Decreased beta-adrenergic responsiveness with age and comorbid conditions makes beta-blockers unattractive. Thus, they should not be considered appropriate for first-line therapy of uncomplicated hypertension in the geriatric population.
Patients 65 years or older may be more sensitive to the effects of the usual adult dose due to the anticholinergic properties of meclizine. Caution is advisable when dosing for this population. Meclizine is an FDA Pregnancy Category B drug.
Tricyclic antidepressants, especially amitriptyline and dothiepin,16 are known to pose a high risk of death in overdosage. These drugs should therefore be avoided in older people whose medication is not supervised and who are at risk of taking an overdose.
Benadryl and older antihistamines
Because as we age, it's harder for our bodies to properly get rid of them. And higher doses may be needed for them to work. That can greatly raise your risk of side effects, including confusion.
Beta-blockers should not be used to treat hypertension in patients older than age 60 unless they have another compelling indication to use these agents, such as heart failure or ischemic heart disease. Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis.
However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving metoprolol.
Is there anybody who shouldn't be prescribed a beta blocker? There are some conditions in which beta blockers are not recommended. This includes uncontrolled heart failure, hypotension (low blood pressure), certain problems with the rhythm of your heart, or bradycardia (a very slow heart beat).
However, elderly patients are more likely to have unwanted effects (eg, severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness) and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving diazepam.
Overdoses are a leading cause of medication fatalities. And although prescription drugs are the most common offenders, it's also possible to overdose on over-the-counter medications. Seniors, in particular, are at risk of overdosing due to declines in memory.
Important examples of drugs with a higher risk of toxic effects because of age-related reductions in first-pass metabolism include nitrates, propranolol, phenobarbital, and nifedipine.
The central nervous system and the brain are very sensitive to anticholinergic side effects due to fewer cholinergic neurons or receptors in the brain of older individuals. In addition, the liver and kidney have less ability to break down and excrete medications. Also, drugs can cross more easily into the brain.
Older adults are more sensitive to adverse events associated with anticholinergics, including confusion, dry mouth, blurry vision, constipation, urinary retention, decreased perspiration, and excess sedation. Anticholinergics have also been associated with increased risk of dementia.
There are actually plenty of reasons for older people to avoid Cipro and other antibiotics known as fluoroquinolones, which have prompted warnings from the Food and Drug Administration about their risks of serious side effects.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of amlodipine in the elderly.
However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving propranolol.
Low-dose thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line medications that should be selected based on comorbidities and risk factors.
Angiotensin Receptor Blockers
ARBs are considered the alternative first-line treatment for hypertension in the elderly population when a diuretic is contraindicated. In elderly hypertensive patients with diabetes or HF, ARBs are considered first-line treatment and an alternative to ACE inhibitors.
Traditional contraindications to beta-blockers are peripheral vascular diseases, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and asthma.
What they actually recommend is that if you're over 65, or if you have liver or kidney problems, you should ask your doctor if it's OK to use it. Since Zyrtec is now an over-the-counter antihistamine and can be taken without a doctor's knowledge, they're just advising caution in older folks.
Who is Defined as Elderly? Typically, the elderly has been defined as the chronological age of 65 or older. People from 65 to 74 years old are usually considered early elderly, while those over 75 years old are referred to as late elderly.
According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), seniors should avoid taking first-generation antihistamines.