Merck Manual

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Some Disorders and Symptoms That Can Be Worsened by Drugs in Older People

Some Disorders and Symptoms That Can Be Worsened by Drugs in Older People

Disorder or Symptom


NSAIDs (such as ibuprofen and naproxen)

Delirium, dementia, or mild cognitive impairment



Drugs with sedative effects (such as benzodiazepines, sedatives, and sleep aids) or anticholinergic effects*

Histamine-2 blockers (cimetidine, famotidine, nizatidine, ranitidine)


Fainting or orthostatic hypotension (sudden decrease in blood pressure when a person stands up)

Chlorpromazine, donepezil, doxazosin, galantamine, olanzapine, prazosin, some older antidepressants (such as amitriptyline and imipramine), rivastigmine, terazosin, thioridazine

Use of more than one antihypertensive drug (or too much of one antihypertensive)

Drugs with sedative effects (such as antiepileptic drugs, antipsychotics, benzodiazepines, eszopiclone, zaleplon, and zolpidem), antidepressants, some antihypertensive drugs when used at high doses, and opioids

Cilostazol, diltiazem, disopyramide, dronedarone (in patients with severe heart failure), NSAIDs and COX-2 inhibitors, pioglitazone, rosiglitazone, verapamil

Caffeine, oral decongestants (such as pseudoephedrine and phenylephrine), stimulants (such as armodafinil, amphetamine, methylphenidate, and modafinil), theophylline, selegiline

Certain antinausea drugs (metoclopramide, prochlorperazine, promethazine) and most antipsychotics except a few such as quetiapine and clozapine

Peptic ulcer disease or stomach bleeding

Aspirin and most NSAIDs

Bupropion, chlorpromazine, clozapine, maprotiline, meperidine, olanzapine, thioridazine, thiothixene, tramadol

Doxazosin, estrogens taken by mouth or through the skin (not applied directly to the vagina), prazosin, terazosin

Urinary retention or urinary symptoms caused by an enlarged prostate (such as slow urinary flow, frequent urination of smaller amounts, and dribbling)

Drugs with anticholinergic effects*, cold remedies containing decongestants, or a combination of antihistamines and decongestants

*Anticholinergic effects include confusion, blurred vision, constipation, dry mouth, light-headedness and loss of balance, and difficulty starting to urinate.

COX-2 inhibitors = coxibs; NSAIDs = nonsteroidal anti-inflammatory drugs.