Propoxyphene (DARVON, DOLENE) offers no more pain relief than acetaminophen (Tylenol) and has narcotic side effects. It may cause constipation, drowsiness, confusion, and (rarely) slowed breathing. Like other narcotics (opioids), it may be addictive.
Of all the nonsteroidal anti-inflammatory drugs, indomethacin (INDOCIN) most affects the brain. It sometimes causes confusion or dizziness. When injected, meperidine (DEMEROL) is a strong analgesic, but when taken orally, it's not very effective for pain and often causes confusion.
Pentazocine (TALWIN) is a narcotic analgesic that is more likely to cause confusion and hallucinations than are other narcotics.
Dipyridamole (PERSANTINE) can cause light-headedness upon standing (orthostatic hypotension) in the elderly. For most people, it offers little advantage over aspirin in preventing blood clots.
Ticlopidine (TICLID) is no more effective than aspirin for most people in preventing blood clots and is considerably more toxic. It may be useful as an alternative for people who can't take aspirin.
Typical doses of some histamine blockers (especially cimetidine (TAGAMET), but also to some extent ranitidine (ZANTAC), nizatidine (AXID), and famotidine (PEPCID)) may cause adverse effects, especially confusion.
Because of its strong anticholinergic and sedating properties, amitriptyline (ELAVIL, ENDEP) usually isn't the best antidepressant for the elderly. Doxepin (SINEQUAN, ZONALON) is also strongly anticholinergic.
Trimethobenzamide (TIGAN) is one of the least effective drugs for nausea and can cause adverse effects, including abnormal movements of the arms, legs, and body.
All nonprescription and many prescription antihistamines have potent anticholinergic eftects. The drugs include chlorpheniramine (CHLOR-TRIMETRON, TELDRIN), diphenhydramine (BENADRYL, NYTOL, SOMINEX), hydroxyzine (ATARAX, VISTARIL), cyproheptadine (PERIACTIN), promethazine (PHENERGAN), tripelennamine, dexchlorpheniramine (POLARAMINE), and combination cold remedies. Although sometimes helpful for allergic reactions and seasonal allergies, antihistamines are generally not appropriate for a runny nose and other symptoms of a viral infection. When antihistamines are needed, those without anticholinergic effects (terfenadine (SELDANE), loratadine (CLARITIN), and astemizole (HISMANAL)) are preferable. Cough and cold remedies that don't include antihistamines are generally safer for the elderly.
Methyldopa (ALDOMET), alone or in combination with other drugs, may slow the heartbeat and worsen depression. Reserpine is risky, as it can induce depression, impotence, sedation, and dizziness upon standing.
Although antipsychotics such as chlorpromazine (THORAZINE), haloperidol (HALDOL), thioridazine (MELLARIL), and thiothixene (NAVANE) are effective in treating psychotic disorders, their effectiveness in treating behavioral disturbances associated with dementia (such as agitation, wandering, repeated questioning, throwing, and hitting) hasn't been established. These drugs are often toxic, producing sedation, movement disorders, and anticholinergic side effects.
Elderly people should use antipsychotics in small doses, if at all. The need for threatment should be reassessed often, and the drugs should be discontinued as soon as possible.
Gastrointestinal antispasmodics, such as dicyclomine (BENTYL), hyoscyamine (LEVSIN), propantheline (PRO-BANTHINE), belladonna alkaloids, and clidinium-chlordiazepoxide, are given to treat stomach cramps and pain. They are highly anticholinergic, and their usefulness - especially at the low doses tolerated by the elderly - is questionable.
Chlorpropamide (DIABINESE) has long-lasting effects, which are exaggerated in the elderly, and can cause prolonged low blood sugar levels (hypoglycemia). Because chlorpropamide causes the body to retain water, it can also lower the level of sodium in the blood.
Doses of ferrous sulfate exceeding 325 milligrams daily don't greatly improve absorption and are likely to cause constipation.
Most muscle relaxants and antispasmodics such as methocarbamol (ROBAXIN), carisoprodol (SOMA), oxybutynin (DIROPAN), chlorzoxazone, metaxalone, and cyclobenzaprine (FLEXERIL), lead to anticholinergic side effects, sedation, and weakness The usefulness of all muscle relaxants and antispasmodics at the low doses tolerated by elderly is questionable.
Meprobamate (EQUANIL, MILTOWN) offers no advantages over benzodiazepines and has many disadvantages.
Chlordiazepoxide (LIBRIUM), diazepam (VALIUM), and flurazepam (DALMANE) - benzodiazepines used to treat anxiety and insomnia - have extremely long-lasting effects in the elderly (often more than 96 hours). These drugs, alone or in combination with others, can cause prolonged drowsiness and increase the risk oi falls and fractures.
Diphenhydramine (BENADRYL, NYTOL, SOMINEX), an antihistamine, is the active ingredient in many over-the-counter sedatives. However, diphenhydramine has potent anticholinergic effects.
Barbiturates, such as secobarbital (SECONAL) and phenobarbital, cause more adverse effects than other drugs used to treat anxiety and insomnia. They also interact with many other drugs. Generally, the elderly should avoid barbiturates except for the treatment of seizure disorders.
