BEERS Criteria - Analgesics

Question 1

List recommendations and reason why skeletal muscle relaxants are in the BEERS Criteria

Answer 1

Skeletal muscle relaxants: orphenadrine, chlorzoxazone, methocarbamol

Recommendation: avoid

Reason: anticholinergic effects (sedation, risk of fractures, questionable effectiveness at lower doses used for geriatrics)

Question 2

Which NSAIDs are in the BEERs criteria, their recommendations and reasons why?

Answer 2

Aspirin > 325 mg/day, Diclofenac, Ibuprofen, Naproxen
Recommendation: Avoid chronic use / use with corticosteroids, anticoagulant, antiplatelets
Reason:
* Risk of GI bleeding/ peptic ulcers
* Increase BP and induce kidney injury
* Use concurrent PPIs! (reduces but does not eliminate GI risks)

Indomethacin, Ketorolac (PO/parenteral)
Recommendation: avoid
Reason:
* Higher risk of GI bleeding/ peptic ulcer and acute kidney injury
* Higher risk of CNS effects than other NSAIDs

Question 3

Which other systems should non-COX2 selective NSAIDs be avoided in and why?

Answer 3

Avoid in history of gastric/ duodenal ulcers, unless no other alternatives

Reason: potential of inducing/ worsening ulcers, take concurrent PPI/ misoprostol!

Question 4

List the risk rationale and recommendations for these 2 DDIs:
* Opioids + Gabapentin, pregabalin
* Opioids + Benzodiazepines

Answer 4

Refer to formularies table

Question 5

List Analgesic Drugs in the BEERS Criteria that require lower doses in reduced kidney function

Answer 5

NSAIDs
* Avoid when CrCl<30
* May increase the risk of AKI and further decline in kidney function

Tramadol
* IR: Dose reduction when CrCl < 30 mL/min
* ER: Avoid when CrCl < 30 mL/min
* causes CNS adverse effects

Gabapentin, pregabalin
* Dose reduction when CrCl≤60
* causes CNS adverse effects (dizziness, drowsiness, respiratory depression)