Name/Class | +condition | =Risk/reason |
|---|---|---|
| Digoxin >125µg/day | Low GFR | Toxicity |
| Diuretic (monotherapy) | Hypertension | Safer, more effective alternatives |
| Thiazides (bendroflumethiazide) | Gout | Exacerbation of gout |
| Non-cardioselective Beta-blocker (propranolol, carvedilol, sotalol etc) | Wheeze (COPD/asthma) | Bronchospasm |
| Beta blocker + verapamil | Any | Heart block |
| Diltiazem or verapamil | Heart failure | Exacerbation of heart failure |
| Calcium channel blockers | Chronic constipation | Exacerbation of constipation |
| Aspirin + Warfarin | Without gastro-protection | Gastrointestinal bleeding |
| Dipyridamole (monotherapy) | Stroke | No evidence for efficacy |
| Aspirin | Peptic ulcer | Bleeding |
| >150mg/day | Bleeding, no evidence for increased efficacy | |
| Without arterial occlusive disease | Not indicated | |
| Dizziness, without stroke as cause | Not indicated | |
| Warfarin >6months | 1st deep vein thrombosis | No proven benefit |
| Warfarin >12months | 1st pulmonary embolus | No proven benefit |
| Aspirin, clopidogrel, dipyridamole or warfarin | Any bleeding disorder | Bleeding |
Name/Class | +condition | =Risk/reason |
|---|---|---|
| Tricyclic antidepressants (amitriptyline,imipramine etc) | Cognitive Impairment | Worsening cognitive impairment |
| Glaucoma | Exacerbation of glaucoma | |
| Cardiac arrhythmia | Pro-arrhythmic effects | |
| Constipation | Exacerbation of constipation | |
| + Opiate or calcium channel blocker | Severe constipation | |
| Prostatism or urinary retention | Urinary retention | |
| Benzodiazpines >1 month | Any | Prolonged sedation, confusion, impaired balance, falls |
| Neuroleptics >1 month (haloperidol, risperidone etc) | If used as hypnotics | Confusion, hypotension, extrapyramidal side effects, falls |
| Parkinsonism | Extra-pyramidal symptoms | |
| Prochlorperazine & chlorpromazine | Epilepsy | Lower seizure threshold |
| Anticholinergics (Procyclidine, orphenadrine, trihexyphenidyl) | To treat extra-pyramidal SE's of neuroleptics | Anticholinergic toxicity |
| Selective serotonin re-uptake inhibitors (SSRIs, fluoxetine etc) | Current or <2 months Hyponatraemia | Further hyponatraemia |
| Old antihistamines (cyclizine, chlorpheniramine, alimenazine etc) | >1 week use | Sedation & anti-cholinergic side effects |
Name/Class | +condition | =Risk/reason |
|---|---|---|
| Constipating drugs (Loperamide or codeine phosphate) | Unexplained diarrhoea | Delayed diagnosis, exacerbate constipation + overflow diarrhoea, toxic megacolon in inflammatory bowel disease, delayed recovery in unrecognised gastroenteritis |
| Severe infective gastroenteritis | Exacerbation or protraction of infection | |
| Prochlorperazine (Stemetil) or metoclopramide | Parkinsonism | Exacerbating parkinsonism |
| High dose proton pump inhibitor > 8weeks | Peptic Ulcer | Dose reduction or earlier discontinuation indicated |
| Anticholinergic antispasmodics (hyoscine, atropine) | Chronic constipation | Exacerbation of constipation |
Name/Class | +condition | =Risk/reason |
|---|---|---|
| Theophylline (monotherapy) | COPD | Safer, more effective alternatives |
| Systemic corticosteroids (instead of inhaled) | COPD | Unnecessary exposure to long term side-effects |
| Ipratropium (nebulised) | Glaucoma | Exacerbation of glaucoma |
Name/Class | +condition | =Risk/reason |
|---|---|---|
| Non-steroidal anti-inflammatory without gastric protection | Peptic ulcer /gastrointestinal bleeding | Peptic ulcer relapse |
| Non-steroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, naproxen, diclofenac etc) | Mod-severe hypertension | Exacerbation of hypertension |
| Heart failure | Exacerbation of heart failure | |
| >3 months in mild osteoarthtitis | Simple analgesics preferable & usually as effective for pain relief | |
| Chronic kidney disease | Deterioration in renal function | |
| + Warfarin | Gastrointestinal bleeding | |
| Corticosteroids (>3 months, monotherapy) | Rheumatoid Arthritis | Major side-effects |
| NSAIDs or colchicine | To prevent gout | Allopurinol first choice prophylactic drug in gout |
Name/Class | +condition | =Risk/reason |
|---|---|---|
| Bladder antimuscarinics (oxybutinin, tolterodine, solifenacin etc) | Cognitive impairment | Increased confusion, agitation |
| Glaucoma | Exacerbation of glaucoma | |
| Constipation | Exacerbation of constipation | |
| chronic prostatism | Urinary retention | |
| Alpha-blockers (doxasocin, tamsulosin, terazocin etc) | Male & urinary incontinence >1daily | Urinary frequency & worsening of incontinence |
| Long-term urinary catheter | Not indicated |
Name/Class | +condition | =Risk/reason |
|---|---|---|
| Glibenclamide or chlorpropamide | Type 2 diabetes mellitus | Prolonged hypoglycaemia |
| Beta-blockers (atenolol, bisoprolol etc) | Hypoglycaemia >1 per month | Masking hypoglycaemic symptoms |
| Oestrogens | Breast cancer | Recurrence |
| Venous thromboembolism | Recurrence | |
| Oestrogens without progestogen | Intact uterus | Endometrial cancer |
Name/Class | +condition | =Risk/reason |
|---|---|---|
| Benzodiazepines | Recurrent falls disorder | Sedative, may cause reduced sensorium, impair balance |
| Neuroleptic drugs | Recurrent falls disorder | Gait dyspraxia, parkinsonism |
| 1st generation antihistamines | Recurrent falls disorder | Sedative, may impair sensorium |
| Vasodilator antihypertensives (hydralazine, minoxidil, sildenafil etc) | >20mmHg drop in sBP | Syncope, falls |
| Long-term opiates | Recurrent falls disorder | Drowsiness, postural hypotension, vertigo |
Name/Class | +condition | =Risk/reason |
|---|---|---|
| Long-term strong opiates | Mild-moderate pain | WHO analgesic ladder not observed |
| Regular opiates >2 weeks + no laxative | Constipation | Severe constipation |
| Long-term opiates | Dementia + not palliative + not managing specific pain syndrome | Exacerbation of cognitive impairment |