geriatrics
Drug Categories of Concern in Older Adults
Antidepressants
Tricyclic antidepressants (TCAs) are effective but should rarely be used in older adults. Selective serotonin reuptake inhibitors (SSRIs) and mixed reuptake inhibitors, such as serotonin-norepinephrinereuptake inhibitors (SNRIs), are as effective as TCAs and cause less toxicity; however, there are some concerns about some of these drugs (below). In addition, all SSRIs, SNRIs, and TCAs can increase the risk of falls and hyponatremia in older adults. Paroxetine: This drug is more sedating than other SSRIs, has anticholinergic effects, and, like some other SSRIs, can inhibit hepatic cytochrome P-450 2D6 enzyme activity, possibly impairing the metabolism of several drugs, includingtamoxifen, some antipsychotics, antiarrhythmics, and TCAs. Citalopramandescitalopram: Doses in older adults should be limited to a maximum of 20 mg/day and 10 mg/day, respectively, because QT prolongation is a concern. Venlafaxineandduloxetine: These drugs may increase blood pressure. Mirtazapine: This drug can be sedating and may stimulate appetite/weight gain. Sertraline: This drug confers the highest risk of diarrhea. 