Geriatrics Master Med List

Alendronate (Fosamax®) – Osteoporosis treatment & prevention

Treatment: 70 mg weekly or 10 mg daily PO; Prevention: 35 mg weekly or 5 mg daily PO; Take with 8 oz water, 30–60 min before food; remain upright 30 min; Avoid if CrCl <30 mL/min

Risedronate (Actonel®) – Osteoporosis treatment & prevention

5 mg daily, 35 mg weekly, or 150 mg monthly PO; Same counseling as alendronate

Ibandronate (Boniva®) – Osteoporosis treatment & prevention

150 mg monthly PO or 3 mg IV every 3 months; Not first-line; limited hip fracture benefit

Zoledronic acid (Reclast®) – Osteoporosis treatment & prevention

Treatment: 5 mg IV yearly; Prevention: 5 mg IV every 2 years; Avoid if CrCl <30 mL/min

Raloxifene (Evista®) – SERM for osteoporosis

60 mg PO daily; Prevention & treatment; avoid in patients with VTE risk

Calcitonin (Miacalcin®) – Osteoporosis pain relief

1 spray in one nostril daily; Use only if other therapies not tolerated; postmenopausal women only

Teriparatide (Forteo®) – PTH analog for osteoporosis

20 mcg SQ daily; Limit to 2 years; BBW for osteosarcoma

Abaloparatide (Tymlos®) – PTH analog for osteoporosis

80 mcg SQ daily; Similar to Forteo; secondary prevention

Denosumab (Prolia®) – Monoclonal antibody for osteoporosis

60 mg SQ every 6 months; Monitor calcium levels; risk of hypocalcemia

Romosozumab (Evenity®) – Monoclonal antibody for osteoporosis

210 mg SQ monthly × 6 months; BBW for cardiovascular risk

Donepezil (Aricept®) – Alzheimer’s (early to moderate)

10 or 23 mg PO daily; GI side effects; titrate over 4–6 weeks

Rivastigmine (Exelon®) – Alzheimer’s (early to moderate)

6 mg PO BID or 13.3 mg patch; Patch has fewer GI effects

Galantamine (Razadyne®) – Alzheimer’s (early to moderate)

IR: 12 mg BID; ER: 24 mg daily; Titrate slowly; monitor for GI effects

Memantine (Namenda®) – Alzheimer’s (moderate to severe)

IR: 10 mg BID; XR: 28 mg daily; May cause confusion, HTN, aggression

Namzaric – Combo for Alzheimer’s

Donepezil 10 mg + memantine ER; Use only after stabilization on donepezil

Donanemab (Kisunla®) – Anti-amyloid MAB for Alzheimer’s

Monthly IV infusion; Discontinue when amyloid low; MRI monitoring required

Lecanemab (Leqembi®) – Anti-amyloid MAB for Alzheimer’s

IV infusion every 2 weeks; Lifelong use; MRI monitoring required

Duloxetine (Cymbalta®) – Stress incontinence

Can be used first-line; Avoid if CrCl <30 mL/min

Mirabegron (Myrbetriq®) – Urge incontinence

Beta-3 agonist; relaxes bladder; Monitor BP; avoid in uncontrolled HTN

Vibegron (Gemtesa®) – Urge incontinence

Beta-3 agonist; similar to mirabegron; Fewer drug interactions

Oxybutynin (Ditropan®) – Urge incontinence

High anticholinergic burden; avoid in elderly; Dry mouth, dizziness, somnolence

Tolterodine (Detrol®) – Urge incontinence

M2/M3 selective; dry mouth, fatigue; LA version has fewer side effects

Solifenacin (Vesicare®) – Urge incontinence

M3 selective; fewer CNS effects; Dry mouth, constipation

Darifenacin (Enablex®) – Urge incontinence

M3 selective; dry mouth, constipation; Lower CNS penetration

Trospium (Sanctura®) – Urge incontinence

M2/M3 selective; less CNS penetration; Dry mouth, constipation

Valbenazine (Ingrezza®) – Tardive dyskinesia

VMAT2 inhibitor; Monitor for sedation, QTc prolongation

Deutetrabenazine (Austedo®) – Tardive dyskinesia

VMAT2 inhibitor; Similar to valbenazine

Trihexyphenidyl (Artane®) – EPS symptoms

Anticholinergic; used for Parkinsonian features; Risk vs benefit in elderly

Risperidone (Risperdal®) – Behavioral symptoms, schizophrenia

0.25–0.5 mg daily (elderly); 2 mg daily (schizophrenia); BBW for mortality in dementia

Quetiapine (Seroquel®) – Behavioral symptoms, schizophrenia

25–50 mg daily (elderly); 300 mg daily (schizophrenia); Sedating; monitor QTc

Brexpiprazole (Rexulti®) – Agitation in Alzheimer’s

FDA-approved; BBW for mortality; Often not covered by Part D

Diphenhydramine (Benadryl®) – Allergy, sleep

Avoid in elderly; high anticholinergic burden; Risk of confusion, falls

Amitriptyline (Elavil®) – Depression, pain

Avoid in elderly; anticholinergic, sedation; Risk of orthostasis, cognitive decline

Doxepin (Sinequan®) – Depression

Avoid in elderly; anticholinergic; Risk of sedation, confusion

Cyclobenzaprine (Flexeril®) – Muscle spasm

Avoid in elderly; sedation, anticholinergic; Risk of falls

Carisoprodol (Soma®) – Muscle spasm

Avoid in elderly; CNS depression; Risk of dependence

Meperidine (Demerol®) – Pain

Avoid in elderly; neurotoxicity; Not recommended

Propoxyphene (Darvon®) – Pain

Removed from market; Avoid in all patients

Pentazocine (Talwin®) – Pain

Avoid in elderly; Risk of confusion, hallucinations

Digoxin – HF, AFib

Avoid >0.125 mg/day in elderly; Monitor levels; narrow therapeutic index

Nitrofurantoin (Macrobid®) – UTI

Avoid if CrCl <30 mL/min; Risk of pulmonary toxicity

Estrogens – Menopause, UI

Wean off if possible; Risk of stroke, breast cancer

Desiccated thyroid (Armour Thyroid®) – Hypothyroidism

Avoid in elderly; Use levothyroxine instead