Geriatric emergency medication safety recommendations: Difference between revisions

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! Exclusions^
! Exclusions^
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| Barbiturates
| [[Barbiturates]]
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*Epilepsy: use other anticonvulsants (e.g., [[lamotrigine]], [[levetiracetam]]).
*Epilepsy: use other anticonvulsants (e.g., [[lamotrigine]], [[levetiracetam]]).
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*Seizures disorders, benzodiazepine or ethanol withdrawal, barbiturates are acceptable to use.
*Seizures disorders, benzodiazepine or ethanol withdrawal, barbiturates are acceptable to use.
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| Benzodiazepines
| [[Benzodiazepines]]
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*Epilepsy: use other anticonvulsants (eg, lamotrigine, levetiracetam).
*Epilepsy: use other anticonvulsants (eg, lamotrigine, levetiracetam).
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*Seizure disorders: benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, and end of life, benzodiazepines are acceptable to use.
*Seizure disorders: benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, and end of life, benzodiazepines are acceptable to use.
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| First-Generation Antihistamines
| First-generation [[antihistamines]]
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*Allergies: use intranasal saline or steroid (eg, fluticasone, beclomethasone), topical antihistamines (eg, azelastine), or second-generation antihistamines (eg, fexofenadine, loratadine).
*Allergies: use intranasal saline or steroid (eg, fluticasone, beclomethasone), topical antihistamines (eg, azelastine), or second-generation antihistamines (eg, fexofenadine, loratadine).
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*For allergic reactions, first-generation antihistamines are acceptable to use.
*For allergic reactions, first-generation antihistamines are acceptable to use.
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|Metoclopramide
|[[Metoclopramide]]
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*For nausea, use ondansetron.
*For nausea, use ondansetron.
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*For gastroparesis, metoclopramide is acceptable to use.
*For gastroparesis, metoclopramide is acceptable to use.
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|First-Generation Antipsychotics
|First-generation [[antipsychotics]]
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*Second-generation antipsychotics (eg, olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone).
*Second-generation antipsychotics (eg, olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone).
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|Skeletal Muscle Relaxants
|Skeletal muscle relaxants
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*Treat musculoskeletal pain first with nonpharmacologic agents (eg, heat, ice, massage) then with Tylenol, short-course NSAIDs, lidocaine patch, diclofenac gel.
*Treat musculoskeletal pain first with nonpharmacologic agents (eg, heat, ice, massage) then with Tylenol, short-course NSAIDs, lidocaine patch, diclofenac gel.
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|Sulfonylureas
|[[Sulfonylureas]]
|Metformin, long-acting insulin (eg, glargine).
|Metformin, long-acting insulin (eg, glargine).
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Revision as of 20:00, 20 May 2026

High-Risk Medications to Avoid for Geriatric Patients at ED Discharge[1]

Therapeutic Class Alternatives Exclusions^
Barbiturates
  • Epilepsy: use other anticonvulsants (e.g., lamotrigine, levetiracetam).
  • Agitation: treat pain first with acetaminophen then low-dose opioid.
  • Severe agitation: use low-dose second-generation antipsychotic (eg, olanzapine, risperidone, quetiapine [Lewy body dementia]).
  • Seizures disorders, benzodiazepine or ethanol withdrawal, barbiturates are acceptable to use.
Benzodiazepines
  • Epilepsy: use other anticonvulsants (eg, lamotrigine, levetiracetam).
  • Agitation: treat pain first with acetaminophen then low-dose opioid.
    • Severe agitation: use nonpharmacologic approach then low-dose second-generation antipsychotic (eg, olanzapine, risperidone, quetiapine [Lewy body dementia]).
  • Seizure disorders: benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, and end of life, benzodiazepines are acceptable to use.
First-generation antihistamines
  • Allergies: use intranasal saline or steroid (eg, fluticasone, beclomethasone), topical antihistamines (eg, azelastine), or second-generation antihistamines (eg, fexofenadine, loratadine).
  • Vertigo: use short-term steroids and canalith repositioning maneuvers.
  • For allergic reactions, first-generation antihistamines are acceptable to use.
Metoclopramide
  • For nausea, use ondansetron.
  • For gastroparesis, metoclopramide is acceptable to use.
First-generation antipsychotics
  • Second-generation antipsychotics (eg, olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone).
Nonbenzodiazepine, Benzodiazepine Receptor Agonist Hypnotics (Z-drugs)
  • Insomnia: use melatonin, ramelteon, doxepin (<=3 mg).
  • Anxiety: use mirtazapine, buspirone, serotonin–norepinephrine reuptake inhibitor (serotonin and norepinephrine reuptake inhibitor, eg, duloxetine, venlafaxine, desvenlafaxine).
Skeletal muscle relaxants
  • Treat musculoskeletal pain first with nonpharmacologic agents (eg, heat, ice, massage) then with Tylenol, short-course NSAIDs, lidocaine patch, diclofenac gel.
Sulfonylureas Metformin, long-acting insulin (eg, glargine).

^Exclusion criteria: valid indications to prescribe potentially inappropriate medications at ED discharge for older adults.

See Also

  1. ↑ Skains, et al. Geriatric Emergency Medication Safety Recommendations (GEMS-Rx). Annals of Emergency Medicine. September 2024. 84(3):274-284. https://doi.org/10.1016/j.annemergmed.2024.01.033
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