TABLE 1.

2015 American Geriatrics Society Beers Criteria for Potentially Inappropriate

Medication Use in Older Adults
From THE AMERICAN GERIATRICS SOCIETY Organ System, Therapeutic Recommendation, Rationale, Quality of Evidence

A POCKET GUIDE TO THE Category, Drug(s)

Anticholinergics
(QE), Strength of Recommendation (SR)

AGS 2015 BEERS CRITERIA First-generation

antihistamines:
■ Brompheniramine
■ Carbinoxamine
Avoid
Highly anticholinergic; clearance reduced with advanced age,
and tolerance develops when used as hypnotic; risk of confusion,
dry mouth, constipation, and other anticholinergic effects or
This guide has been developed as a tool to assist healthcare providers in improving ■ Chlorpheniramine toxicity
medication safety in older adults. The role of this guide is to inform clinical decision- ■ Clemastine
Use of diphenhydramine in situations such as acute treatment of
making, research, training, quality measures and regulations concerning the prescribing of ■ Cyproheptadine
severe allergic reaction may be appropriate
medications for older adults to improve safety and quality of care. It is based on The AGS ■ Dexbrompheniramine
■ Dexchlorpheniramine QE = Moderate; SR = Strong
2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
■ Dimenhydrinate
Originally conceived of in 1991 by the late Mark Beers, MD, a geriatrician, the Beers ■ Diphenhydramine (oral)
Criteria catalogues medications that cause side effects in the elderly due to the ■ Doxylamine
physiologic changes of aging. In 2011, the AGS sponsored its first update of the criteria, ■ Hydroxyzine
■ Meclizine
assembling a team of experts and using an enhanced, evidence-based methodology. In
■ Promethazine
2015, the AGS again funded the development of the Updated Criteria using an evidence- ■ Triprolidine
based methodology and rating each Criterion (quality of evidence and strength of
Antiparkinsonian agents Avoid
evidence) using the American College of Physicians’ Guideline Grading System, which is ■ Benztropine (oral) Not recommended for prevention of extrapyramidal symptoms
based on the GRADE scheme developed by Guyatt et al. ■ Trihexyphenidyl with antipsychotics; more-effective agents available for
The full document, along with accompanying resources can be viewed in their entirety treatment of Parkinson disease
online at geriatricscareonline.org. QE = Moderate; SR = Strong

INTENDED USE Antispasmodics: Avoid

■ Atropine (excludes Highly anticholinergic, uncertain effectiveness
The goal of this guide is to improve care of older adults by reducing their exposure to ophthalmic)
Potentially Inappropriate Medications (PIMS). QE = Moderate; SR = Strong
■ Belladonna alkaloids
■ Clidinium-
■ This should be viewed as a guideline for identifying medications for which the risks
Chlordiazepoxide
of their use in older adults outweigh the benefits. ■ Dicyclomine
■ These criteria are not meant to be applied in a punitive manner. ■ Hyoscyamine
■ This list is not meant to supersede clinical judgment or an individual patient’s values ■ Propantheline
and needs. Prescribing and managing disease conditions should be individualized ■ Scopolamine
and involve shared decision-making. Antithrombotics
■ These criteria also underscore the importance of using a team approach to ■ Dipyridamole, oral Avoid
prescribing and the use of non-pharmacological approaches and of having short-acting (does not May cause orthostatic hypotension; more effective alternatives
economic and organizational incentives for this type of model. apply to the extended- available; IV form acceptable for use in cardiac stress testing
■ Two companion pieces were developed for the 2015 update. The first addresses release combination QE = Moderate; SR = Strong
the best way for patients, providers, and health systems to use (and not use) the with aspirin)
2015 AGS Beers Criteria. The second is a list of alternative medications included
■ Ticlopidine Avoid
in the current use of High-Risk Medications in the Elderly and Potentially Harmful
Drug-Disease Interactions in the Elderly quality measures. Both pieces can be found Safer, effective alternatives available
on geriatricscareonline.org. QE = Moderate; SR = Strong

The criteria are not applicable in all circumstances (i.e. patient’s receiving palliative and
hospice care). If a provider is not able to find an alternative and chooses to continue to CNS=central nervous system; NSAIDs=nonsteroidal anti-inflammatory drugs; SIADH, syndrome of
use a drug on this list in an individual patient, designation of the medication as potentially inappropriate antidiuretic hormone.
inappropriate can serve as a reminder for close monitoring so that adverse drug effects
can be incorporated into the electronic health record and prevented or detected early.

AGS THE AMERICAN GERIATRICS SOCIETY

Geriatrics Health Professionals.
✃

Leading change. Improving care for older adults.

PAGE 1 PAGE 2 Table 1 (continued on page 3)
 Table 1 Continued Table 1 Continued
Organ System, Therapeutic Organ System, Therapeutic
Category, Drug(s) Recommendation, Rationale, QE, SR Category, Drug(s) Recommendation, Rationale, QE, SR
Anti-infective Nifedipine, immediate Avoid
■ Nitrofurantoin Avoid in individuals with creatinine clearance <30 mL/min or release Potential for hypotension; risk of precipitating myocardial
for long-term suppression of bacteria ischemia
Potential for pulmonary toxicity, hepatoxicity, and peripheral QE = High; SR = Strong
neuropathy, especially with long-term use; safer alternatives available
QE = Low; SR = Strong Amiodarone Avoid amiodarone as first-line therapy for atrial fibrillation
unless the patient has heart failure or substantial left ventricular
Cardiovascular hypertrophy
Peripheral alpha-1 Avoid use as an antihypertensive Amiodarone is effective for maintaining sinus rhythm but has
blockers High risk of orthostatic hypotension; not recommended as greater toxicities than other antiarrhythmics used in atrial
■ Doxazosin routine treatment for hypertension; alternative agents have fibrillation; it may be reasonable first-line therapy in patients
■ Prazosin superior risk/benefit profile with concomitant heart failure or substantial left ventricular
■ Terazosin hypertrophy if rhythm control is preferred over rate control
QE = Moderate; SR = Strong
QE = High; SR = Strong
Central alpha agonists Avoid clonidine as first-line antihypertensive. Avoid others as
■ Clonidine listed Central nervous system
■ Guanabenz High risk of adverse CNS effects; may cause bradycardia and
■ Guanfacine
Antidepressants, alone or Avoid
orthostatic hypotension; not recommended as routine treatment in combination
■ Methyldopa for hypertension Highly anticholinergic, sedating, and cause orthostatic
■ Amitriptyline hypotension; safety profile of low-dose doxepin (≤6 mg/d)
■ Reserpine (>0.1 mg/d)
QE = Low; SR = Strong ■ Amoxapine comparable with that of placebo
■ Clomipramine
Disopyramide Avoid QE = High; SR = Strong
■ Desipramine
Disopyramide is a potent negative inotrope and therefore may ■ Doxepin >6 mg/d
induce heart failure in older adults; strongly anticholinergic; ■ Imipramine
other antiarrhythmic drugs preferred ■ Nortriptyline
QE = Low; SR = Strong ■ Paroxetine
■ Protriptyline
Dronedarone Avoid in individuals with permanent atrial fibrillation or severe ■ Trimipramine
or recently decompensated heart failure Antipsychotics, first- Avoid, except for schizophrenia, bipolar disorder, or short-term
Worse outcomes have been reported in patients taking (conventional) and use as antiemetic during chemotherapy
dronedarone who have permanent atrial fibrillation or severe or second- (atypical) Increased risk of cerebrovascular accident (stroke) and greater
recently decompensated heart failure generation rate of cognitive decline and mortality in persons with dementia
QE = High; SR = Strong Avoid antipsychotics for behavioral problems of dementia and/
or delirium unless nonpharmacological options (e.g., behavioral
Digoxin Avoid as first-line therapy for atrial fibrillation. Avoid as first-
interventions) have failed or are not possible and the older adult
line therapy for heart failure. If used for atrial fibrillation or
is threatening substantial harm to self or others
heart failure, avoid dosages >0.125 mg/d
QE = Moderate; SR = Strong
Use in atrial fibrillation: should not be used as a first-line agent
in atrial fibrillation, because more-effective alternatives exist
and it may be associated with increased mortality Barbiturates Avoid
Use in heart failure: questionable effects on risk of hospitalization ■ Amobarbital High rate of physical dependence, tolerance to sleep benefits,
and may be associated with increased mortality in older adults ■ Butabarbital greater risk of overdose at low dosages
with heart failure; in heart failure, higher dosages not associated ■ Butalbital
QE = High; SR = Strong
with additional benefit and may increase risk of toxicity ■ Mephobarbital
■ Pentobarbital
Decreased renal clearance of digoxin may lead to increased ■ Phenobarbital
risk of toxic effects; further dose reduction may be necessary in ■ Secobarbital
those with Stage 4 or 5 chronic kidney disease.
QE = Atrial fibrillation: moderate. Heart failure: low.
Dosage >0.125 mg/d: moderate; SR = Atrial fibrillation: strong.
Heart failure: strong. Dosage >0.125 mg/d: strong
✃

PAGE 3 Table 1 (continued on page 4) PAGE 4 Table 1 (continued on page 5)

 Table 1 Continued Table 1 Continued
Organ System, Therapeutic Organ System, Therapeutic
Category, Drug(s) Recommendation, Rationale, QE, SR Category, Drug(s) Recommendation, Rationale, QE, SR
Benzodiazepines Avoid Estrogens with or without Avoid oral and topical patch. Vaginal cream or tablets:
Short- and intermediate- Older adults have increased sensitivity to benzodiazepines and progestins acceptable to use low-dose intravaginal estrogen for
acting: decreased metabolism of long-acting agents; in general, all management of dyspareunia, lower urinary tract infections, and
■ Alprazolam other vaginal symptoms
benzodiazepines increase risk of cognitive impairment, delirium,
■ Estazolam
falls, fractures, and motor vehicle crashes in older adults Evidence of carcinogenic potential (breast and endometrium);
■ Lorazepam
May be appropriate for seizure disorders, rapid eye movement lack of cardioprotective effect and cognitive protection in older
■ Oxazepam
sleep disorders, benzodiazepine withdrawal, ethanol withdrawal, women.
■ Temazepam
■ Triazolam
severe generalized anxiety disorder, and periprocedural Evidence indicates that vaginal estrogens for the treatment of
anesthesia vaginal dryness are safe and effective; women with a history of
Long-acting: breast cancer who do not respond to nonhormonal therapies
■ Clorazepate
QE = Moderate; SR = Strong
are advised to discuss the risk and benefits of low-dose vaginal
■ Chlordiazepoxide (alone
estrogen (dosages of estradiol <25 mcg twice weekly) with their
or in combination health care provider
with amitriptyline or
clidinium) QE = Oral and patch: high. Vaginal cream or tablets: moderate.;
■ Clonazepam
SR = Oral and patch: strong. Topical vaginal cream or tablets: weak
■ Diazepam Growth hormone Avoid, except as hormone replacement following pituitary gland
■ Flurazepam removal
■ Quazepam Impact on body composition is small and associated with edema,
Meprobamate Avoid arthralgia, carpal tunnel syndrome, gynecomastia, impaired fasting
High rate of physical dependence; very sedating glucose
QE = Moderate; SR = Strong QE = High; SR = Strong
Insulin, sliding scale Avoid
Nonbenzodiazepine, Avoid Higher risk of hypoglycemia without improvement in
benzodiazepine receptor hyperglycemia management regardless of care setting; refers
Benzodiazepine-receptor agonists have adverse events similar to sole use of short- or rapid-acting insulins to manage or avoid
agonist hypnotics to those of benzodiazepines in older adults (e.g., delirium, falls,
■ Eszopiclone
hyperglycemia in absence of basal or long-acting insulin; does
fractures); increased emergency room visits/hospitalizations; not apply to titration of basal insulin or use of additional short- or
■ Zolpidem motor vehicle crashes; minimal improvement in sleep latency
■ Zaleplon
rapid-acting insulin in conjunction with scheduled insulin (ie,
and duration correction insulin)
QE = Moderate; SR = Strong QE = Moderate; SR = Strong
Megestrol Avoid
Ergoloid mesylates Avoid Minimal effect on weight; increases risk of thrombotic events
(dehydrogenated ergot Lack of efficacy and possibly death in older adults
alkaloids) QE = High; SR = Strong QE = Moderate; SR = Strong
Isoxsuprine
Sulfonylureas, long- Avoid
Endocrine duration Chlorpropamide: prolonged half-life in older adults; can cause
Androgens Avoid unless indicated for confirmed hypogonadism with ■ Chlorpropamide prolonged hypoglycemia; causes SIADH
■ Methyltestosterone clinical symptoms ■ Glyburide
■ Testosterone
Glyburide: higher risk of severe prolonged hypoglycemia in older
Potential for cardiac problems; contraindicated in men with adults
prostate cancer
QE = High; SR = Strong
QE = Moderate; SR = Weak
Gastrointestinal
Metoclopramide Avoid, unless for gastroparesis
Desiccated thyroid Avoid
Can cause extrapyramidal effects, including tardive dyskinesia;
Concerns about cardiac effects; safer alternatives available risk may be greater in frail older adults
QE = Low; SR = Strong QE = Moderate; SR = Strong
Mineral oil, given orally Avoid
Potential for aspiration and adverse effects; safer alternatives
available
QE = Moderate; SR = Strong
✃

PAGE 5 Table 1 (continued on page 6) PAGE 6 Table 1 (continued on page 7)

 Table 1 Continued TABLE 2. 2015 American Geriatrics Society Beers Criteria for Potentially Inappropriate
Organ System, Therapeutic Medication Use in Older Adults Due to Drug–Disease or Drug–Syndrome Interactions That
Category, Drug(s) Recommendation, Rationale, QE, SR May Exacerbate the Disease or Syndrome
Proton-pump inhibitors Avoid scheduled use for >8 weeks unless for high-risk patients
(e.g., oral corticosteroids or chronic NSAID use), erosive Recommendation, Rationale,
esophagitis, Barrett’s esophagitis, pathological hypersecretory Disease or Quality of Evidence (QE), Strength
condition, or demonstrated need for maintenance treatment Syndrome Drug(s) of Recommendation (SR)
(e.g., due to failure of drug discontinuation trial or H2 blockers) Cardiovascular
Risk of C difficile infection and bone loss and fractures Heart failure NSAIDs and COX-2 inhibitors Avoid
QE = High; SR = Strong
Nondihydropyridine CCBs (diltiazem, Potential to promote fluid retention and
Pain medications verapamil)—avoid only for heart exacerbate heart failure
Meperidine Avoid, especially in those with chronic kidney disease failure with reduced ejection QE = NSAIDs: moderate. CCBs:
Not effective oral analgesic in dosages commonly used; may fraction moderate. Thiazolidinediones: high.
have higher risk of neurotoxicity, including delirium, than other Thiazolidinediones (pioglitazone, Cilostazol: low. Dronedarone: high;
opioids; safer alternatives available
rosiglitazone) SR = Strong
QE = Moderate; SR = Strong
Cilostazol
Non-cyclooxygenase- Avoid chronic use, unless other alternatives are not effective
selective NSAIDs, oral: and patient can take gastroprotective agent (proton-pump Dronedarone (severe or recently
■ Aspirin >325 mg/d inhibitor or misoprostol) decompensated heart failure)
■ Diclofenac Increased risk of gastrointestinal bleeding or peptic ulcer Syncope Acetylcholinesterase inhibitors Avoid
■ Diflunisal disease in high-risk groups, including those aged >75 or
■ Etodolac
(AChEIs) Increases risk of orthostatic
taking oral or parenteral corticosteroids, anticoagulants, or
■ Fenoprofen antiplatelet agents; use of proton-pump inhibitor or misoprostol Peripheral alpha-1 blockers hypotension or bradycardia
■ Ibuprofen reduces but does not eliminate risk. Upper gastrointestinal ■ Doxazosin QE = Peripheral alpha-1 blockers:
■ Ketoprofen ulcers, gross bleeding, or perforation caused by NSAIDs occur ■ Prazosin
■ Meclofenamate
high. TCAs, AChEIs, antipsychotics:
in approximately 1% of patients treated for 3–6 months and in ■ Terazosin moderate; SR = AChEIs, TCAs:
■ Mefenamic acid ~2–4% of patients treated for 1 year; these trends continue with
■ Meloxicam longer duration of use Tertiary TCAs strong. Peripheral alpha-1 blockers,
■ Nabumetone ■ Chlorpromazine antipsychotics: weak
■ Naproxen
QE = Moderate; SR = Strong
■ Thioridazine
■ Oxaprozin ■ Olanzapine
■ Piroxicam
■ Sulindac Central nervous system
■ Tolmetin Chronic Bupropion Avoid
■ Indomethacin Avoid seizures or Chlorpromazine Lowers seizure threshold; may be
■ Ketorolac, includes Indomethacin is more likely than other NSAIDs to have adverse epilepsy Clozapine acceptable in individuals with well-
parenteral CNS effects. Of all the NSAIDs, indomethacin has the most Maprotiline controlled seizures in whom alternative
adverse effects. Olanzapine agents have not been effective
Increased risk of gastrointestinal bleeding/peptic ulcer disease, Thioridazine QE = Low; SR = Strong
and acute kidney injury in older adults Thiothixene
QE = Moderate; SR = Strong Tramadol
Pentazocine Avoid Delirium Anticholinergics* Avoid
Opioid analgesic that causes CNS adverse effects, including Antipsychotics Avoid in older adults with or at high
confusion and hallucinations, more commonly than other opioid Benzodiazepines risk of delirium because of potential of
analgesic drugs; is also a mixed agonist and antagonist; safer Chlorpromazine inducing or worsening delirium
alternatives available Corticosteroids a

QE = Low; SR = Strong Avoid antipsychotics for behavioral

H2-receptor antagonists problems of dementia and/or delirium
Skeletal muscle relaxants Avoid ■ Cimetidine unless nonpharmacological options
■ Carisoprodol Most muscle relaxants poorly tolerated by older adults because ■ Famotidine
■ Chlorzoxazone (e.g., behavioral interventions) have
some have anticholinergic adverse effects, sedation, increased ■ Nizatidine failed or are not possible and the
■ Cyclobenzaprine risk of fractures; effectiveness at dosages tolerated by older
■ Metaxalone ■ Ranitidine older adult is threatening substantial
adults questionable
■ Methocarbamol Meperidine harm to self or others. Antipsychotics
■ Orphenadrine
QE = Moderate; SR = Strong
Sedative hypnotics are associated with greater risk of
Genitourinary cerebrovascular accident (stroke) and
Desmopressin Avoid for treatment of nocturia or nocturnal polyuria mortality in persons with dementia
High risk of hyponatremia; safer alternative treatments QE = Moderate; SR = Strong
QE = Moderate; SR = Strong
✃

PAGE 7 PAGE 8 Table 2 (continued on page 9)

 Table 2 Continued Table 2 Continued
Disease or Disease or
Syndrome Drug(s) Recommendation, Rationale, QE, SR Syndrome Drug(s) Recommendation, Rationale, QE, SR
Dementia Anticholinergics* Avoid Parkinson All antipsychotics (except Avoid
or cognitive Benzodiazepines Avoid due to adverse CNS effects disease aripiprazole, quetiapine, clozapine) Dopamine-receptor antagonists with
impairment H2-receptor antagonists Avoid antipsychotics for behavioral Antiemetics potential to worsen parkinsonian
problems of dementia and/or delirium ■ Metoclopramide symptoms
Nonbenzodiazepine,
unless nonpharmacological options ■ Prochlorperazine Quetiapine, aripiprazole, clozapine
benzodiazepine receptor agonist
(e.g., behavioral interventions) have ■ Promethazine appear to be less likely to precipitate
hypnotics
■ Eszopiclone failed or are not possible and the worsening of Parkinson disease
■ Zolpidem older adult is threatening substantial QE = Moderate; SR = Strong
■ Zaleplon harm to self or others. Antipsychotics
are associated with greater risk of
Antipsychotics, chronic and as- Gastrointestinal
cerebrovascular accident (stroke) and
needed use History of Aspirin (>325 mg/d) Avoid unless other alternatives are
mortality in persons with dementia
QE = Moderate; SR = Strong gastric or Non-COX-2 selective NSAIDs not effective and patient can take
duodenal gastroprotective agent (ie, proton-
ulcers pump inhibitor or misoprostol)
History of Anticonvulsants Avoid unless safer alternatives are
falls or not available; avoid anticonvulsants May exacerbate existing ulcers or
Antipsychotics cause new/additional ulcers
fractures Benzodiazepines except for seizure and mood disorders.
Nonbenzodiazepine, Opioids: avoid, excludes pain QE = Moderate; SR = Strong
benzodiazepine receptor agonist management due to recent fractures or
hypnotics joint replacement Kidney/Urinary tract
■ Eszopiclone May cause ataxia, impaired Chronic NSAIDs (non-COX and COX- Avoid
■ Zaleplon psychomotor function, syncope, kidney selective, oral and parenteral)
■ Zolpidem additional falls; shorter-acting May increase risk of acute kidney
disease injury and further decline of renal
TCAs benzodiazepines are not safer than Stages
long-acting ones function
SSRIs IV or less
If one of the drugs must be used, QE = Moderate; SR = Strong
Opioids (creatinine
consider reducing use of other CNS- clearance <30
active medications that increase risk of mL/min)
falls and fractures (ie, anticonvulsants,
opioid-receptor agonists, antipsychotics,
Urinary Estrogen oral and transdermal Avoid in women
antidepressants, benzodiazepine-
incontinence (excludes intravaginal estrogen) Aggravation of incontinence
receptor agonists, other sedatives/
(all types) in Peripheral Alpha-1 blockers
hypnotics) and implement other QE = Estrogen: High. Peripheral alpha-1
women ■ Doxazosin
strategies to reduce fall risk blockers: Moderate; SR = Estrogen:
■ Prazosin Strong. Peripheral alpha-1 blockers:
QE = High. Opioids: Moderate;
■ Terazosin Strong
SR = Strong. Opioids: Strong

Insomnia Oral decongestants Avoid Lower Strongly anticholinergic drugs, Avoid in men
■ Pseudoephedrine CNS stimulant effects urinary tract except antimuscarinics for urinary May decrease urinary flow and cause
■ Phenylephrine symptoms, incontinence.* urinary retention
QE = Moderate; SR = Strong
Stimulants benign QE = Moderate; SR = Strong
■ Amphetamine prostatic
■ Armodafinil hyperplasia
■ Methylphenidate
■ Modafinil a
e xcludes inhaled and topical forms. Oral and parenteral corticosteroids may be required for conditions such as
■ Theobromines exacerbations of COPD but should be prescribed in the lowest effective dose and for the shortest possible duration.
■ Theophylline CCB=calcium channel blocker; AChEI=acetylcholinesterase inhibitor; CNS=central nervous system;
■ Caffeine COX=cyclooxygenase; NSAIDs=nonsteroidal antiinflammatory drug; TCAs=tricyclic antidepressant.
*See Table 7 in
*See
full Table
criteria
7 inavailable
full criteria
on www.geriatricscareonline.org.
available on www.geriatricscareonline.org.
a
excludes inhaled
a
excludes
and topical
inhaledforms.
and Oral
topical
andforms.
parenteral
Oral and
corticosteroids
parenteral corticosteroids
may be required
mayforbe
conditions
required for
suchconditions
as exacerbations
such as exacerbations
of COPD but should
of COPD
be prescribed
but should be
in the
prescribed
lowest effective
in the lowest
doseeffective
and for the
dose
shortest
and forpossible
the shortest
duration.
possible duration.
CCB=calciumCCB=calcium
channel blocker;channel
AChEI=acetylcholinesterase
blocker; AChEI=acetylcholinesterase
inhibitor; CNS=central
inhibitor; CNS=central
nervous system;nervous
COX=cyclooxygenase;
system; COX=cyclooxygenase;
NSAIDs=nonsteroidal
NSAIDs=nonsteroidal
antiinflammatory
antiinfl
drug;
ammatory
TCAs=tricyclic
drug; TCAs=tricyclic
antidepressant.
antidepressant.
✃

PAGE 9 Table 2 (continued on page 10) PAGE 10 Table 2 (continued on page 11)
 TABLE 3. 2015 American Geriatrics Society Beers Criteria for Potentially Inappropriate TABLE 4. 2015 American Geriatrics Society Beers Criteria for Potentially Clinically Important
Medications to Be Used with Caution in Older Adults Non-anti-infective Drug–Drug Interactions That Should Be Avoided in Older Adults
Recommendation, Rationale, Quality of Evidence (QE), Interacting Drug Recommendation, Risk Rationale, Quality of Evidence
Drug(s) Strength of Recommendation (SR) Object Drug and Class and Class (QE), Strength of Recommendation (SR)
Aspirin for primary Use with caution in adults ≥80 years old ACEIs Amiloride or Avoid routine use; reserve for patients with
triamterene demonstrated hypokalemia while taking an ACEI
prevention of Lack of evidence of benefit versus risk in adults ≥80 years old
cardiac events Increased risk of hyperkalemia
QE = Low; SR = Strong QE = Moderate; SR = Strong
Anticholinergic Anticholinergic Avoid, minimize number of anticholinergic drugs
Dabigatran Use with caution in adults ≥75 years old and in patients with CrCl <30 Increased risk of cognitive decline
mL/min QE = Moderate; SR = Strong
Increased risk of gastrointestinal bleeding compared with warfarin and Antidepressants (ie, ≥2 other CNS- Avoid total of ≥3 CNS-active drugsa; minimize number
reported rates with other target-specific oral anticoagulants in adults TCAs and SSRIs) active drugsa of CNS-active drugs
≥75 years old; lack of evidence of efficacy and safety in individuals with Increased risk of falls
CrCl <30 mL/min QE = Moderate; SR = Strong
QE = Moderate; SR = Strong Antipsychotics ≥2 other CNS- Avoid total of ≥3 CNS-active drugsa; minimize number
active drugsa of CNS active drugs
Increased risk of falls
Prasugrel Use with caution in adults aged ≥75
QE = Moderate; SR = Strong
Increased risk of bleeding in older adults; benefit in highest-risk older
adults (e.g., those with prior myocardial infarction or diabetes mellitus) Benzodiazepines ≥2 other CNS- Avoid total of ≥3 CNS-active drugsa; minimize number
and active drugsa of CNS active drugs
may offset risk nonbenzodiazepine, Increased risk of falls and fractures
QE = Moderate; SR = Weak benzodiazepine QE = High; SR = Strong
receptor agonist
hypnotics
Antipsychotics Use with caution Corticosteroids, NSAIDs Avoid; if not possible, provide gastrointestinal
Diuretics May exacerbate or cause SIADH or hyponatremia; monitor sodium oral or parenteral protection
Carbamazepine level closely when starting or changing dosages in older adults Increased risk of peptic ulcer disease or
Carboplatin QE = Moderate; SR = Strong gastrointestinal bleeding
Cyclophosphamide QE = Moderate; SR = Strong
Cisplatin
Lithium ACEIs Avoid, monitor lithium concentrations
Mirtazapine
Oxcarbazepine Increased risk of lithium toxicity
SNRIs QE = Moderate; SR = Strong
SSRIs Lithium Loop diuretics Avoid, monitor lithium concentrations
TCAs Increased risk of lithium toxicity
Vincristine QE = Moderate; SR = Strong
Opioid receptor ≥2 other CNS- Avoid total of ≥3 CNS-active drugsa; minimize number of
Vasodilators Use with caution. agonist analgesics active drugsa CNS drugs
May exacerbate episodes of syncope in individuals with history of Increased risk of falls
syncope QE = High; SR = Strong
QE = Moderate; SR = Weak Peripheral Alpha-1 Loop diuretics Avoid in older women, unless conditions warrant
blockers both drugs
Increased risk of urinary incontinence in older women
CrCl= creatinine clearance; SNRIs = Serotonin-nonrepinephrine reuptake inhitibors; QE = Moderate; SR = Strong
SSRIs = Selective serotonin reuptake inhitibors; TCA=tricyclic antidepressant.
Theophylline Cimetidine Avoid
Increased risk of theophylline toxicity
QE = Moderate; SR = Strong
Warfarin Amiodarone Avoid when possible; monitor INR closely
Increased risk of bleeding
QE = Moderate; SR = Strong
Warfarin NSAIDs Avoid when possible; if used together, monitor for
bleeding closely
Increased risk of bleeding
QE = High; SR = Strong
Central nervous system (CNS)-active drugs: antipsychotics; benzodiazepines; nonbenzodiazepine,
a

benzodiazepine receptor agonist hypnotics; tricyclic antidepressants (TCAs); selective serotonin reuptake
inhibitors (SSRIs); and opioids.
✃

ACEI = angiotensin-converting enzyme inhibitor; NSAID=nonsteroidal antiinflammatory drug.

PAGE 11 PAGE 12
 TABLE 5. 2015 American Geriatrics Society Beers Criteria for Non-Anti-Infective Medications Table 5 Continued
That Should Be Avoided or Have Their Dosage Reduced with Varying Levels of Kidney Creatinine Clearance,
Function in Older Adults Medication Class mL/min, at Which
and Medication Action Required Recommendation, Rationale, QE, SR
Creatinine Clearance, Levetiracetam ≤80 Reduce dose
Medication Class mL/min, at Which Recommendation, Rationale, Quality of Evidence (QE),
and Medication Action Required Strength of Recommendation (SR) CNS adverse effects
Cardiovascular or hemostasis QE = Moderate; SR = Strong
Amiloride <30 Avoid Pregabalin <60 Reduce dose
Increased potassium and decreased sodium CNS adverse effects
QE = Moderate; SR = Strong QE = Moderate; SR = Strong
Apixaban <25 Avoid Tramadol <30 Immediate release: Reduce dose
Extended release: avoid
Increased risk of bleeding
CNS adverse effects
QE = Moderate; SR = Strong
QE = Low; SR = Weak
Dabigatran <30 Avoid
Gastrointestinal
Increased risk of bleeding
Cimetidine <50 Reduce dose
QE = Moderate; SR = Strong
Mental status changes
Edoxaban 30–50 CrCl 30-50: Reduce dose
<30 or >95 CrCl <30 or >95: Avoid QE = Moderate; SR = Strong
Increased risk of bleeding Famotidine <50 Reduce dose
QE = Moderate; SR = Strong Mental status changes
Enoxaparin <30 Reduce dose QE = Moderate; SR = Strong
Increased risk of bleeding Nizatidine <50 Reduce dose
QE = Moderate; SR = Strong Mental status changes
Fondaparinux <30 Avoid QE = Moderate; SR = Strong
Increased risk of bleeding Ranitidine <50 Reduce dose
QE = Moderate; SR = Strong Mental status changes
Rivaroxaban 30–50 CrCl 30-50: Reduce dose QE = Moderate; SR = Strong
<30 CrCl <30: Avoid Hyperuricemia
Increased risk of bleeding Colchicine <30 Reduce dose; monitor for adverse effects
QE = Moderate; SR = Strong Gastrointestinal, neuromuscular, bone marrow toxicity
Spironolactone <30 Avoid QE = Moderate; SR = Strong
Increased potassium Probenecid <30 Avoid
QE = Moderate; SR = Strong Loss of effectiveness
Triamterene <30 Avoid QE = Moderate; SR = Strong
Increased potassium and decreased sodium CNS=central nervous system.
QE = Moderate; SR = Strong
Central nervous system and analgesics
Duloxetine <30 Avoid
Increased gastrointestinal adverse effects (nausea,
diarrhea)
QE = Moderate; SR = Weak The primary target audience is the practicing clinician. The intentions of the criteria include 1) improving
Gabapentin <60 Reduce dose the selection of prescription drugs by clinicians and patients; 2) evaluating patterns of drug use within
populations; 3) educating clinicians and patients on proper drug usage; and 4) evaluating health-outcome,
CNS adverse effects quality-of-care, cost, and utilization data.
QE = Moderate; SR = Strong
Copyright © 2015 by the American Geriatrics Society. All rights reserved. Except where authorized, no part
of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise without written permission of the
American Geriatrics Society, 40 Fulton Street, 18th Floor, New York, NY  10038.
✃

PAGE 13 Table 5 (continued on page 14) PAGE 14