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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