Beers Criteria
Encyclopedia
The Beers Criteria is a list of specific medication
s that are generally considered inappropriate when given to elderly people. For a wide variety of individual reasons, the medications listed tend to cause side effects
in the elderly due to the physiologic changes of aging. The list was originally created by geriatrician
Mark H. Beers
. The criteria were created through consensus of a panel of experts by using the Delphi method
; they were originally published in the Archives of Internal Medicine
in 1991 and were most recently updated in 2003.
An alternative to Beers list has also been created, called the STOPP (Screening Tool for Older Persons of potentially inappropriate Prescriptions) criteria. The STOPP Criteria criticizes the Beers List because, when used as a simple checklist, the Beers List neglects the patient's medical diagnosis, psychosocial status, and ADLs (activities of daily living), drug availability (e.g., European Agency approved or FDA approved), and causality. This is documented in the Archives of Internal Medicine June, 2011.
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
s that are generally considered inappropriate when given to elderly people. For a wide variety of individual reasons, the medications listed tend to cause side effects
Adverse drug reaction
An adverse drug reaction is an expression that describes harm associated with the use of given medications at a normal dosage. ADRs may occur following a single dose or prolonged administration of a drug or result from the combination of two or more drugs...
in the elderly due to the physiologic changes of aging. The list was originally created by geriatrician
Geriatrics
Geriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
Mark H. Beers
Mark H. Beers
Mark Howard Beers was an American geriatrician whose research on drug interactions among the elderly led to the creation of the eponymous Beers Criteria, which lists prescription medications that may have deleterious side effects in older patients.-Biography:Born in Brooklyn, New York, Beers...
. The criteria were created through consensus of a panel of experts by using the Delphi method
Delphi method
The Delphi method is a structured communication technique, originally developed as a systematic, interactive forecasting method which relies on a panel of experts.In the standard version, the experts answer questionnaires in two or more rounds...
; they were originally published in the Archives of Internal Medicine
Archives of Internal Medicine
The Archives of Internal Medicine is a peer-reviewed medical journal published twice a month by the American Medical Association. The Archives of Internal Medicine was established in 1908 and covers all aspects of internal medicine, including cardiovascular disease, geriatrics, infectious disease,...
in 1991 and were most recently updated in 2003.
An alternative to Beers list has also been created, called the STOPP (Screening Tool for Older Persons of potentially inappropriate Prescriptions) criteria. The STOPP Criteria criticizes the Beers List because, when used as a simple checklist, the Beers List neglects the patient's medical diagnosis, psychosocial status, and ADLs (activities of daily living), drug availability (e.g., European Agency approved or FDA approved), and causality. This is documented in the Archives of Internal Medicine June, 2011.
Revised list
The 2003 revised list is as follows:- alprazolamAlprazolamAlprazolam is a short-acting anxiolytic of the benzodiazepine class of psychoactive drugs. Alprazolam, like other benzodiazepines, binds to specific sites on the GABAA gamma-amino-butyric acid receptor...
(Xanax) - amiodaroneAmiodaroneAmiodarone is an antiarrhythmic agent used for various types of tachyarrhythmias , both ventricular and supraventricular arrhythmias. Discovered in 1961, it was not approved for use in the United States until 1985...
(Cordarone) - amitriptylineAmitriptylineAmitriptyline is a tricyclic antidepressant . It is the most widely used TCA and has at least equal efficacy against depression as the newer class of SSRIs...
(Elavil) - amphetamines
- anorexic agents
- barbiturateBarbiturateBarbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
s - belladonnaBelladonnaBelladonna, from the Italian expression "bella donna" meaning "beautiful lady", may refer to:-Plants:* Atropa belladonna or belladonna or deadly nightshade, a perennial herbaceous plant...
alkaloids (Donnatal) - bisacodylBisacodylBisacodyl is a stimulant laxative drug that works directly on the large colon to produce a bowel movement. It is typically prescribed for relief of constipation and for the management of neurogenic bowel dysfunction as well as part of bowel preparation before medical examinations, such as for a...
(Dulcolax) - carisoprodolCarisoprodolCarisoprodol is a centrally-acting skeletal muscle relaxant. Carisoprodol is slightly soluble in water and freely soluble in alcohol, chloroform and acetone. The drug's solubility is practically independent of pH. Carisoprodol is manufactured and marketed in the United States by Meda Pharmaceuticals...
(Soma) - cascara sagradaRhamnus purshianaRhamnus purshiana Rhamnus purshiana Rhamnus purshiana (Cascara Buckthorn, Cascara, Bearberry, and in the Chinook Jargon, Chittam or Chitticum; syn...
- chlordiazepoxideChlordiazepoxideChlordiazepoxide, is a sedative/hypnotic drug and benzodiazepine. It is marketed under the trade names Angirex, Klopoxid, Librax , Libritabs, Librium, Mesural, Multum, Novapam, Risolid, Silibrin, Sonimen and Tropium.Chlordiazepoxide was the first benzodiazepine to be synthesised and...
(Librium, Mitran) - chlordiazepoxideChlordiazepoxideChlordiazepoxide, is a sedative/hypnotic drug and benzodiazepine. It is marketed under the trade names Angirex, Klopoxid, Librax , Libritabs, Librium, Mesural, Multum, Novapam, Risolid, Silibrin, Sonimen and Tropium.Chlordiazepoxide was the first benzodiazepine to be synthesised and...
-amitriptylineAmitriptylineAmitriptyline is a tricyclic antidepressant . It is the most widely used TCA and has at least equal efficacy against depression as the newer class of SSRIs...
(Limbitrol) - chlorpheniramine (Chlor-Trimeton)
- chlorpropamideChlorpropamideChlorpropamide is a drug in the sulphonylurea class used to treat type 2 diabetes mellitus. It is a long-acting sulphonylurea. It has more side effects than other sulphonylureas and its use is no longer recommended.-Mechanism of action:...
(Diabinese) - chlorzoxazone (Paraflex)
- cimetidineCimetidineCimetidine INN is a histamine H2-receptor antagonist that inhibits the production of acid in the stomach. It is largely used in the treatment of heartburn and peptic ulcers. It is marketed by GlaxoSmithKline under the trade name Tagamet...
(Tagamet) - clidinium-chlordiazepoxideChlordiazepoxideChlordiazepoxide, is a sedative/hypnotic drug and benzodiazepine. It is marketed under the trade names Angirex, Klopoxid, Librax , Libritabs, Librium, Mesural, Multum, Novapam, Risolid, Silibrin, Sonimen and Tropium.Chlordiazepoxide was the first benzodiazepine to be synthesised and...
(Librax) - clonidineClonidineClonidine is a sympatholytic medication used to treat medical conditions, such as high blood pressure, some pain conditions, ADHD and anxiety/panic disorder...
(Catapres) - clorazepateClorazepateClorazepate , also known as clorazepate dipotassium, is a drug that is a benzodiazepine derivative. It possesses anxiolytic, anticonvulsant, sedative, hypnotic and skeletal muscle relaxant properties. Clorazepate is a prodrug for desmethyldiazepam, which is rapidly produced as an active metabolite...
(Tranxene) - cyclandelateCyclandelateCyclandelate is a vasodilator used in the treatment of claudication, arteriosclerosis and Raynaud's disease. It is also used to treat nighttime leg cramps, and has been investigated for its effect against migraine. It is orally administered....
(Cyclospasmol) - cyclobenzaprineCyclobenzaprineCyclobenzaprine is a muscle relaxant medication used to relieve skeletal muscle spasms and associated pain in acute musculoskeletal conditions. It is the most well-studied drug for this application, and it also has been used off-label for fibromyalgia treatment.- Mechanism of action :The mechanism...
(Flexeril) - cyproheptadineCyproheptadineCyproheptadine , sold under the brand name Periactin, is a first-generation antihistamine with additional anticholinergic, antiserotonergic, and local anesthetic properties.- Indications :...
(Periactin) - desiccated thyroid
- dexchlorpheniramineDexchlorpheniramineDexchlorpheniramine is an antihistamine with anticholinergic properties used to treat allergic conditions such as hay fever or urticaria...
(Polaramine) - diazepamDiazepamDiazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
(Valium) - dicyclomineDicyclomineDicyclomine, also known as dicycloverine, is an anticholinergic that blocks muscarinic receptors. Dicycloverine was first synthesized in the United States circa 1947.- Clinical uses :...
(Bentyl) - digoxinDigoxinDigoxin INN , also known as digitalis, is a purified cardiac glycoside and extracted from the foxglove plant, Digitalis lanata. Its corresponding aglycone is digoxigenin, and its acetyl derivative is acetyldigoxin...
(Lanoxin) - diphenhydramineDiphenhydramineDiphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
(Benadryl) - dipyridamoleDipyridamoleDipyridamole is a drug that inhibits thrombus formation when given chronically and causes vasodilation when given at high doses over a short time.-Mechanism and effects:...
(Persantine) - disopyramideDisopyramideDisopyramide is an antiarrhythmic medication. It is a Class Ia antiarrhythmic used in the treatment of ventricular tachycardias...
(Norpace, Norpace CR) - doxazosinDoxazosinDoxazosin mesylate, a quinazoline compound sold by Pfizer under the brand names Cardura and Carduran, is an α1a-selective alpha blocker used to treat high blood pressure and urinary retention associated with benign prostatic hyperplasia ....
(Cardura) - doxepinDoxepinDoxepin is a psychotropic agent with tricyclic antidepressant and anxiolytic properties, known under many brand-names such as Aponal, the original preparation by Boehringer-Mannheim, now part of the Roche group; Adapine, Doxal , Deptran, Sinquan and Sinequan...
(Sinequan) - ergot mesyloids (Hydergine)
- estrogenEstrogenEstrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
s - ethacrynic acidEthacrynic acidEtacrynic acid or ethacrynic acid , trade name Edecrin, is a loop diuretic used to treat high blood pressure and the swelling caused by diseases like congestive heart failure, liver failure, and kidney failure....
(Edecrin) - ferrous sulfate (iron)
- fluoxetineFluoxetineFluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...
(Prozac) - flurazepamFlurazepamFlurazepam is a drug which is a benzodiazepine derivative. It possesses anxiolytic, anticonvulsant, sedative and skeletal muscle relaxant properties. It produces a metabolite with a very long half-life , which may stay in the bloodstream for up to four days...
(Dalmane) - guanadrelGuanadrelGuanadrel is an antihypertensive agent. It is used in the form of its sulfate.-Mechanism of action:Guanadrel is a postganglionic adrenergic blocking agent...
(Hylorel) - guanethidineGuanethidineGuanethidine is an antihypertensive drug that reduces the release of catecholamines, such as norepinephrine. Guanethidine is transported across the sympathetic nerve membrane by the same mechanism that transports norepinephrine itself , and uptake is essential for the drug's action...
(Ismelin) - halazepamHalazepamHalazepam is a benzodiazepine derivative and is marketed under the brand names Alapryl and Pacinone It is no longer marketed in the United States. It had been marketed under the name Paxipam, but was withdrawn by its manufacturer, Schering Plough, for poor sales. It possesses anxiolytic,...
(Paxipam) - hydroxyzineHydroxyzineHydroxyzine is a first-generation antihistamine of the diphenylmethane and piperazine classes. It was first synthesized by Union Chimique Belge in 1956 and was marketed by Pfizer in the United States later the same year, and is still in widespread use today....
(Vistaril, Atarax) - hyoscyamineHyoscyamineHyoscyamine is a tropane alkaloid. It is a secondary metabolite found in certain plants of the Solanaceae family, including henbane , mandrake , jimsonweed , tomato and deadly nightshade...
(Levsin, Levsinex) - indomethacin (Indocin, Indocin SR)
- isoxsuprineIsoxsuprineIsoxsuprine, or Isoxsuprine hydrochloride, is a drug used as a vasodilator in humans and equines.-Reasons for use and controversy:Isoxsuprine is most commonly used to treat hoof-related problems in the horse, most commonly for laminitis and navicular disease, as its effects as a vasodilator are...
(Vasodilan) - ketorolacKetorolacKetorolac or ketorolac tromethamine is a non-steroidal anti-inflammatory drug in the family of heterocyclic acetic acid derivative, often used as an analgesic...
(Toradol) - lorazepamLorazepamLorazepam is a high-potency short-to-intermediate-acting 3-hydroxy benzodiazepine drug that has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant, antiemetic and muscle relaxant...
(Ativan) - meperidine (Demerol)
- meprobamateMeprobamateMeprobamate is a carbamate derivative which is used as an anxiolytic drug...
(Miltown, Equanil) - mesoridazineMesoridazineMesoridazine is a piperidine neuroleptic drug belonging to the class of drugs called phenothiazines, used in the treatment of schizophrenia. It is a metabolite of thioridazine...
(Serintil) - metaxaloneMetaxaloneMetaxalone is a muscle relaxant used to relax muscles and relieve pain caused by strains, sprains, and other musculoskeletal conditions. Its exact mechanism of action is not known, but it may be due to general central nervous system depression...
(Skelaxin) - methocarbamolMethocarbamolMethocarbamol is a central muscle relaxant used to treat skeletal muscle spasms...
(Robaxin) - methyldopaMethyldopaMethyldopa is an alpha-adrenergic agonist psychoactive drug used as a sympatholytic or antihypertensive. Its use is now mostly deprecated following the introduction of alternative safer classes of agents...
(Aldomet) - methyldopaMethyldopaMethyldopa is an alpha-adrenergic agonist psychoactive drug used as a sympatholytic or antihypertensive. Its use is now mostly deprecated following the introduction of alternative safer classes of agents...
-hydrochlorothiazideHydrochlorothiazideHydrochlorothiazide, abbreviated HCTZ, HCT, or HZT, is a first-line diuretic drug of the thiazide class that acts by inhibiting the kidneys' ability to retain water. This reduces the volume of the blood, decreasing blood return to the heart and thus cardiac output and, by other mechanisms, is...
(Aldoril) - methyltestosteroneMethyltestosteroneMethyltestosterone is a 17-alpha-alkylated anabolic steroid used to treat men with a testosterone deficiency. It is also used in women to treat breast cancer, breast pain, swelling due to pregnancy, and with the addition of estrogen it can treat symptoms of menopause...
(Android, Testred, Virilon) - mineral oilMineral oilA mineral oil is any of various colorless, odorless, light mixtures of alkanes in the C15 to C40 range from a non-vegetable source, particularly a distillate of petroleum....
- naproxenNaproxenNaproxen sodium is a nonsteroidal anti-inflammatory drug commonly used for the reduction of pain, fever, inflammation and stiffness caused by conditions such as:...
(Naprosyn, Avaprox, Aleve) - Neoloid
- nifedipineNifedipineNifedipine is a dihydropyridine calcium channel blocker...
(Procardia, Adalat) - nitrofurantoinNitrofurantoinNitrofurantoin is an antibiotic which is marketed under the following brand names; Furadantin, Macrobid, Macrodantin, Nitrofur Mac, Nitro Macro, Nifty-SR, Martifur-MR, Martifur-100 , Urantoin, and Uvamin . It is usually used in treating urinary tract infection...
(Microdantin) - orphenadrineOrphenadrineOrphenadrine is an anticholinergic drug of the ethanolamine antihistamine class with prominent CNS and peripheral actions used to treat painful muscle spasms, other similar conditions, as well as the treatment...
(Norflex) - oxaprozinOxaprozinOxaprozin, also known as Oxaprozinum, is a non-steroidal anti-inflammatory drug , used to relieve the inflammation, swelling, stiffness, and joint pain associated with osteoarthritis and rheumatoid arthritis. Chemically, it is a propionic acid derivative. It is available in 600 mg tablets...
(Daypro) - oxazepamOxazepamOxazepam , is a drug which is a short to intermediate acting 3-hydroxy benzodiazepine derivative...
(Serax) - oxybutyninOxybutyninOxybutynin is an anticholinergic medication used to relieve urinary and bladder difficulties, including frequent urination and inability to control urination , by decreasing muscle spasms of the bladder. It competitively antagonizes the M1, M2, and M3 subtypes of the muscarinic acetylcholine...
(Ditropan) - pentazocinePentazocinePentazocine is a synthetically prepared prototypical mixed agonist-antagonist narcotic drug of the benzomorphan class of opioids used to treat moderate to moderately severe pain...
(Talwin) - perphenazinePerphenazinePerphenazine is a typical antipsychotic drug. Chemically, it is classified as a piperazinyl phenothiazine. It has been in clinical use for decades....
-amitriptylineAmitriptylineAmitriptyline is a tricyclic antidepressant . It is the most widely used TCA and has at least equal efficacy against depression as the newer class of SSRIs...
(Triavil) - piroxicamPiroxicamPiroxicam is a non-steroidal anti-inflammatory drug of the oxicam class used to relieve the symptoms of rheumatoid and osteoarthritis, primary dysmenorrhoea, postoperative pain; and act as an analgesic, especially where there is an inflammatory component...
(Feldene) - promethazinePromethazinePromethazine is a first-generation antihistamine of the phenothiazine family. The drug has anti-motion sickness, antiemetic, and anticholinergic effects, as well as a strong sedative effect and in some countries is prescribed for insomnia when benzodiazepines are contraindicated...
(Phenergan) - propantheline (Pro-Banthine)
- propoxyphene (Darvon) and combination products (Off the market)
- quazepamQuazepamQuazepam is a benzodiazepine derivative drug developed by the Schering Corporation in the 1970s. Quazepam is indicated for the treatment of insomnia including sleep induction and sleep maintenance...
(Doral) - reserpineReserpineReserpine is an indole alkaloid antipsychotic and antihypertensive drug that has been used for the control of high blood pressure and for the relief of psychotic symptoms, although because of the development of better drugs for these purposes and because of its numerous side-effects, it is rarely...
(Serpalan, Serpasil) - temazepamTemazepamTemazepam is an intermediate-acting 3-hydroxy benzodiazepine. It is mostly prescribed for the short-term treatment of sleeplessness in patients who have difficulty maintaining sleep...
(Restoril) - thioridazineThioridazineThioridazine is a piperidine typical antipsychotic drug belonging to the phenothiazine drug group and was previously widely used in the treatment of schizophrenia and psychosis...
(Mellaril) - ticlopidineTiclopidineTiclopidine is an antiplatelet drug in the thienopyridine family. Like clopidogrel, it is an adenosine diphosphate receptor inhibitor. It is used in patients in whom aspirin is not tolerated, or in whom dual antiplatelet therapy is desirable...
(Ticlid) - triazolamTriazolamTriazolam is a benzodiazepine drug. It possesses pharmacological properties similar to that of other benzodiazepines, but it is generally only used as a sedative to treat severe insomnia...
(Halcion) - trimethobenzamideTrimethobenzamideTrimethobenzamide is an antiemetic used to prevent nausea and vomiting. It is often prescribed for patients with gastroenteritis, medication-induced nausea, and other illnesses...
(Tigan) - tripelennamineTripelennamineTripelennamine is psychoactive drug and member of the pyridine and ethylenediamine classes that is used as an antipruritic and first-generation antihistamine...