For neuropathic pain—SNRI, gabapentin, capsaicin topical, pregabalin, lidocaine patch arbiturate naproxen) if no heart failure or eGFR > mL/Amobarbital utabarbital utalbital Mephobarbital Opioids For epilepsy—other anticonvulsants (e.g., lamotrigine, levetiracetam) min and given with PPI Pentobarbital Phenobarbital Secobarbital for The AGS Beers Criteria ® and the list of alternatives are resources, not a replacement, for the expertise and knowledge of your healthcare provider. The AGS Health in Aging Foundation has developed this resource to help you talk to your healthcare provider about these possible alternatives to Beers Criteria ® medications you’re taking. Originally conceived of in 1991 by the late Mark Beers, MD, a geriatrician, the Beers Criteria catalogues medications that cause side effects in the elderly due to the physiologic changes of aging. Notable drug interactions added include opioids plus benzodiazepines or gabapentenoids.1 Use of the Beers list has not been convincingly shown to reduce morbidity, mortality, or cost but is often used by organizations as quality measures. 1The American Geriatrics Society 2015 Beers Criteria Update Expert Panel (2015). American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015 Nov;63(11):2227-46. 2Hanlon JT, Semla TP, Schmader KE. Alternative Medications for Medications in the Use of High-Risk 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 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 Since 2011, the AGS has been the steward of the criteria and has pro-duced updates on a regular cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. What is the Beers Criteria? The Beers Criteria was first developed by Dr. Mark Beers in 1991 when he defined inappropriate prescribing of medication as those drugs whose risks outweigh the benefits, namely as it relates to the geriatric population. Over the years this list has evolved and is revised and updated by the American Geriatrics Society. New medication interactions to note include opioids with benzodiazepines, gabapentin (Neurontin), or pregabalin (Lyrica) because of the risk of severe respiratory depression; phenytoin Beers Criteria®: American Geriatrics Society updated AGS Beers Criteria® for potentially inappropriate medication use in older adults (2023) About the Guideline • This guideline is provided by the American Geriatric Society (AGS) regarding potentially inappropriate medications (not definitively inappropriate medications) for individuals ages 65 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; 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. The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly known as the Beers Criteria, is a list of medicines that may be harmful to older adults. It shows which medicines have a higher risk of harmful reactions in adults over age 65. 1. Fick DM, Cooper JW, Wade WE et al. Updating the beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716‐2724. 2. Guay DR. Beers 2003 update: An advance of the same? Consultant Pharmacist. The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults is a list of medications that healthcare providers reference to safely prescribe medications for people above age 65. Healthcare providers use the Beers Criteria as a guide to do no harm. 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. 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. To accompany the updated AGS Beers Criteria® in 2015, the AGS also developed a list of safer medications 12 attempted to preserve the spirit and intent of the original Beers Criteria by providing an explicit 13 list of PIMs that are best avoided by older adults in most circumstances or under specific 14 . situations, such as certain diseases, conditions, or care settings. 15 Potentially Harmful Drugs in the Elderly: Beers List In 1991, Dr. Mark Beers and colleagues published a methods paper describing the development of a consensus list of medicines considered to be inappropriate for long-term care facility residents. 12 The American Geriatrics Society Beers Criteria or “Beers list” is now in its fifth
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