geriatrics
Drug Categories of Concern in Older Adults
Antihyperglycemics
Doses of antihyperglycemics should be titrated carefully in patients with diabetes mellitus. Risk of hypoglycemia due to sulfonylureas may increase with age. As described in the table Potentially Inappropriate Drugs in Older Adults (Based on the American Geriatrics Society 2019 Beers Criteria® Update) , Metformin, a biguanide excreted by the kidneys, increases peripheral tissue sensitivity toinsulinand can be effective given alone or with sulfonylureas. Risk of lactic acidosis, a rare but serious complication, increases with degree of renal impairment and with patient age. Symptomatic heart failure is a contraindication. Sodium-glucose cotransporter-2 (SGLT2) inhibitors (canagliflozin,dapagliflozin, andempagliflozin) can increase risk of urinary tract infections, fungal infections, and hypovolemia with orthostatic hypotension; they should be avoided in patients with impaired renal function. 