Drug Class & Examples	Prescribing Concerns
🌼 First-generation (sedating) antihistamines Diphenhydramine, Chlorpheniramine, Promethazine, Cyproheptadine, Clemastine, Hydroxyzine, Doxylamine	Sedating and strongly anticholinergic → ↑ delirium, falls, urinary retention, dry mouth, constipation. Note: Diphenhydramine may be appropriate in severe allergic reactions.
💊 Antispasmodics Dicyclomine, Hyoscyamine, Propantheline, Oxybutynin (IR), Scopolamine, Belladonna alkaloids, Clidinium	Strong anticholinergic properties → delirium, urinary retention, constipation. Note: Hyoscyamine, scopolamine, and belladonna may be appropriate in palliative care (secretions).
📘 Tricyclic Antidepressants (TCAs) Amitriptyline, Doxepin, Imipramine, Nortriptyline	Avoid in elderly → sedating, strong anticholinergic, cause delirium, falls, constipation, orthostatic hypotension.
🧠 Anticholinergic Anti-Parkinson Agents Benztropine, Trihexyphenidyl	Avoid → sedation, anticholinergic toxicity. Better alternatives exist for Parkinson’s disease and EPS prevention.
💪 Muscle Relaxants Cyclobenzaprine, Methocarbamol, Carisoprodol, Metaxalone	Limited benefit in elderly. Cause sedation, delirium, and ↑ falls risk.
😴 Benzodiazepines Alprazolam, Lorazepam, Diazepam, Chlordiazepoxide, Clorazepate	Avoid for delirium, sleep disorders, agitation. ↑ risk of sedation and falls. Note: May be appropriate for alcohol/benzo withdrawal.
🌙 Non-benzodiazepine Hypnotics Zolpidem	Similar to benzodiazepines: ↑ sedation, delirium, falls, fractures. Avoid in elderly.
🧩 Antipsychotic Agents (Atypical & Conventional) Haloperidol, Thioridazine, Chlorpromazine, Olanzapine, Quetiapine, Risperidone	↑ Risk of stroke & death in elderly with dementia. Use only if non-drug measures fail and patient is at risk to self/others.
⬇️ Alpha-1 Blockers Doxazosin, Prazosin, Terazosin	Avoid as antihypertensives → high risk of orthostatic hypotension. Better agents available.
🩺 CNS-acting Alpha Agonists Clonidine, Methyldopa	Associated with bradycardia, hypotension, sedation, delirium, depression. Avoid methyldopa; use clonidine cautiously.
❤️ Cardiac Glycosides Digoxin (>0.125 mg/day)	Higher doses ↑ toxicity risk in elderly due to reduced renal clearance. No additional benefit at high doses.
💓 Antiarrhythmic Drugs Amiodarone, Flecainide, Procainamide, Sotalol, Quinidine, Disopyramide	Rate control often safer than rhythm control in elderly. Amiodarone → thyroid/lung toxicity, QT prolongation. Disopyramide → HF, anticholinergic.
💊 Non-COX Selective NSAIDs Aspirin (>325 mg/day), Ibuprofen, Naproxen, Piroxicam, Indomethacin	↑ GI bleeding, renal impairment, and HF exacerbation risk. If unavoidable, add PPI for gastroprotection.
🍬 Long-acting Sulfonylureas Chlorpropamide, Glyburide	↑ Risk of prolonged hypoglycaemia. Avoid in elderly.
🧪 Urinary Anti-infective Agent Nitrofurantoin	Avoid if CrCl <60 ml/min → ineffective & ↑ neuropathy, hepatotoxicity risk.

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Drugs to avoid Elderly

About: Always check the BNF guidelines here for updated information.

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