenone (Inspra, Espler)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 ertuglifozin (Steglatro)
Drug(s) sodium-glucose cotransporter-2 (SGLT2) inhibitors
Rationale Older adults may be at increased risk of urogenital infections, particularly women in the first month of treatment. An increased risk of euglycemic diabetic ketoacidosis has also been seen in older adults.
Recommendation Use with caution.
Monitor patients for urogenital infections and ketoacidosis.
 Quality of evidence: Moderate, Strength of Recommendation: Weak
 escitalopram (Lexapro)
Drug(s) antidepressants (selected: SSRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 ethacrynic acid (edecrin)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 F
 finerenone (Kerendia)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 FLUoxetine (PROzac)
Drug(s) antidepressants (selected: SSRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 fluPHENAZine (Prolixin)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 fLuvoxaMINE (Luvox)
Drug(s) antidepressants (selected: SSRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 furosemide (Lasix)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 H
 haloperidol (Haldol)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 hydroCHLOROthiazide (HydroDiuril, Microzide, HCTZ)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 I
 iloperidone (Fanapt)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 imipramine (Tofranil)
Drug(s) antidepressants (selected: TCAs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 indapamide (Lozol)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 L
 levomilnacipran (Fetzima)
Drug(s) antidepressants (selected: SNRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 loxapine (Loxitane)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 lurasidone (Latuda)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 M
 mannitol
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 methazolAMIDE (Neptazane)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 metOLazone (Zaroxolyn)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 milnacipran (SavElla)
Drug(s) antidepressants (selected: SNRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 mirtazipine (Remeron)
Drug(s) antidepressants (selected)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 N
 nortriptyline (Pamelor)
Drug(s) antidepressants (selected: TCAs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 O
 OLANZapine (ZyPREXA)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 OXcarbazepine (Oxtellar XR)
Drug(s) antiepileptics (selected)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 P
 paliperidone (Invega)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 PARoxetine (Paxil)
Drug(s) antidepressants (selected: SSRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 perphenazine (Trilafon)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 pimavanserin (Nuplazid)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 pimozide (Orap)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 prasugrel (Effient)
Drug(s) prasugrel
Rationale Increases the risk of major bleeding in older adults compared with cLopidogrel, especially among those 75 years old and older. However, this risk may be offset by cardiovascular benefits in select patients.
Recommendation Use with caution, particularly in adults 75 years old and older.
If prasugrel is used, consider a lower dose (5 mg) for those 75 years old and older.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 prochlorperazine (Compazine)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 Q
 QUEtiapine (SEROquel)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 R
 risperiDONE (RisperDAL)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 S
 sertraline (Zoloft)
Drug(s) antidepressants (selected: SSRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 spironolactone (Aldactone, Carospir)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 spironolactone-hydroCHLOROthiazide (Aldactazide)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 T
 thioridazine (MEllaril)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 thiothixine (Navane)
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 ticagrelor (Brilinta)
Drug(s) ticagrelor
Rationale Increases the risk of major bleeding in older adults compared with cLopidogrel, especially among those 75 years old and older. However, this risk may be offset by cardiovascular benefits in select patients.
Recommendation Use with caution, particularly in adults 75 years old and older.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 torsemide (Demadex)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 traMADol (Ultram)
Drug(s) traMADol
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 triamterene (Dyrenium)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 triamterene-hydroCHLOROthiazide (Dyazide, Maxzide)
Drug(s) diuretics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 trifluoperazine (Stelazine)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 trimethoprim-sulfamethoxazole (Bactrim, Septra)
Drug(s) trimethoprim-sulfamethoxazole
Rationale Increased risk of hyperkalemia when used concurrently with an ACEI, ARB, or ARNI in presence of decreased CrCl.
Recommendation Use with caution in patients on ACEI, ARB, or ARNI and decreased CrCl.
 Quality of evidence: Low, Strength of Recommendation: Strong
 V
 venlafaxine (Effexor)
Drug(s) antidepressants (selected: SNRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 Z
 ziprasidone (Geodon)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
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