Medications That Are High-Risk for Seniors: What to Review

Every year, thousands of seniors end up in the hospital-not because of a fall, heart attack, or infection, but because of a medication they were told was safe. The truth is, some drugs that work fine for younger adults can be dangerous for older bodies. Aging changes how your body processes medicine. Your liver slows down. Your kidneys don’t filter as well. Your brain becomes more sensitive to sedatives. What was once a harmless pill can become a silent threat.

Why Seniors Are at Higher Risk

People over 65 are more likely to take five or more medications at once. That’s called polypharmacy. And with each added pill, the risk of bad reactions goes up. One drug can interfere with another. A mild side effect can turn into a fall, a broken hip, or confusion that looks like dementia. The AGS Beers Criteria is the gold standard doctors use to spot these dangers. First created in 1991 and updated every two years, it lists medications that are more likely to cause harm than benefit in older adults. In 2023, the list was expanded to include five new high-risk drugs and removed three others based on new evidence.

The Centers for Disease Control and Prevention (CDC) says about 40% of seniors take five or more prescriptions. That’s not unusual-it’s the norm. But here’s the problem: many of these drugs were never tested on people over 70. Most clinical trials include younger, healthier volunteers. So when a doctor prescribes a drug based on those studies, they’re guessing how it will affect an 80-year-old with kidney trouble and three other conditions.

Top 5 High-Risk Medications for Seniors

1. Zolpidem (Ambien®) - This sleep aid might help you fall asleep, but it doesn’t let your brain wake up fully. Residual drowsiness can last up to 11 hours. Seniors who take it are 2.5 times more likely to fall and break a hip. Many report sleepwalking, confusion, or memory gaps the next day. In one study, 22% of users had falls serious enough to need medical care.
2. Glyburide (Diabeta®) - Used for type 2 diabetes, this drug can cause dangerously low blood sugar. For seniors, the risk is nearly double compared to newer options like glipizide. About 29% of elderly patients on glyburide experience hypoglycemia severe enough to land them in the ER. The FDA added a boxed warning in 2023, calling it especially risky for those over 65.
3. Diphenhydramine (Benadryl®) - Found in sleep aids, allergy pills, and even some cold medicines, this antihistamine has a high Anticholinergic Cognitive Burden (ACB) score of 3. That means it blocks a brain chemical called acetylcholine, which is critical for memory and focus. Long-term use increases dementia risk by 54%. Even one pill a day for over three years can cause lasting cognitive decline.
4. Nitrofurantoin (Macrobid®) - A common antibiotic for urinary tract infections, but it’s risky if your kidneys aren’t working well. For seniors with an eGFR below 60, this drug can cause serious lung damage. Studies show an 12.8-fold increase in pulmonary toxicity, with mortality rates as high as 18.3% in severe cases.
5. Promethazine (Phenergan®) - Often used for nausea or allergies, this drug can trigger tremors, stiffness, and even seizures in seniors, especially those with Parkinson’s or epilepsy. Many family members report extreme drowsiness lasting over 24 hours. Reddit communities filled with caregivers consistently recommend switching to ondansetron instead.

What Else to Watch Out For

Some drugs aren’t dangerous on their own-but become risky when combined. For example:

• Ciprofloxacin + Warfarin - This combo can spike your INR levels by 47%, leading to uncontrolled bleeding. The risk jumps 3.8 times in seniors over 70.
• Alpha-blockers (Doxazosin, Terazosin) - Used for high blood pressure or prostate issues, these cause sudden drops in blood pressure when standing. Seniors over 75 are 3.2 times more likely to faint than those on other blood pressure meds.
• Benzodiazepines (Lorazepam, Diazepam) - These are linked to a 50% higher risk of death over five years when used for sleep. They also increase car crash risk by 48% in drivers over 75.

Even something as simple as an over-the-counter sleep aid can be a hidden danger. Many seniors don’t realize that Benadryl, Unisom, or NyQuil all contain diphenhydramine. And if they’re already taking another anticholinergic drug-like an antidepressant or bladder medication-the effects multiply.

What’s Safer Instead?

The good news? There are often better choices.

• For sleep: Try trazodone (a low-dose antidepressant) or cognitive behavioral therapy for insomnia (CBT-I). Studies show CBT-I works better than sleeping pills long-term and has no physical side effects.
• For diabetes: Switch from glyburide to glipizide or metformin. Glipizide has a shorter half-life, so it’s less likely to cause low blood sugar overnight.
• For allergies or nausea: Replace promethazine with ondansetron or cetirizine. Both have minimal anticholinergic effects.
• For UTIs: Use nitrofurantoin only if kidney function is normal. Otherwise, fosfomycin or cephalexin are safer options.
• For anxiety or agitation: Avoid benzodiazepines. Try sertraline or escitalopram instead. They’re less sedating and don’t increase fall risk.

One patient, 78, was on glyburide and kept fainting. After switching to glipizide, her energy returned. She stopped falling. Her doctor told her, “You’re not just safer-you’re more alive.” That’s the difference.

How to Review Your Meds

You don’t need to wait for a crisis. Start now.

1. Do a brown bag review. Take all your pills-prescription, over-the-counter, vitamins, supplements-to your doctor or pharmacist. Don’t just list them. Bring the actual bottles.
2. Ask: “Is this still necessary?” Many drugs are prescribed for short-term use but kept for years. Ask if you can stop one at a time.
3. Check the anticholinergic burden. Use the Anticholinergic Risk Scale. If your total score is 3 or higher, talk to your doctor. Even one high-score drug can be enough to cause problems.
4. Use the Beers Criteria. Search “AGS Beers Criteria 2023” online. It’s free. Print the list. Bring it to your appointment.
5. Ask about alternatives. Don’t settle for “This is what we’ve always used.” Ask: “Is there a safer option for someone my age?”

Medicare requires annual medication reviews for beneficiaries enrolled in Part D. But only 32% of seniors say their doctor actually talked to them about risks. Don’t wait for them to bring it up. Be the one to ask.

What to Do If You’re Already Taking a High-Risk Drug

Don’t stop cold turkey. That can be dangerous. Instead:

• Work with your pharmacist. Clinical pharmacists specialize in medication safety. They can help you taper off safely and suggest alternatives.
• Monitor symptoms. Keep a journal. Note dizziness, confusion, constipation, or unusual fatigue. These are early warning signs.
• Ask for a medication therapy management (MTM) session. Medicare offers free consultations with pharmacists for people taking multiple drugs. Call your Part D plan to schedule one.
• Use tech tools. Apps like Surescripts and pharmacy systems now flag high-risk prescriptions in real time. If your pharmacist hesitates, ask why.

One study found that when pharmacists led medication reviews, high-risk drug use dropped by 35% in just six months. That’s not magic-it’s smart management.

The Bigger Picture

This isn’t just about pills. It’s about quality of life. A senior who stops a risky sleep aid might sleep better and stay independent. One who switches from glyburide might avoid an ER trip and keep driving. Another who drops diphenhydramine might remember names, follow recipes, and enjoy time with grandkids again.

The system is catching up. Electronic health records now auto-alert doctors when they try to prescribe a Beers Criteria drug to someone over 65. Medicare Advantage plans deny coverage for some of these drugs unless special approval is given. But technology doesn’t replace conversation. Only you can speak up for your health.

If you’re caring for an older parent or loved one, sit with them. Go through their meds. Ask questions. Don’t assume the doctor knows best. The truth is, doctors are busy. They might not know every drug on the Beers list by heart. But you can. And that makes you their most powerful ally.

Next Steps for Seniors and Caregivers

Start today. Grab a notebook. Write down every pill, patch, inhaler, and supplement you or your loved one takes. Include doses and why you’re taking them. Then call your pharmacist. Ask: “Which of these are on the Beers Criteria list?” Don’t wait for a fall, a hospital visit, or a dementia diagnosis. The safest medication is the one you don’t need.