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

Every year, tens of 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. It’s not rare. It’s not unusual. It’s high-risk medications quietly doing damage in homes across America. If you or someone you love is 65 or older and taking five or more pills a day, this isn’t just a reminder-it’s a wake-up call.

What Makes a Medication High-Risk for Seniors?

It’s not about how strong the drug is. It’s about how the aging body handles it. As we get older, our kidneys slow down. Our liver doesn’t process toxins as quickly. Our brains become more sensitive to sedatives. Even drugs that work fine for a 40-year-old can become dangerous for someone over 65.

The gold standard for identifying these risks is the AGS Beers Criteria, a regularly updated list of medications that pose higher risks than benefits for older adults, developed by the American Geriatrics Society. The latest version, released in May 2023, flags 30 drug classes and 14 individual drugs that should be avoided in most seniors. These aren’t random picks. They’re backed by years of clinical data showing increased falls, confusion, kidney damage, and even death.

Top 5 High-Risk Medications You Should Review Right Now

• Zolpidem (Ambien®) - This sleep aid might help you fall asleep, but it leaves you groggy, disoriented, and at risk of falling the next morning. Studies show seniors on zolpidem have a 2.5 times higher chance of hip fractures. Some users report sleepwalking, confusion, or even driving while half-asleep. The risk doesn’t go away after a few days-it builds up over time.
• Glyburide (Diabeta®) - A common diabetes pill, but a dangerous one for seniors. It can cause severe low blood sugar without warning. In people over 65, glyburide leads to hypoglycemia in nearly 30% of users-more than double the rate of safer alternatives like glipizide. Emergency room visits from low blood sugar are common, and many seniors don’t even realize they’re having an episode until they collapse.
• Diphenhydramine (Benadryl®) - Found in allergy pills, sleep aids, and even some cold medicines, this anticholinergic drug is everywhere. But it’s also one of the worst offenders for brain fog. Long-term use increases dementia risk by 54%. One study showed that seniors who took it for more than three years had a significantly higher chance of developing Alzheimer’s. It also causes dry mouth, constipation, and urinary retention-problems that are already common in older adults.
• Nitrofurantoin (Macrobid®) - Prescribed for urinary tract infections, this drug can cause deadly lung damage in seniors with even mild kidney issues. If your eGFR (kidney function number) is below 60, this medication can lead to scarring in the lungs. Mortality rates from these reactions hit nearly 20%. There are safer antibiotics for UTIs in older adults-this one shouldn’t be the first choice.
• Alpha-1 blockers (Doxazosin, Terazosin) - These are often given for high blood pressure or enlarged prostate, but they cause sudden drops in blood pressure when standing up. One in four seniors on these drugs experiences dizziness or fainting. That’s not just uncomfortable-it’s life-threatening. For most seniors, chlorthalidone or ACE inhibitors are far safer choices.

Why So Many Seniors Are on These Drugs

You might be wondering: If these drugs are so risky, why are they still being prescribed?

The answer is simple: inertia. Many doctors don’t get updated training on geriatric pharmacology. Prescriptions get handed down from one visit to the next without review. A patient gets a sleep aid after a hospital stay, a painkiller for arthritis, an antihistamine for allergies, a diabetes pill from years ago, and a muscle relaxant for back pain-all added without a full picture of what’s already in the system.

And then there’s the myth that “it’s just a little medicine.” But when you stack five, six, or seven drugs together, the interactions multiply. For example, taking ciprofloxacin, an antibiotic with warfarin, a blood thinner can spike your INR levels by 47%, putting you at risk of internal bleeding. That’s not a side effect-it’s a medical emergency waiting to happen.

What to Do Instead: Safer Alternatives

The good news? There are almost always better options.

• For sleep: Try trazodone, a low-dose antidepressant with minimal fall risk instead of zolpidem. Cognitive behavioral therapy for insomnia (CBT-I) works better long-term and has no side effects.
• For diabetes: Switch from glyburide to glipizide, a shorter-acting sulfonylurea with lower hypoglycemia risk. Or consider metformin, SGLT2 inhibitors, or GLP-1 agonists-all safer for seniors.
• For allergies or sleep: Replace diphenhydramine with loratadine, a non-sedating antihistamine or cetirizine, another low-risk option. Both are available over the counter and won’t cloud your thinking.
• For UTIs: Use nitrofurantoin is risky; fosfomycin or cephalexin are safer alternatives for seniors with kidney concerns.
• For blood pressure or prostate: Switch from doxazosin to chlorthalidone, a diuretic with proven safety in seniors or an ACE inhibitor like lisinopril.

How to Start a Medication Review

You don’t need to wait for your doctor to bring it up. Take control.

1. Do a brown bag review. Gather every pill, capsule, supplement, and OTC medicine you take-including patches, eye drops, and creams. Bring them to your next appointment.
2. Ask your doctor: “Which of these medications are high-risk for someone my age?”
3. Request a check of your anticholinergic burden. If you’re taking three or more drugs with anticholinergic effects (like diphenhydramine, amitriptyline, oxybutynin), your brain is under stress. Ask for a score using the Anticholinergic Risk Scale.
4. Ask if any drugs can be stopped entirely. Many seniors are taking medications for conditions that no longer exist-like a cholesterol pill after a gallbladder removal, or a blood thinner after a past clot that’s long resolved.
5. Ask for a referral to a clinical pharmacist. These specialists are trained in senior drug safety. Studies show they reduce high-risk prescriptions by over 30% in just six months.

What You Can Do Today

You don’t have to wait for your annual checkup. Start now:

• Check your medicine cabinet. Look for diphenhydramine, zolpidem, glyburide, or nitrofurantoin. Write them down.
• Call your pharmacy. Ask if they’ve flagged any of your medications as high-risk for seniors. Most pharmacies now use electronic alerts tied to the Beers Criteria.
• Use the free Beers Criteria app, available through the American Geriatrics Society to look up any drug by name.
• Talk to a family member. If you’re helping care for an older parent, ask to see their medication list. Many seniors don’t know what they’re taking-or why.

Medication safety isn’t about cutting pills. It’s about choosing better ones. The goal isn’t fewer drugs-it’s smarter drugs. And for seniors, that can mean the difference between living independently and ending up in the hospital.

Frequently Asked Questions

Next Steps

If you’re a senior: Take out your pill bottles today. Write down every medication. Call your doctor tomorrow and ask for a Beers Criteria check. Don’t wait for symptoms. Prevention is the only thing that works.

If you’re helping a parent or loved one: Don’t assume they know what they’re taking. Go through their meds with them. Sit down with their pharmacist. Bring up the Beers Criteria by name. You might save their independence-or their life.

Medication safety isn’t complicated. It’s just rarely talked about. But when you know what to look for, you can stop the silent harm before it starts.