Beers Criteria medication list: the drugs to avoid in older adults and what the current update changed

The current criteria are the 2023 update, published by the American Geriatrics Society in May 2023 after an interprofessional panel reviewed the evidence accumulated since the 2019 edition. That update revised criteria covering warfarin, aspirin, rivaroxaban, dronedarone, digoxin, antidepressants, antipsychotics, benzodiazepines, androgens, systemic estrogens, sulfonylureas, proton pump inhibitors, oral NSAIDs and skeletal muscle relaxants, and removed entries with very low utilization or no US availability.

In July 2025 the AGS published a separate companion document, Alternative Treatments to Selected Medications in the 2023 AGS Beers Criteria, the first refresh of the alternatives resource in roughly a decade. It pairs the flagged medications with pharmacologic substitutes and non-pharmacologic management strategies, which is the part clinicians most often want when a Beers flag fires. The criteria themselves remain the 2023 edition; check the American Geriatrics Society for the current release before relying on any summary, including this one.

No, and the panel is explicit about this. The word in the title is "potentially" inappropriate. The criteria are a screening tool meant to prompt a deliberate conversation about risk and benefit in a specific patient, not a set of prohibitions and not a quality measure to be applied mechanically. Several entries carry explicit exceptions written into them, and a well justified prescription of a Beers-listed drug in the right patient is good medicine.

Used badly, the list produces two failure modes. One is alert fatigue, where every older patient generates a screen full of flags that get dismissed unread. The other is reflexive deprescribing, where a benzodiazepine a patient has taken stably for fifteen years is stopped abruptly and the patient withdraws. Both come from treating the criteria as an answer rather than as a question worth asking.

The classes that keep appearing in real medication lists are benzodiazepines and Z-drugs for sleep, first generation antihistamines including the diphenhydramine in over-the-counter sleep aids, proton pump inhibitors continued years past their original eight-week indication, oral NSAIDs for chronic musculoskeletal pain, and skeletal muscle relaxants started for an episode of back pain and never stopped.

There is a pattern in that list. Almost all of them are drugs that were appropriate when they were started, for a problem that has since resolved or changed, and that nobody has revisited. That makes the Beers Criteria most useful not at the moment of prescribing but at the annual medication review, where the question is not "should I start this" but "does this still need to be here". The over-the-counter items also mean the patient interview matters as much as the medication list, since diphenhydramine bought at a pharmacy appears nowhere in the chart.

They overlap but answer different questions. The Beers Criteria names specific drugs and drug-disease combinations to avoid. Anticholinergic burden scoring adds up the cumulative anticholinergic effect of a whole regimen, which catches the situation where no single drug is on the Beers list but four mildly anticholinergic drugs together produce meaningful cognitive impairment and fall risk. Our reference on anticholinergic burden covers how the scales work.

STOPP/START, developed in Ireland and widely used internationally, adds something the Beers Criteria largely does not: the START half flags medications that should arguably be present and are missing, such as a statin in established vascular disease. Prescribing quality in older adults is as often about omission as about excess, and a tool that only counts what is on the list cannot see that.

A Beers flag is only useful in context. Knowing that a drug appears on the list matters far less than knowing that this particular patient, at 82 with a creatinine clearance of 38, on a benzodiazepine and an anticholinergic already, and with a fall three months ago, is being offered a fifth agent that pushes in the same direction.

Prescriber.io takes the actual regimen and returns the interaction check, the contraindication and allergy check, the renal and hepatic dose considerations, and guideline-based alternatives in one card with sources cited, so the age-relevant risk is visible next to everything else rather than in a separate lookup nobody performs. It is decision-support for licensed US clinicians and it does not prescribe. You review each flag against the published criteria and the current labeling, apply judgment, and sign.