Table 3 Prevalence of specific Beers’ PIMs with recommendations and rationale

Furosemide

77 (43)

Use with caution

May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults

Tramadol

25 (14.5)

Avoid if CrCl < 30 = 1

CNS adverse effect

Use with caution = 24

May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults

Spironolactone

22 (11.4)

Avoid in patients with CrCl < 30 = 2

Increased potassium

Use with caution = 20

May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults

Ranitidine

17 (8.8)

Reduce dose if CrCl is < 50

Mental status changes

Cimetidine

13 (7.2)

Reduce dose if CrCl is < 50

Mental status changes

Metoclopramide

8 (4.7)

Avoid, unless for gastroparesis with a duration of use not to exceed 12 weeks except in rare cases

Can cause extrapyramidal effects, including tardive dyskinesia; the risk may be greater in frail older adults

Digoxin

4 (2.1)

Avoid this rate control agent as first-line therapy for atrial fibrillation

Should not be used as a first-line agent in atrial fibrillation, because there are safer and more effective alternatives for rate control

Aspirin and Warfarin

3 (1.5)

Avoid when possible; if used together, monitor INR closely

Increased risk of bleeding

Hydrochlorothiazide

3 (2.1)

Use with caution

May exacerbate or cause SIADH or hyponatremia; monitor sodium level closely when starting or changing dosages in older adults

Amitriptyline

2 (1.0)

Avoid

Highly anticholinergic, sedating, and cause orthostatic hypotension

Warfarin and Ciprofloxacin

2 (1.0)

Avoid when possible; if used together, monitor INR closely

Increased risk of bleeding

Aspirin

1 (0.5)

Use with caution in patients ≥ 70 years

Aspirin for primary prevention of cardiovascular disease

Dexamethasone and NSAID

1 (0.5)

Avoid; if not possible, provide gastrointestinal protection

Increased risk of peptic ulcer disease or gastrointestinal bleeding

Sliding-scale regular Insulin alone

1 (0.5)

Avoid

Insulin regimens that include only short-or rapid-acting insulin increase the risk of hypoglycemia without improvement in hyperglycemia management regardless of the care setting

Risperidone

1 (0.5)

Avoid

Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium