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American Geriatrics Society 2022 Updated AGS Beers Criteria® for Potentially . 2 . Inappropriate Medication Use in Older Adults . 3 . By the 2022 American Geriatrics Society Beers Criteria® Update Expert Panel . 4 . 5 The Beers Criteria were developed by Mark Beers, MD, and colleagues at the University of 2023 AGS BEERS CRITERIA® THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. AGS Leading change. Improving care for older adults. This clinical tool, based on the 2023 AGS Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults (AGS Beers Criteria®), has been developed to assist healthcare Beers Criteria is also known as the Beers list. What are the five Beers criteria? The American Geriatrics Society uses specific criteria to list potentially inappropriate medications for adults over age 65. The five sections of the Beers Criteria are: Medications to avoid if you’re over 65 years old and not in a hospice or a palliative care Gabapentin. Pregabalin. Increased risk of severe sedation-related adverse events, including respiratory depression and death. Avoid; exceptions are when transitioning from opioid therapy to gabapentin or pregabalin, or when using gabapentinoids to reduce opioid dose, although caution should be used in all circumstances. Moderate: Strong Alternatives for neuropathic pain may include SNRIs, gabapentin, pregabalin, capsaicin, or lidocaine patch (U.S.), depending on etiology and comorbidities. For more help choosing, see our chart, Pharmacotherapy of Neuropathic Pain. Pregabalin in patient with CrCl <60 mL/min., or with opioids (also see Anticonvulsants) This clinical tool, based on the 2023 AGS Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults (AGS Beers Criteria ® ), has been developed to assist healthcare providers in improving medication safety in older adults. Gabapentinoids (pregabalin and gabapentin) which had been on the list to be used in only low doses due to ataxia and falls are now recommended to be avoided in combination with opioids due to sedation, respiratory depression, and death; New medication interactions to note include opioids with benzodiazepines, gabapentin (Neurontin), or pregabalin (Lyrica) because of the risk of severe respiratory depression; phenytoin (Dilantin The Beers criteria (named after Dr. Beers and not your Friday night escapades) is a guideline to help guide safe prescribing practices in the geriatric population. Polypharmacy and medication side effects are a common, and generally under-recognized, reason for patients to present to the emergency department. Recently, the American Geriatrics Society (AGS) released the 2023 AGS Beers Criteria ® for Potentially Inappropriate Medication Use in Older Adults. For more than 20 years, the Beers Criteria ® have been a valuable resource for healthcare providers about the safety of prescribing drugs for older people. According to Beers List and STOPP Criteria Note: These guidelines are not applicable in all circumstances. Avoid use when possible. Use with caution when necessary. CENTRAL NERVOUS SYSTEM Beers List Anticholinergic Antidepressants (alone or in combination): Amitriptyline, amoxapine, clomipramine, desipramine, doxepin (> 6 The list of American Geriatrics Society Beers Criteria For Potentially Inappropriate Medication Use In Older Adults was reviewed by experts. The complete 2019 AGS Beers list is available in pdf for educators, doctors, clinicians, researchers, etc. Many of the drugs on the Beers and Canadian lists are included because of sedative and anticholinergic adverse effects. CNS depressants can cause sedation and cognitive impairment in the elderly, resulting in difficulty with self-care and falls. Key words: medications; drugs; older adults; Beers list; Beers Criteria The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been For neuropathic pain—SNRI, gabapentin, pregabalin, capsaicin topical, lidocaine patch enzodiazepines Nonbenzodiazepine hypnotics (“Z” drugs: eszopiclone, zaleplon, zolpidem) For anxiety—buspirone, SNRI For sleep—evidence-based physiological behavioral treatments for insomnia, see reverse side of this resource “Do not drink alcohol or take other medicines that make you sleepy or dizzy while taking [gabapentin] without first talking with your healthcare provider. Taking [gabapentin] with alcohol or drugs that cause sleepiness or dizziness may make your sleepiness or dizziness worse.” As such, you should avoid alcohol when taking gabapentin. Is Gabapentin Addictive? Although the DEA doesn’t schedule most medications containing gabapentin as controlled substances, there is potential for abuse. Because of this, some states have reclassified gabapentin as a Schedule V controlled substance. Doctors prescribe gabapentin with caution because of its misuse potential. Opioids used concurrently with gabapentin or pregabalin may increase the risk of severe sedation, including respiratory depression and death. Multiple anticholinergic medications used concurrently increase the risk of cognitive decline, delirium, and falls/fractures. Notable beers updates in 2019. While it is worthwhile for those treating geriatric patients to review the complete Beers Criteria, these updates stood out as notable changes that might impact prescribers’ and pharmacists’ routine decision making at the point of care. Dementia and H2 blockers
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