The American Geriatrics Society (AGS) has published the 2019 Beers Criteria which includes updated information on medications that may be potentially inappropriate for use in older adults. The entire guideline has been published in the Journal of the American Geriatrics Society.

The AGS Beers Criteria is comprised of 5 lists: Drugs that should be avoided by most older people; drugs that should be avoided by older people with specific health conditions; drugs that should be avoided in combination with other treatments because of drug-drug interactions; drugs that should be used with caution, and drugs that should be dosed differently or avoided in those with reduced renal function.

Over 1400 clinical trials and research studies were reviewed by a panel of 13 experts to develop the new guideline. Specific changes for 2019 include the addition of 30 drugs or drug classes to avoid in older patients, 40 medications that should be used with caution or avoided in certain patients because of comorbidity, and several changes to drugs that were previously considered inappropriate and were either removed from the list or moved to a different category.

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Some examples of drugs that were removed from the 2015 AGS Beers Criteria include ticlopidine and oral pentazocine, which is no longer available in the US.  For patients with dementia or cognitive impairment, H2-receptor antagonists were removed from the “avoid” list. “This is because evidence for adverse cognitive effects in these conditions is weak, and because the panel expressed concern that the intersection of this criterion with another criterion that discourages chronic use of proton pump inhibitors in the absence of strong indications would overly restrict therapeutic options for older adults with dementia who have gastroesophageal reflux or similar issues,” the authors explained.

New drugs that have been added to the “Use with Caution” list since 2015 include, rivaroxaban (increased risk of serious bleeding), tramadol (risk of SIADH/hyponatremia), dextromethorphan/quinidine (limited efficacy in dementia patients without pseudobulbar affect), and trimethoprim-sulfamethoxazole (hyperkalemia risk with concomitant ACEIs, ARBs in patients with reduced kidney function).

“The AGS Beers Criteria should never solely dictate how medications are prescribed, nor should it justify restricting health coverage,” said Michael Steinman, MD, a fellow co-chair of the AGS Beers Criteria panel. “This tool works best as a starting point for a discussion—one guided by personal needs and priorities as we age.”

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This article originally appeared on MPR