Related article: effects and should, therefore, be avoided in the elderly. G3. Phenylbutazone may produce serious hematological side effects and should not be used in elderly patients. G4. Pentazocine is a narcotic analgesic that causes more central nervous system side effects, including confusion and hallucinations, more commonly than other narcotic drugs. Additionally, it is a mixed agonist and antagonist. For both reasons, its use should generally be avoided in the elderly. G5. Trimethobenzamide is one of the least effective antiemetic drugs, yet it can cause extrapyramidal side effects. When possible, it should be avoided in the elderly. G6. Most muscle relaxant and antispasmodic drugs (Robaxin, Soma, Ditroban, Paroflex, Skelaxin, Flexaril) are poorly tolerated by the elderly, leading to anticholinergic side effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by the elderly is questionable. Whenever possible, they should not be used by he elderly. G7. Benzodiazepine hypnotic such as Dalmane has an extremely Cheap Generic Clonazepam long half-life in the elderly (often days), producing prolonged sedation and increasing the incidence of falls and fractures. Medium- or short-acting benzodiazepines are preferable. G8. Because of it's strong anticholinergic and sedating properties, amitriptyline (Limbitrol, Sinequan, Triavil) is rarely the antidepressant of choice for the elderly. G9. Meprobamate is a highly addictive and sedating anxiolytic. Avoid in elderly patients. Those using meprobamate for prolonged periods may be addicted and may need to be withdrawn slowly. G10. Because of increased sensitivity to benzodiazepines in the elderly, smaller doses may be effective as well as safer. Total daily doses should rarely exceed the following suggested maximums. Drug NMT per Day Ativan 3mg Serax 60mg Xanax 2mg Restoril 15mg Ambien 5mg Halcion .25mg G11. Chlordiazepoxide and diazepam have a long half-life in the elderly (often several days), producing prolonged sedation and increasing the risk of falls and fractures. Short - and intermediate-acting benzodiazepines are preferred if Cheap Generic Clonazepam a benzodiazepine is required. G12. Disopyramide, of all antiarrhythmic drugs, is the most potent negative inotrope and therefore may induce heart failure in the elderly. It is also strongly anticholinergic. When appropriate, other antiarrhythmic drugs should be used. G13. Because of decreased renal clearance of digoxin, doses in the elderly should rarely exceed 0.125mg daily, except when treating atrial arrhythmias. G14. Dipyridamole (Persaritine) frequently causes orthostatic hypotension in the elderly. It has been proven beneficial only in patients with artificial heart valves. Whenever possible, its use in the elderly should be avoided. G15. Methyldopa may cause bradycardia and exacerbate depression in the elderly. Alternate treatments for hypertension are generally preferred. G16. Reserpine imposes unnecessary risk in the elderly, inducing depression, potence, sedation, and orthostatic hypotension. Safer alternatives exist. G17. Chlorpropamide has a prolonged half-life in the elderly and can cause prolonged and serious hypoglycemia. Additionally, it is the only oral hypoglycemic agent that causes SIADH. Avoid in the elderly. G18. Gastrointestinal antispasmodic drugs are highly anticholinergic and genrally produce substantial toxic effects in the elderly. additionally their effectiveness at doses tolerated by the elderly is questionable. All these drugs are best avoided in the elderly, especially for long-term use. G19. All non-prescirption and many prescirption antihistamines have potent anticholinergic properties. Many cough and cold preparations are available without Cheap Generic Clonazepam antihistamines, and these are safer substitutes in the elderly. G20. Diphenhydramine is potently antichoinergic and usually should not be used as a hypnotic in the elderly. When used to treat or prevent allergic reactions, it should be used in the smallest possible dose and with great caution. G21. Hydergine (ergot mesyloids) and the cerebral vasodilators have not been shown to be effective, in the doses studied, for the treatment of dementia or any other condition. G22. Iron supplements rarely need to be given in doses exceeding 325mg of ferrous sulfate daily. When doses are higher, total absorption is not substantially increased, but constipation is more likely to occur. G23. Barbiturates cause more side effects than most other sedative or hypnotic drugs in the elderly and are highly addictive. They should not be started as new therapy in the elderly except when used to control seizures.
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