Beers Criteria checker
Psychiatric medications from the 2023 AGS Beers Criteria for older adults. Type in a drug name to see Beers status and rationale. Reference lookup, not a recommendation.
| Drug | Beers Status | Rationale |
|---|---|---|
| Diphenhydramine (Benadryl) Antihistamine | Avoid | Strong anticholinergic; sedation; older adults sensitive. Avoid. |
| Doxylamine (Unisom) Antihistamine | Avoid | Strong anticholinergic. Avoid. |
| Hydroxyzine (Vistaril, Atarax) Antihistamine / anxiolytic | Avoid | Anticholinergic burden. Prefer non-anticholinergic anxiolytics. |
| Amitriptyline (Elavil) Tricyclic antidepressant | Avoid | Highly anticholinergic; sedation; orthostasis. Avoid. |
| Nortriptyline (Pamelor) Tricyclic antidepressant | Use with caution | Less anticholinergic than amitriptyline but still avoid unless specific indication. |
| Clomipramine (Anafranil) Tricyclic antidepressant | Avoid | Highly anticholinergic and serotonergic. |
| Imipramine (Tofranil) Tricyclic antidepressant | Avoid | Anticholinergic burden. Orthostasis. |
| Doxepin (higher doses; not Silenor 3-6 mg) Tricyclic antidepressant | Use with caution | Low-dose (3-6 mg for sleep) is Beers-acceptable; higher doses avoided due to anticholinergic burden. |
| Paroxetine (Paxil) SSRI | Avoid | Only SSRI with significant anticholinergic activity. Prefer sertraline or escitalopram. |
| Chlorpromazine (Thorazine) First-generation antipsychotic | Avoid | Sedation, anticholinergic, orthostasis, QT. Avoid. |
| Thioridazine (Mellaril) First-generation antipsychotic | Avoid | QT prolongation black box; anticholinergic. Avoid. |
| Olanzapine (Zyprexa) Atypical antipsychotic | Use with caution | Anticholinergic burden and metabolic effects; boxed warning for dementia-related psychosis mortality. |
| Benztropine (Cogentin) Anticholinergic (EPS) | Avoid | Anticholinergic burden. Use only for severe acute EPS. |
| Trihexyphenidyl (Artane) Anticholinergic (EPS) | Avoid | Anticholinergic burden. |
| Diazepam (Valium) Long-acting benzodiazepine | Avoid | Long half-life; falls, cognitive impairment. Avoid. |
| Clonazepam (Klonopin) Long-acting benzodiazepine | Avoid | Long half-life; falls, cognitive impairment. |
| Chlordiazepoxide (Librium) Long-acting benzodiazepine | Avoid | Long half-life; active metabolites accumulate. |
| Flurazepam (Dalmane) Long-acting benzodiazepine | Avoid | Very long-acting metabolite. Avoid entirely. |
| Alprazolam (Xanax) Short-acting benzodiazepine | Avoid | Falls, cognitive impairment, interdose withdrawal. Avoid for chronic use. |
| Lorazepam (Ativan) Intermediate benzodiazepine | Avoid | Beers avoids all benzodiazepines in older adults. Lorazepam is preferred over long-acting if needed briefly. |
| Temazepam (Restoril) Benzodiazepine (sleep) | Avoid | Falls, cognitive impairment. Avoid. |
| Zolpidem (Ambien) Z-drug (sleep) | Avoid | Falls, delirium, parasomnia. Avoid chronic use. |
| Eszopiclone (Lunesta) Z-drug (sleep) | Avoid | Same class concerns as zolpidem. |
| Zaleplon (Sonata) Z-drug (sleep) | Avoid | Same class concerns. |
| Meperidine (Demerol) Opioid | Avoid | Neurotoxic metabolite normeperidine; delirium risk. Avoid. |
| Muscle relaxants (cyclobenzaprine, methocarbamol, carisoprodol) Muscle relaxant | Avoid | Anticholinergic, sedation, weakness, falls. |
Reference data current as of July 2026. Source: American Geriatrics Society 2023 Updated AGS Beers Criteria. J Am Geriatr Soc. 2023;71(7):2052-2081.
About this tool
The 2023 AGS Beers Criteria is the standard reference for identifying potentially inappropriate medications in older adults. This tool lets you look up individual psychiatric medications quickly to see their Beers status and rationale.
The Beers Criteria classification is a screening tool, not a hard rule. Patients with specific indications may appropriately continue Beers-listed drugs after individual risk-benefit assessment. Deprescribing conversations should include the alternatives, the underlying indication, and the patient's preferences.
The full Beers Criteria covers many non-psychiatric drugs as well. This tool focuses on psychiatric medications and closely-associated OTC and non-psychiatric drugs. For the full reference, see the AGS website.
Common questions
- What are the Beers Criteria?
The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, updated 2023, identifies drugs to avoid or use with caution in adults 65 and older. Purpose is reducing adverse drug events, falls, cognitive impairment, and hospitalizations in older adults.
- Should I always avoid Beers-listed drugs?
No. Beers Criteria identifies drugs where the risk-benefit generally does not favor use in older adults. Individual patients with specific indications may still appropriately receive Beers-listed drugs after informed shared decision-making. The criteria are a starting point, not an absolute rule.
- What are the safer alternatives?
Common substitutions: diphenhydramine for sleep → melatonin, ramelteon, low-dose doxepin (Silenor); paroxetine → sertraline or escitalopram; TCAs → SNRIs or SSRIs; benzodiazepines → CBT, buspirone; oxybutynin → mirabegron. See our antidepressants for elderly guide.