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, infection, or heart problem-but because of a medication they were told to take. It’s not rare. It’s not an accident. It’s a pattern. And it’s preventable.

If you or someone you love is over 65 and taking five or more pills a day, you’re not alone. About 40% of older adults in the U.S. are doing the same. But here’s the hard truth: some of those pills might be doing more harm than good. The Beers Criteria, updated in 2023 by the American Geriatrics Society, is the gold standard for spotting which medications are risky for seniors. It’s not a suggestion. It’s a warning. And if your doctor hasn’t reviewed your meds against it, you’re flying blind.

What Makes a Medication High-Risk for Seniors?

It’s not about the drug being dangerous for everyone. It’s about how aging changes the body. As we get older, our kidneys slow down. Our liver doesn’t break down drugs as fast. Our brains become more sensitive to sedatives. And that changes everything.

Take zolpidem (Ambien®). It’s a common sleep aid. But in seniors, it lingers in the system-up to 11 hours after taking it. That’s why 2.5 times more older adults who take it fall and break hips. Sleepwalking, confusion, dizziness-these aren’t side effects you can ignore. They’re red flags.

Then there’s glyburide (Diabeta®), a diabetes pill. It’s cheap. It’s old. And it’s dangerous for seniors. While younger people can handle it, older adults have a 29.3% chance of dropping their blood sugar so low they end up in the ER. That’s nearly three times higher than with glipizide, a safer alternative. The FDA even added a boxed warning in 2023-clearly saying: avoid this in people over 65.

Anticholinergic drugs are another silent killer. These include diphenhydramine (Benadryl®), amitriptyline (Elavil®), and promethazine (Phenergan®). They block a brain chemical called acetylcholine. Sounds harmless, right? But in seniors, that leads to memory loss, confusion, constipation, and even a 54% higher risk of dementia after just three years of use. One study found that taking these drugs for more than 1,095 days-about three years-doubles the odds of developing Alzheimer’s.

And don’t forget nitrofurantoin (Macrobid®), often prescribed for UTIs. It’s fine for younger people. But if your kidneys aren’t working perfectly-common in seniors-it can cause deadly lung damage. The risk? 12.8 times higher if your kidney filter rate is below 60. And when it happens, nearly 1 in 5 people don’t survive.

The Top 5 High-Risk Medications to Review Now

These aren’t hypotheticals. These are real drugs, prescribed every day, that are putting seniors at serious risk. Here’s what to look for:

1. Zolpidem (Ambien®, Zolpimist) - Sleep aid. Increases fall risk by 82%. Residual drowsiness lasts hours. Avoid in anyone over 65. Safer alternatives: trazodone, cognitive behavioral therapy for insomnia (CBT-I).
2. Glyburide (Diabeta®, Glynase) - Diabetes pill. Causes severe low blood sugar. 4.2 episodes per 100 patients each year. Switch to glipizide or metformin.
3. Diphenhydramine (Benadryl®, Unisom) - Allergy or sleep aid. Anticholinergic score of 3 (highest risk). Linked to dementia. Use loratadine or cetirizine instead.
4. Promethazine (Phenergan®) - Nausea and allergy drug. Causes extreme drowsiness, tremors, and seizures in seniors with Parkinson’s or epilepsy. Ondansetron is safer.
5. Benzodiazepines (Lorazepam, Diazepam, Alprazolam) - Anxiety and sleep meds. Increase fall risk by 50%. Risk of death over five years goes up. Try non-drug options first: mindfulness, light exercise, sleep hygiene.

These five alone account for over 60% of preventable hospitalizations related to medications in seniors. And they’re all still being prescribed-often because no one asked if they were still needed.

Why Doctors Keep Prescribing Them

You might wonder: if these drugs are so risky, why are they still on the shelf? The answer isn’t malice. It’s inertia.

Many doctors were trained to prescribe these drugs decades ago. They’re familiar. They’re cheap. And if a patient says, “I can’t sleep,” it’s easier to write a script than to spend 20 minutes talking about sleep hygiene, caffeine, or anxiety.

Also, many seniors see multiple doctors. One prescribes a sleep aid. Another adds an antihistamine for allergies. A third gives a muscle relaxant. No one sees the full picture. That’s polypharmacy-the danger of too many pills stacking up. It’s not just the drugs themselves. It’s how they interact.

For example, combining ciprofloxacin (an antibiotic) with warfarin (a blood thinner) can spike INR levels by 47%. That means a higher chance of internal bleeding. One patient I know was on both. She started bruising easily. Her doctor didn’t connect the dots until she ended up in the ER with a bleeding ulcer.

What You Can Do: The Brown Bag Review

You don’t need to be a doctor to protect yourself or a loved one. Here’s how to start:

1. Collect every pill, vitamin, supplement, and OTC medicine you take. Put them in a brown bag.
2. Bring them to your doctor or pharmacist. Say: “I want to review every one of these. Are any of them risky for someone my age?”
3. Ask: “Is this still necessary? Can we try something safer? What happens if I stop this?”
4. Request an Anticholinergic Burden Score. If it’s above 3, you’re in danger zone.
5. Ask for a medication list update. Keep it in your wallet or phone.

This is called a “brown bag review.” It’s simple. It’s free. And it’s proven to cut high-risk medication use by over 30% when done by a pharmacist. Medicare even pays for it through its Medication Therapy Management program-if you’re on Part D and take multiple chronic meds.

Safer Alternatives That Actually Work

You don’t have to suffer just because a drug is risky. There are better options.

For sleep: Instead of zolpidem, try trazodone (a low-dose antidepressant with sedating effects) or CBT-I. Studies show CBT-I works better than pills for seniors-and lasts longer.

For allergies: Swap diphenhydramine for loratadine (Claritin®) or cetirizine (Zyrtec®). No drowsiness. No brain fog.

For diabetes: Glipizide or metformin replace glyburide. Both are safer. Both are just as effective.

For nausea: Ondansetron (Zofran®) is far safer than promethazine. No tremors. No seizures.

For anxiety: Don’t reach for lorazepam. Try walking, yoga, or talking therapy. If you need medicine, SSRIs like sertraline are much safer for long-term use.

For UTIs: Nitrofurantoin is risky. If your kidney function is low, ask about fosfomycin or cephalexin. Both are safer for seniors.

What’s Changing in 2025

The system is starting to wake up. In January 2024, Medicare launched a new program called “Medication Safety for Seniors.” It ties 5% of Medicare Advantage plan payments to how well they reduce high-risk prescriptions. That means insurers now have a financial reason to push doctors to switch meds.

Electronic health records like Epic and Cerner now automatically flag Beers Criteria drugs when a doctor tries to prescribe them to someone over 65. If you’re on a modern system, your doctor should see a warning pop up.

And pharmacies? Most now use tools like Surescripts that check your meds in real time. If you’re on a risky combo, the pharmacist can call your doctor before filling it.

This isn’t perfect. But it’s progress. And it means you have more power than you think.

When to Say No-and How to Do It

Sometimes, you’ll be told: “This is the only option.” That’s not true.

Here’s what to say:

• “I’ve read this might be risky for seniors. Is there a safer alternative?”
• “Can we try stopping this for a few weeks and see how I feel?”
• “I’m worried about falls. Is this contributing to that?”
• “Can we schedule a medication review with a pharmacist?”

Doctors want to help. But they’re busy. You have to speak up. You’re not being difficult. You’re being smart.

And if your doctor resists? Get a second opinion. Go to a geriatrician. Ask for a medication therapy management session. These services exist for a reason.

Final Thought: Your Meds Are Not Set in Stone

Medications aren’t tattoos. They’re tools. And tools can be swapped out when they’re no longer safe.

If you’re taking five or more pills, chances are at least one of them could be replaced-or removed-without hurting your health. Maybe even improving it.

Don’t wait for a fall. Don’t wait for confusion. Don’t wait for a hospital stay. Start today. Grab your brown bag. Make the call. Ask the questions.

Because the best medicine for seniors isn’t always a pill. Sometimes, it’s the courage to ask: ‘Do I really need this?’