Avoiding Dangerous Medications

By Wayne Persky

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As more adults age with chronic conditions such as inflammatory bowel diseases, the 2025 American Geriatrics Society (AGS) Annual Scientific Meeting has revealed a new tool to help clinicians take safer, smarter, steps when it comes to prescribing medications for older patients. This was developed as a companion to the AGS Beers Criteria. The Beers Criteria Alternatives List highlights safer pharmacologic and non-drug alternatives to medications considered high-risk in older adults, as discussed in an online Medscape article (Salahi, 2025, May 15).1​

Most MC patients are older.

For seniors with microscopic colitis (MC), this development offers much-needed support, since MC is often treated with medications. Older adults are more vulnerable to side effects and drug interactions, and many commonly prescribed drugs are now flagged as inappropriate.​

According to Dr. Michael Steinman, a geriatrician, and professor of medicine at UCSF, who helped lead the initiative, the goal of the list is to improve both function and safety, not just to reduce pills. Older adults process drugs differently due to changes in metabolism, kidney function, and body composition—making adverse effects more common.

We definitely need to avoid certain medications.

For MC patients, chronic diarrhea already puts patients at risk for electrolyte imbalance and nutrient deficiencies. Commonly prescribed medications (like NSAIDs, PPIs, and SSRIs) can worsen MC symptoms or trigger flares. Polypharmacy (taking multiple medications) is common in seniors and further complicates management.

The Beers Criteria flags many medications that may be dangerous for seniors, especially when safer alternatives are available. Some are particularly relevant to MC:

• NSAIDs (for example, ibuprofen, and naproxen) can worsen colitis and increase GI bleeding risk.
• PPIs (long-term use) are linked to bone loss, infection, and worsened diarrhea. Restrict to short-term use only.
• SSRIs (for example, sertraline, fluoxetine) may increase GI motility, cause diarrhea, and MC flare.
• Diphenhydramine (Benadryl) can cause cognitive decline, falls, and sedation.
• Desmopressin (for nocturia [the need to urinate at least twice during the night]) can increase the risk of hyponatremia (low levels of sodium in the blood), and confusion.​

The Alternatives List developed by Steinman and colleagues goes beyond warning labels. It provides step-by-step substitutions, including:

• Nonpharmacologic interventions first (for example, dietary changes, physical therapy, behavioral counseling)
• Safer drug alternatives with lower side effect profiles
• Condition-specific strategies (for exam,ple, GERD, insomnia, nocturia)

For instance, instead of continuing long-term PPIs for acid reflux (often overprescribed in older adults), the list recommends:

• Avoiding trigger foods
• Elevating the head of the bed
• Using H2 blockers (for example, famotidine) for intermittent symptom control
• Transitioning gradually off PPIs to avoid rebound effects​

Does that sound familiar? It should, because it's what we've been recommending for many years.

Care should be personalized.

Importantly, Steinman emphasized that this isn't a call to automatically stop medications, but rather to create individualized plans that involve the patient. That’s especially important for MC patients, who may be juggling:
​

• Multiple medications for autoimmune diseases, arthritis, or depression
• Conflicting dietary and treatment needs
• The need for nutrition preservation, especially during flares

The recommended changes won't happen overnight.

Dr. Judith Beizer, a clinical professor of pharmacology at St. John’s University, underscored that implementation takes time, and requires team-based care:

• Nurses and pharmacists can explain tapering plans
• Dietitians can help reduce reliance on GI-risky drugs by improving symptom control through nutrition
• Behavioral health specialists can support anxiety, depression, and sleep without high-risk drugs

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For primary care physicians with limited time, the list is designed to be quickly referenced, and it will soon be published in:

• Journal of the American Geriatrics Society
• GeriatricsCareOnline.org
• HealthinAgingOnline.org

MC patients should work with their providers.

1. Request a medication review: Older MC patients should have their prescriptions evaluated against the Beers Criteria and the new Alternatives List.
2. Look beyond prescriptions: Non-drug therapies (like fluid timing, physical therapy, cognitive therapy, or dietary modification) may work as well, or better, than high-risk meds.
3. Use shared decision-making: Rather than accept a new prescription automatically, ask: “Is there a safer or non-drug option I could try first?”
4. Coordinate with a pharmacist or geriatric specialist: Especially for those on multiple medications.

​Conclusion:

The AGS Beers Criteria Alternatives List brings a much-needed update to the way clinicians approach medication safety for older adults — especially those managing an autoimmune disease such as MC. With targeted recommendations, safer substitutes, and a greater emphasis on individualized care, these long overdue recommendations for changes in treatment policies should reduce the risks of overmedication while preserving quality of life.

Reference

1. Salahi, L. (2025, May 15). The New Playbook for Ditching Dangerous Senior Meds. Medscape. Retrieved from https://www.medscape.com/viewarticle/new-playbook-ditching-dangerous-senior-meds-2025a1000c0r