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High-Risk Medication Guide
Therapeutic Class High-Risk Medication
Common Indications
Alternative Medication Option
Antianxiety
Meprobamate
Buspirone, Fluoxetine
Non-pharmacologic treatment,
Doxepin, Melatonin,
Mirtazapine, Trazodone
Antibiotics
Nitrofurantoin
Ciprofloxacin,Trimethoprim,
(increased risk with long-term use >90 days) Trimethoprim/sulfamethoxazole DS
Antiemetics
Promethazine, Trimethobenzamide
Granisetron, Ondansetron,
Prochlorperazine
Guaifenesin/Dextromethorphan
Antihistamines
Brompheniramine, Carbinoxamine,
Cetirizine, Fexofenadine,
Chlorpheniramine, Clemastine,
Fluticasone nasal spray
Cyproheptadine, Dexchlorpheniramine, Itching/Rash
Cetirizine, Loratadine,
combination product) Diphenhydramine (oral), Doxylamine,
Topical Steroids
Hydroxyzine, Promethazine,
Triprolidine
Non-pharmacologic treatment,
Doxepin, Melatonin,
Mirtazapine, Trazodone
Antiparkinson
Benztropine (oral),
Amantadine,
Trihexyphenidyl
Carbidopa/Levodopa
Quetiapine
Antipsychotic
Thioridazine
Haloperidol, Olanzapine,
Quetiapine, Risperidone
Barbiturates
Amobarbital, Butabarbital, Butalbital, Sleep
Non-pharmacologic treatment,
Pentobarbital, Phenobarbital,
Doxepin, Melatonin,
Secobarbital
Mirtazapine, Trazodone
Acetaminophen/Aspirin/Caffeine,
Ibuprofen, Naproxen
Cardiovascular
Guanfacine, Methyldopa,
ACEI, ARB, Beta Blockers, CCBs,
Reserpine (>0.1mg/day),
Thiazide, Nifedipine ER (long acting)
Nifedipine (short acting)
Digoxin (>0.125mg/day)
ACEI, Beta Blockers
Disopyramide
Digoxin (<0.125mg/day),
Diltiazem XT, Metoprolol,
Verapamil SR
Dipyridamole (oral, short acting),
Aspirin, Clopidogrel
Ticlopidine
High-Risk Medication Guide
Therapeutic Class High-Risk Medication
Common Indications
Alternative Medication Option
Endocrine
Desiccated Thyroid
Levothyroxine
Megestrol
Dietary supplements
Estrogens
Conjugated Estrogens
Alendronate,
(PREMARIN, PREMPRO),
Calcium and Vitamin D
Esterified Estrogens, Estradiol,
Hot flashes: Gabapentin,
Estrogen Patch (VIVELLE-DOT),
Venlafaxine
Estropipate
Vaginal symptoms: Estradiol
Vaginal (cream, tab, ring)
Evaluate appropriateness of ongoing therapy. Use lowest effective dose for the shortest amount of time.
Hypnotics
Eszopiclone (LUNESTA),
Non-pharmacologic treatment,
Zaleplon (SONATA), Zolpidem
Doxepin, Melatonin, Mirtazapine,
(AMBIEN), Chloral hydrate
Trazodone
Hypoglycemics
Chlorpropramide, Glyburide
Glimepiride, Glipizide
Narcotics
Meperidine, Pentazocine
Morphine LA, Hydrocodone/APAP,
Ibuprofen, Meloxicam,
Naproxen, Acetaminophen,
Consider other non-narcotics
Ketorolac, Indomethacin
Morphine LA, Hydrocodone/APAP,
Ibuprofen, Meloxicam, Naproxen,
Acetaminophen
Skeletal Muscle
Carisoprodol, Chlorzoxazone,
Non-pharmacologic treatment,
Relaxants
Cyclobenzaprine, Metaxalone,
Baclofen, Tizanidine
Methocarbamol, Orphenadrine,
Tertiary TCAs
Amitriptyline, Clomipramine,
Fluoxetine, Sertraline,
Doxepin (>6mg/day), Imipramine,
Citalopram
Trimipramine
Duloxetine, Gabapentin,
Venlafaxine
Non-pharmacologic treatment,
Doxepin, Melatonin, Mirtazapine,
Trazodone
Vasodilators
Ergoloid Mesylates, Isoxsuprine
Aspirin, Clopidogrel
Donepezil, Memantine
This list of high-risk medications is provided by Blue Cross and Blue Shield of Alabama as recommendations to improve medication management with elderly patients. It’s not intended to substitute the clinical judgment of the attending physician.
Blue Advantage (PPO) is a Medicare-approved PPO plan. Enrollment in Blue Advantage (PPO) depends on CMS contract renewal. BlueRx (PDP) is a Medicare-approved part D plan. Enrollment in BlueRx (PDP) depends on CMS contract renewal. Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association.

Source: http://www.bcbsalpromotions.com/providers/pdfs/HRM_Alternatives.pdf