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Some Disorders and Symptoms That Can Be Worsened by Drugs in Older People

Some Disorders and Symptoms That Can Be Worsened by Drugs in Older People

Disorder or Symptom


NSAIDs (such as ibuprofen and naproxen)

Delirium, dementia, or mild cognitive impairment

Antipsychotic drugs


Drugs with sedative effects (such as benzodiazepines, sedatives, and sleep aids, including eszopiclone, zaleplon, and zoldipem) or anticholinergic effects*

Histamine-2 blockers (cimetidine, famotidine, nizatidine, ranitidine)


Fainting or orthostatic hypotension (sudden decrease in blood pressure when a person stands up)

Acetylcholinesterase inhibitors (for example, donepezil, galantamine, rivastigmine), peripheral alpha-1 blockers (used to treat hypertension or prostate symptoms in older men, such as doxazosin, prazosin, terazosin), some tricyclic antidepressants (for example, amitriptyline, doxepin, imipramine), antipsychotics (such as chlorpromazine, thioridazine, olanzapine), and beta-blockers (for example, metoprolol, atenolol, carvedilol)

Drugs with sedative effects (such as antiseizure drugs, antipsychotics, benzodiazepines, eszopiclone, zaleplon, and zolpidem), antidepressants, and opioids


Some (nondihydropyridine) calcium channel blockers (diltiazem, verapamil), usually used to treat hypertension

NSAIDs, COX-2 inhibitors, thiazolidinediones (pioglitazone, rosiglitazone), dronedarone

Certain antinausea drugs (metoclopramide, prochlorperazine, promethazine) and most antipsychotics except a few such as quetiapine, clozapine, and pimavanserin

Peptic ulcer disease or stomach bleeding

Aspirin and most NSAIDs

Doxazosin, estrogens taken by mouth or through the skin (not applied directly to the vagina), prazosin, terazosin

Urinary retention or urinary symptoms caused by an enlarged prostate (such as slow urinary flow, frequent urination of smaller amounts, and dribbling)

Drugs with anticholinergic effects*, cold remedies containing decongestants, or a combination of antihistamines and decongestants

* Anticholinergic effects include confusion, blurred vision, constipation, dry mouth, light-headedness and loss of balance, and difficulty starting to urinate.

COX-2 inhibitors = coxibs; NSAIDs = nonsteroidal anti-inflammatory drugs.

Adapted from The American Geriatrics Society 2019 Beers Criteria Update Expert Panel: American Geriatrics Society updated Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 67(4):674-694, 2019. doi:10.1111/jgs.15767