Drug Safety Among Seniors: Things You Should Know

Certain Drugs Work Differently Among Elderly Populations

Woman with pills in hand
Guido Mieth/Moment/Getty Images

If you're a senior, you may have questions about drug safety. Medicines that are helpful to young adults and middle-aged folks can sometimes do more harm than good to seniors. Bodily changes that many older people experience, such as weight loss, fatty tissue increase, and lowered liver and kidney functions affect the way drugs work. Here's a rundown on some common over-the-counter (OTC) and prescription medications that can pose danger for those in their mid-60s and older, and some advice in general about seniors and drug safety.

Antidepressants and Anti-Anxiety Drugs

Elavil (amitriptyline): A common adverse effect of this prescription tricyclic antidepressant is slowed electrical impulses in the heart, which can lead to arrhythmia, also known as irregular heartbeat, especially in seniors. For those who are aged 65 and older, an electrocardiogram, or EKG, should be taken before taking Elavil. The EKG measures the heart's electrical activity, which should then be monitored annually while taking this drug.

Seniors on Elavil who are also taking blood pressure-lowering medications are susceptible to sudden drops in blood pressure when rising from a seated position (a phenomenon called orthostatic hypotension), so standing up should always be done slowly to avoid fainting.

Prozac (fluoxetine): The first selective serotonin reuptake inhibitor (SSRI), prescription Prozac can have adverse effects such as lightheadedness or dizziness, particularly in older people who have dementia.

This medication may also elevate the risk of developing diabetes, especially in those who are overweight or have a family history of the disease.

Librium (chlordiazepoxide): Adverse effects that include aggression, anger and rage are more likely in seniors taking prescription Librium, a benzodiazepine intended to relieve anxiety disorders and symptoms of alcohol withdrawal.

Valium (diazepam): Another prescription benzodiazepine, Valium, may cause drowsiness, unsteadiness or breathing difficulties in seniors with liver or kidney disease, because this medication lingers in the body longer.


Macrodantin (nitrofurantoin): Older patients may be more likely to experience adverse effects of this prescription antibiotic, which include fatigue, drowsiness, dizziness, itching, rash, loss of appetite, nausea, diarrhea and vomiting.

Cardiovascular Medications

Beta Blockers Inderal (propranolol) and Levatol (penbutolol): In patients over age 60, beta blockers should only be used as a prescription for hypertension, because they come with a higher risk of stroke, myocardial infarction (heart attack) and death than other blood pressure medications. Serious conditions such as heart failure or ischemic heart disease may still require the use of beta blockers, even in seniors, because the benefits outweigh the risks.

Calcium Channel Blockers Norvasc (amlodipine) and Cardizem (diltiazem): Prescription calcium channel blockers prescribed to reduce blood pressure can cause heart failure, a condition in which the heart can't pump enough blood to ward off fluid build up in the body.

Coumadin (warfarin): Although Coumadin or another similarly prescribed "blood thinner" is not more dangerous for seniors than it is for other people when taken by itself, blood thinners many medication interactions, or interaction with other drugs, have caused them to be the primary reason why people over age 65 seek emergency room treatment.

Although it's safe to take these medications with an over-the-counter (OTC) or prescription acetaminophen, such as Tylenol, ask your physician before using or any nonsteroidal anti-inflammatory drug (NSAID), which includes Advil (ibuprofen) or Aleve (naproxen). The combination of these medicines with Coumadin or the similar medications may inhibit blood clotting and lead to bleeding in the stomach and intestines in some high-risk patients, which can be fatal. Many other drugs and natural remedies, such as St. John's wart, can also cause dangerous internal bleeding in conjunction with Coumadin. If you are taking this medication, let your doctor know about each new medicine--whether OTC or prescription--you may be adding to your daily regimen.

Insomnia/Allergy Medications

Benadryl and Simply Sleep (diphenhydramine): These OTC drugs are available without a prescription to relieve allergy symptoms or insomnia; they can cause mental impairment, sleep cycle interruptions, urinary retention, constipation and blurred visions in older adults.

Original article content edited by Naveed Saleh, MD, MS, on 2/10/2016.


Agostini, Joseph V., Linda S. Leo-Summers, and Sharon K. Inouye. "Cognitive and Other Adverse Effects of Diphenhydramine Use in Hospitalized Older Patients." Archives of Internal Medicine 161:17(2001): 2091-7. 24 Feb. 2009

"Amitriptyline." myhealth.ucsd.edu. 26 Mar. 2008. University of California San Diego. 24 Feb. 200

Budnitz, Daniel S., Nadine Shehab, Scott R. Kegler, and Chelsey L. Richards. "Medication Use Leading to Emergency Department Visits for Adverse Drug Events in Older Adults." Annals of Internal Medicine 147:11(2007): 755-65. 24 Feb. 2009

"Calcium Channel Blockers." fairview.org. 3 Oct. 2006. Fairview Health Services. 24 Feb. 2009

"Cimetidine." myhealth.ucsd.edu. 14 Apr. 2006. University of California San Diego. 24 Feb. 2009

"Diazepam." myhealth.ucsd.edu. 1 Apr. 2008. University of California San Diego. 24 Feb. 2009

"Diazepam (Valium, Diastat)." med.nyu.edu. 2008. NYU Langone Medical Center. 24 Feb. 2009
"Diphenhydramine." nlm.nih.gov. 10 Dec. 2008. National Institutes of Health. 24 Feb. 2009
"Elavil (Amitriptyline)." psychatlanta.com. 2008. Northwestern Behavioral Medicine. 24 Feb. 2009.

Kunin, Calvin. "Inappropriate Medication Use in Older Adults: Does Nitrofurantoin Belong on the List for the Reasons Stated?" Archives of Internal Medicine 164:15(2004). 24 Feb. 2009.

"Librium (Chlordiazepoxide)." psychatlanta.com. 2008. Northwestern Behavioral Medicine. 24 Feb. 2009

"Olanzapine/Fluoxetine, Oral." fairview.org. 8 Oct. 2007. Fairview Health Services. 24 Feb. 2009

"P&T Committee Update on Nitrofurantoin." hss.state.ak.us. 17 Dec 2002. State of Alaska. 24 Feb. 2009

"Potentially Harmful Drugs in the Elderly: Beers List and More." fmda.org. 2007. Florida Medical Directors Association. 24 Feb. 2009

"Propoxyphene." myhealth.ucsd.edu. 36 Mar. 2008. University of California San Diego. 24 Feb. 2009
Schumann, Sarah-Anne and John Hickner. "When Not to Use Beta-Blockers in Seniors With Hypertension." The Journal of Family Practice 57:1(2008) 24 Feb. 2009

"Tricyclic Antidepressants." psychatlanta.com. 2008. Northwestern Behavioral Medicine. 24 Feb. 2009
"Warfarin." myhealth.ucsd.edu. 14 Feb. 2008. University of California San Diego. 24 Feb. 2009


Continue Reading