Medications and Older Adults | AAAAI (2024)

Medications and Older Adults | AAAAI (1)As people age, the number of medications they take often increases significantly. It is essential that older patients have an awareness of what medications they are taking, how to take them and what the potential side effects can be. This is especially true for older adults with allergies or asthma.

It is important not to let your treatments become asthma triggers. The best way to avoid medication-induced asthma is to talk with your physician about what medications are best for you.

Asthma Medications
There are times when a medication can be very beneficial for one ailment, but has the potential to cause concern for another condition. Such is the case with a particular class of asthma medications: inhaled corticosteroids (ICS). On the one hand, corticosteroids are known to contribute to the development of osteoporosis (a condition leading to brittle bones), which is a common problem for older patients, especially women. On the other hand, ICS is the most effective class of drugs in the treatment of asthma. There is concern that ICS may lead to osteoporosis because oral and injected steroids are well-known to contribute to this process.

Apart from being a potentially life-threatening disease, uncontrolled asthma puts you at a high risk for other complications. If your asthma is uncontrolled, you may not be sleeping well, it could become difficult to maintain an active lifestyle and you may require hospitalization. Reduced levels of activity, in turn, can also cause osteoporosis.

An allergist / immunologist, often referred to as an allergist, has extensive training in the management of asthma and in minimizing the side effects of medications such as inhaled corticosteroids.

Allergy Medications
Allergies such as allergic rhinitis (hay fever), allergic conjunctivitis (eye allergy) and urticaria (hives) are common problems for older adults and often require the use of antihistamines. Antihistamines are divided into two classes: first generation antihistamines and second generation antihistamines.
First generation antihistamines, while very effective at controlling symptoms, are often associated with symptoms in older adults such as anxiety, confusion, sedation, blurred vision, reduced mental alertness, urinary retention and constipation. These side effects are even more common if you are being treated with certain antidepressant medications.

The second and third generation antihistamines do not cross the blood-brain barrier as readily and, therefore, cause fewer side effects. If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine. Physician and allergist prescribed antihistamines currently in use are generally second or third generation drugs that have an extremely favorable safety profile for users.

Drugs That Can Trigger Asthma
These drugs are often used for problems such as high blood pressure, heart disease and migraine headache. They may also be used in an eye drop form for treating the eye disease glaucoma. They are classified in one of two groups: non-specific and specific.

Non-specific beta-blockers, such as propanalol, are the most important ones to avoid. Ideally, a person with asthma would avoid all beta-blockers, but these types of drugs may be quite important for certain patients' health and may not substantially worsen their asthma. Your physician may conduct a trial using a "specific" beta-blocker. Remember that even beta-blockers in eye drops may make asthma worse, so be sure to tell your ophthalmologist that you have asthma.

Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
This group of medications include some common over-the-counter pain relievers, such as ibuprofen and naproxen. Approximately 10 to 20% of people with asthma may notice that one or more of these drugs trigger their asthma. These asthma attacks may be severe and even fatal, so patients with known aspirin sensitivity must be very careful to avoid these drugs. Medications that usually don't cause increased asthma in aspirin-sensitive patients include acetaminophen (low to moderate dose), propoxyphene and prescribed narcotics such as codeine.

ACE Inhibitors
These drugs, which may be used for hypertension or heart disease, include lisinopril and enalapril. Although they usually don't cause asthma, approximately 10% of patients who receive one of these drugs develop a cough. This cough may be confused with asthma in some patients and possibly trigger increased wheezing in others. In addition, any cough can be associated with reflux (acid coming up from the stomach into the esophagus) which can cause more coughing and worsen asthma.

Healthy Tips
• Older patients should always know what medications they are taking, how they to take them and what the potential side effects can be. Work regularly with your allergist to fine tune your medications and control your asthma-related side effects.
• Inhaled corticosteroids (ICS) are the most effective class of drugs in the treatment of asthma, but are known to contribute to the development of osteoporosis.
• If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine.
• Some drugs, such as beta-blockers and non-steroidal anti-inflammatory drugs (NSAIDs), may trigger asthma in some people.

Medications and Older Adults | AAAAI (2024)


How does medication affect older adults? ›

As you age, changes in your body can affect how well medicines work. For example, the body may become less able to absorb the medicine. Older adults often have multiple medical conditions or take several medications at the same time, which can also affect how medicines work.

What is the common medication problem in the elderly? ›

Drug-related problems are common in older adults and include drug ineffectiveness, adverse drug effects, overdosage, underdosage, inappropriate treatment, inadequate monitoring, nonadherence, and drug interactions. (See also Overview of Drug Therapy in Older Adults.)

What medications are inappropriate for older adults? ›

AVOID Certain Medications used for Anxiety and/or Insomnia
  • Benzodiazepines, such as diazepam (Valium), alprazolam (Xanax), or chlordiazepoxide (Librium)
  • Sleeping pills such as zaleplon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta)

What are 5 drugs to avoid in the elderly? ›

While it's not a complete list, below we discuss important ones you should know and safer alternatives to consider.
  • Benadryl and older antihistamines. ...
  • Sleep medications. ...
  • Muscle relaxers. ...
  • Antispasmodics. ...
  • Seroquel and other antipsychotic medications. ...
  • Tricyclic antidepressants. ...
  • Barbiturates. ...
  • Indomethacin.
Nov 22, 2022

How does aging affect medication response? ›

As you get older, body changes can affect the way medicines are absorbed and used. For example, changes in the digestive system can affect how fast medicines enter the bloodstream. Changes in body weight can influence the amount of medicine you need to take and how long it stays in your body.

Why are elderly sensitive to medication? ›

Age-related changes in physiology and pharmaco*kinetics (how drugs are used in the body) lead to increased drug sensitivity and potentially harmful drug effects.

What age is considered elderly? ›

Traditionally, the “elderly” are considered to be those persons age 65 and older.

Why is Benadryl bad for the elderly? ›

Diphenhydramine can cause decreased reaction times and dizziness. In older people with other medical problems or physical impairments, this may lead to falls or accidents, especially while getting up to urinate at night. The potential for bone fractures is a notable concern.

What is the key concern in medicating patients over 60 years of age? ›

What You Need to Know. People over 60, who may take daily medications for multiple chronic conditions, are at risk for overmedication and other complications of polypharmacy. Complications can include sedation, increased risk for falls and side effects.

What are the two worst blood pressure medications? ›

5 of the worst blood pressure medications
  1. Beta blockers. Usually, beta blockers aren't used as first-choice therapies to lower blood pressure. ...
  2. Loop diuretics. Furosemide (Lasix) is a type of diuretic (water pill) known as a loop diuretic. ...
  3. Alpha blockers. ...
  4. Vasodilators. ...
  5. Alpha-2 agonists.
Feb 14, 2024

Why should people over 65 not take Zyrtec? ›

However, one group of people is more likely to experience side effects from Zyrtec: older adults, or people 65 years and older. For this age group, even second-generation antihistamines can cause excessive fatigue and sleepiness, which could lead to other problems, like accidental falls and injury.

Which are medications that most often cause confusion in older adults? ›

Narcotics and opiates such as codeine, hydrocodone (Vicodin®, Norco®), oxycodone (OxyContin®), morphine (MS Contin®, Roxanol®), fentanyl (Duragesic®) and hydromorphone (Dilaudid®) are often used for pain relief. Unfortunately, they often can cause confusion and falls in older adults.

Why can't seniors take ibuprofen? ›

If you're over 65, ibuprofen can make you more likely to get stomach ulcers. Your doctor will prescribe you a medicine to protect your stomach if you're taking ibuprofen for a long-term condition.

What are the 9 prescription drugs that cause dementia? ›

Some anticholinergic drugs linked to dementia risk include:
  • Amitriptyline (Elavil)
  • Aripiprazole (Abilify)
  • Benztropine (Cogentin)
  • Biperiden (Akineton)
  • Brompheniramine (Dimaphen DM)
  • Carbamazepine (Tegretol)
  • Chlorpheniramine (ChlorTrimeton)
  • Chlorpromazine (Thorazine)
Jun 19, 2023

Is Tylenol PM OK for seniors? ›

Older adults may be more sensitive to the side effects of this drug, especially dizziness, drowsiness, confusion, constipation, or trouble urinating. Dizziness, drowsiness, and confusion can increase the risk of falling.

What is the most common medication problem? ›

Common misuses that lead to adverse drug events are taking incorrect doses, taking doses at the wrong times, forgetting to take doses, or stopping the medication too soon (all nonadherence issues).

What is the most common adverse drug effect seen in the elderly? ›

Adverse drug reactions (ADRs) are common in older adults, with falls, orthostatic hypotension, delirium, renal failure, gastrointestinal and intracranial bleeding being amongst the most common clinical manifestations.

What is the most common disorder in the elderly? ›

The most common mental health conditions for older adults are depression and anxiety.


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