High Risk Medications and the Elderly

Use of High-Risk Medication in the Elderly

The Healthcare Effectiveness Data and Information Set (HEDIS®) measure “Use of High-Risk Medications in the Elderly” targets safe use of medications in patients ages 65 and older.

Medications on the list are based on the Beer’s list, the recognized consensus standards for medication use in older adults.

The medications listed below have been determined to be harmful, regardless of medication dose, frequency, or patient’s underlying health status:

Therapeutic Class	Medication Name
Antianxiety	▪ meprobamate   ▪ aspirin-meprobamate
Antiemetic	▪ trimethobenzamide                                                           ▪ scopolamine
Analgesic	▪ ketorolac                                                                           ▪ acetaminophen-diphenhydramine ▪ diphenhydramine-magnesium salicylate
Antihistamines	▪ APAP/dextromethorphan/diphenhydramine                    ▪ promethazine ▪ APAP/diphenhydramine/phenylephrine                          ▪ diphenhydramine ▪ APAP/diphenhydramine/pseudoephedrine                      ▪ hydroxyzine hydrochloride ▪ acetaminophen-diphenhydramine                                    ▪ diphenhydramine-tripelennamine ▪ codeine/phenylephrine/promethazine                              ▪ diphenhydramine-phenylephrine ▪ diphenhydramine-pseudoephedrine                                ▪ cyproheptadine ▪ dexchlorpheniramine/guaifenesin/PSE                            ▪ dextromethorphan-promethazine ▪ dexchlorpheniramine-pseudoephedrine                            ▪ codeine-promethazine ▪ dexchlorpheniramine/dextromethorphan/PSE                 ▪ phenylephrine-promethazine ▪ dexchlorpheniramine/methscopolamine/PSE                  ▪ dexaclropheniramine  ▪ diphenhydramine-magnesium salicylate                          ▪ tripelennamine ▪ diphenhydramine/hydrocodone/phenylephrine                ▪ hydroxyzine pamoate ▪ atropine/CPM/hyoscyamine/PE/PPA/scolpolamine         ▪ carbetapentane/diphenhydramine/ ▪ dexachlorpheniramine/hydrocodone/phenylephrine            ▪ phenylephrine
Antipsychotics, typical	▪ thioridazine                              ▪ mesoridazine
Amphetamines	▪ dexmethylphetamine               ▪ benzphetamine               ▪ methylphenidate  ▪ pemoline                                  ▪ phendimetrazine             ▪ phentermine ▪ dexmethylphenidate                ▪ diethylpropion                ▪ methamphetamine                    ▪ amphetamine-dextroamphetamine
Barbiturates	▪ amobarbital                              ▪ secobarbital                    ▪ amobarbital-secobarbital   ▪ butabarbital                              ▪ mephobarbital                ▪ phenobarbital ▪ pentobarbital
Long-acting benzodiazepines	▪ chlordiazepoxide                      ▪ flurazepam                     ▪ amitriptyline-chlordiazepoxide ▪ diazepam                                                                            ▪ chlordiazepoxide-clidinium
Calcium channel blockers	▪ nifedipine –short acting only
GI antispasmodics	▪ propantheline                            ▪ dicyclomine
Belladonna alkaloids	▪ belladonna/ergotamine/phenobarbital                                ▪ atropine                                               ▪ atropine/hyoscyamine/PB/scopolamine                             ▪ atropine–difenoxin ▪ butabarbital/hycosycamine/phenzopyridine                       ▪ atropine-diphenoxylate ▪ digestive enzymes/hyoscyamine/phenyltoloxamine          ▪ hyosycamine ▪ belladonna/caffeine/ergotamine/pentobarbital                   ▪ belladonna   ▪ atropine/CPM/hyoscyamine/PE?scoplamine                     ▪ atropine-edrophonium              ▪ hyoscyamine/methenam/m-blue/phenyl salicyl                  ▪ hyosycamine-phenobarbital
Skeletal muscle relaxants	▪ ASA /caffeine/orphenadrine    ▪ aspirin-methocarbamol    ▪ carisprodol ▪ ASA/carisoprodol/codeine       ▪ aspirin-carisoprodol        ▪ chlorzoxazone ▪ aspirin –meprobamate              ▪ cyclobenzaprine              ▪ metaxalone                              ▪ methocarbamol                         ▪ orphenadrine
Oral estrogen	▪ esterified estrogen-methyltestosterone                               ▪ conjugated estrogen ▪ estropipate                                ▪ esterified estrogen           ▪ conjugated estrogen-medroxyprogesterone
Oral hypoglycemics	▪ chlorpropamide
Narcotics	▪ ASA/caffeine/propoxyphene    ▪ meperidine                   ▪ meperidine-promethazine ▪ propoxyphene napsylate          ▪ pentazocine                   ▪ naloxone-pentazocine    ▪ acetaminophen-pentazocine     ▪ belladonna-opium         ▪ propoxyphene hydrochloride   ▪ acetaminophen-propoxyphene
Vasodilators	▪ cyclandelate   ▪ ergot mesyloid  ▪ isoxsuprine                   ▪ dipyridamole-short acting only
Others	▪ methyltestosterone                    ▪ thyroid desiccated         ▪ nitrofurantoin macrocrytals ▪ nitrofurantoin                            ▪ nitrofurantoin macrocrystals-monohydrate

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This list is promulgated by Optima Health as recommendations for the clinical management using specific medications in the elderly. Clinical data in a particular case may necessitate or permit deviation from these recommendations. The list of High Risk Medications in the Elderly is institutionally endorsed and is not intended as a substitute for clinical judgment. 9/08