Potentially Inappropriate Prescriptions (PIPs)
for older people (modified from ‘STOPP/START 2’ O’Mahony et al 2014)

Scroll down below to see the full list or download the PDF here

Consider holding (or deprescribing - consult with patient):
1. Any drug prescribed without an evidence-based clinical indication
2. Any drug prescribed beyond the recommended duration, where well-defined
3. Any duplicate drug class (optimise monotherapy)

Avoid hazardous combinations e.g.:

1. The Triple Whammy:
 NSAID + ACE/ARB + diuretic in all ≥ 65 year olds (NHS Scotland 2015)

2. Sick Day Rules drugs:
 Metformin or ACEi/ARB or a diuretic or NSAID in ≥ 65 year olds presenting with dehydration and/or acute kidney injury (AKI) (NHS Scotland 2015)
 
3. Anticholinergic Burden (ACB): 
 Any additional medicine with anticholinergic properties when already on an Anticholinergic/antimuscarinic (listed overleaf) in > 65 year olds (risk of falls, increased anticholinergic toxicity: confusion, agitation, acute glaucoma, urinary retention, constipation). The following are known to contribute to the ACB:
  • Amantadine
  • Antidepressants, tricyclic: Amitriptyline, Clomipramine, Dosulepin, Doxepin, Imipramine, Nortriptyline, Trimipramine and SSRIs: Fluoxetine, Paroxetine
  • Antihistamines, first generation (sedating): Clemastine, Chlorphenamine, Cyproheptadine, Diphenhydramine/-hydrinate, Hydroxyzine, Promethazine; also Cetirizine, Loratidine
  • Antipsychotics: especially Clozapine, Fluphenazine, Haloperidol, Olanzepine, and phenothiazines e.g. Prochlorperazine, Trifluoperazine 
  • Baclofen
  • Carbamazepine 
  • Disopyramide
  • Loperamide
  • Oxcarbazepine
  • Pethidine
  • Pizotifen
  • Tizanidine 

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