APPENDIX A:
Potentially Inappropriate Medications Commonly Prescribed for Older, Community-Dwelling Individuals

Drug Class

Particular Inappropriate Drugs Prescribed

Description & Side Effects Negatively Impacting Driving Ability

Antidepressants

Amitriptyline

(“Elavil”; “Endep”; “Limbitrol” - combination with chlordiazepoxide)

Amitriptyline is a tricyclic antidepressant used to treat symptoms of depression. Amitriptyline may cause side effects including: drowsiness, weakness or tiredness; excitement or anxiety; difficulty falling asleep or staying asleep; restlessness; blurred vision; pain, burning, or tingling in the hands or feet; confusion; and unsteadiness.

Doxepin

(“Adapin;” “Sinequan”)

Doxepin is used to treat depression and anxiety.
Side effects from doxepin are common: drowsiness
weakness or tiredness; excitement or anxiety; and insomnia.

Benzodiazepines

Chlordiazepoxide

(“Librium”)

Chlordiazepoxide is a long-acting benzodiazepine used to relieve anxiety and to control agitation caused by alcohol withdrawal. Side effects from chlordiazepoxide are common and include: drowsiness, dizziness, tiredness, and weakness.

Diazepam

(“Valium”)

Diazepam is a long-acting benzodiazepine used to relieve anxiety, muscle spasms, and seizures and to control agitation caused by alcohol withdrawal. Side effects include: drowsiness, dizziness, tiredness, and weakness

Flurazepam

(“Dalmane”)

Flurazepam is a short-acting benzodiazepine used on a short-term basis to help people fall asleep and stay asleep through the night. Side effects from flurazepam are common and include: headache, hangover effect (grogginess), drowsiness, dizziness or lightheadedness, and weakness.

Anti-Diabetic (Hypoglycemics)

Chlorpropamide

(“Diabinese”)

Chlorpropamide is used to treat type II (noninsulin-dependent) diabetes (formerly 'adult-onset'), particularly in people whose diabetes cannot be controlled by diet alone. Chlorpropamide lowers blood sugar by stimulating the pancreas to secrete insulin and helping the body to use insulin efficiently.

Anti-Platelet Agents

Dipridamole

(“Persantine”)

Dipyridamole is used with other drugs to reduce the risk of blood clots after heart valve replacement. It works by preventing excessive blood clotting. It is used in combination with blood thinners such as Coumadin. Dipyridamole is also used with aspirin to reduce the risk of death after a heart attack and to prevent another heart attack.. Although side effects from dipyridamole are not common, they can occur, and include: dizziness, headache, flushing (feeling of warmth), and itching.  

Antihistamine

Hydroxyzine

(”Atarax”; “Vistaril”)

Hydroxyzine is an antihistamine with anticholinergic (drying) and sedative properties that is used to treat allergic reactions (used to relieve the itching caused by allergies) It is also used to control the nausea and vomiting caused by various conditions, including motion sickness. It is also used for anxiety and to treat the symptoms of alcohol withdrawal. Although side effects from hydroxyzine are not common, they include: drowsiness; dizziness; chest congestion; headache.

Anti-Anxiety

Meprobamate

(“Equanil;” “Meprospan;” “Miltown;” “Miltown 600;” “Neuramate”)

Meprobamate is used to treat anxiety disorders or for short-term relief of the symptoms of anxiety.  It is also used for muscle relaxation. Although side effects from meprobamate are not common, they can occur, and include: drowsiness; headache; difficulty coordinating movements (clumsiness and unsteadiness); excitement; and weakness.

Antispasmodic
(urinary tract)

Oxybutynin

(“Ditropan”)

Oxybutynin is used to relieve urinary and bladder difficulties, including frequent urination and inability to control urination. It also helps to decrease muscle spasms of the bladder. Although side effects from oxybutynin are not common, they can occur, and include: blurred vision, dry eyes, and drowsiness

Narcotic Analgesic

Propoxyphene

(“Darvon Puvules;” “Darvon-N”)

Propoxyphene is used to relieve mild to moderate pain.
Although side effects from propoxyphene are not common, they can occur, and include: dizziness, lightheadedness, drowsiness, mood changes, and headache.  

Non-steroidal anti-inflammatory drugs (NSAIDs)

Specific drugs not mentioned in literature, but Beers list includes: Indomethacin, phenylbutazone, ketorolac, mefenamic acid, and piroxicam

Nonsteroidal anti-inflammatory drugs (also called NSAIDs) are used to relieve some symptoms caused by arthritis (rheumatism), such as inflammation, swelling, stiffness, and joint pain. Certain side effects, such as confusion, swelling of the face, feet, or lower legs, or sudden decrease in the amount of urine, may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of nonsteroidal anti-inflammatory drugs. Also, elderly people are more likely than younger adults to get very sick if these medicines cause stomach problems. With phenylbutazone, blood problems may also be more likely to occur in the elderly.

Barbiturates

Specific drugs not listed in literature, but Beers list includes: butalbital, pentobarbital, and secobarbital.

Barbiturates belong to the group of medicines called central nervous system (CNS) depressants (medicines that cause drowsiness). Some of the barbiturates may be used before surgery to relieve anxiety or tension. In addition, some of the barbiturates are used as anticonvulsants to help control seizures in certain disorders or diseases, such as epilepsy. The barbiturates have been used to treat insomnia (trouble in sleeping); but if they are used regularly (for example, every day) for insomnia, they are usually not effective for longer than 2 weeks. The barbiturates have also been used to relieve nervousness or restlessness during the daytime. However, the barbiturates have generally been replaced by safer medicines for the treatment of insomnia and daytime nervousness or tension. Confusion, mental depression, and unusual excitement may be more likely to occur in the elderly, who are usually more sensitive than younger adults to the effects of barbiturates