Disclaimer for the 2023 American Geriatrics Society Updated Beers Criteria Guideline Summary

Drug-Disease or Drug-Syndrome Interactions That May Exacerbate the Disease or Syndrome

Drug-Drug Interactions That Should Be Avoided in Older Adults

Medications/Criterion Added, Removed or Modified Since 2019

Select Highlights for Medications to Avoid, Adjust Dosage for or Use with Caution

Alternative Treatments to Selected Medications

Document Overview

Design and created by Guideline Central in participation with the American Geriatrics Society.

Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

American Geriatrics Society

Publication Date: May 3, 2023

Page Last Updated: Feb 24, 2026

Drug Table 2023

Medication	Comments
Alprazolam	Avoid
Amiloride	Avoid if CrCl <30 mL/min
Amiodarone	Avoid as first-line therapy for atrial fibrillation for most patients
Amitriptyline	Avoid; has strong anticholinergic properties
Amobarbital	Removed from 2023 versiom - per 2019, Avoid
Amoxapine	Avoid; has strong anticholinergic properties
Androgens	Avoid unless indicated for symptomatic hypogonadism
Apixaban	Per 2023, Emerging evidence and clinical experience supporting safe use at lower levels of renal function, Per 2019, Avoid if CrCl <25 mL/min
Aripiprazole	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Asenapine	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Aspirin	Avoid initiating aspirin for primary prevention of cardiovascular disease. Consider deprescribing aspirin in older adults already taking it for primary prevention.; Use with caution in adults ≥70 years; Avoid in most patients with history of gastric or duodenal ulcers; avoid chronic use with >325 mg/day
Atropine (excludes ophthalmic)	Avoid; has strong anticholinergic properties
Baclofen	Avoid in older adults with impaired kidney function (eGFR <60 mL/min); If cannot be avoided, use the lowest effective dose and monitor for signs of CNS toxicity, including altered mental status
Belladonna alkaloids	Avoid; has strong anticholinergic properties
Benztropine (oral)	Avoid; has strong anticholinergic properties
Brexpiprazole	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Brompheniramine	Avoid; has strong anticholinergic properties
Butobarbital	Removed from 2023 versiom - per 2019, Avoid
Butalbital	Avoid
Canigliflozin	Use with caution. Monitor patients for urogenital infections and ketoacidosis.
Carbamazepine	Use with caution
Carbinoxamine	Removed from 2023 versiom - per 2019, Avoid; has strong anticholinergic properties
Cariprazine	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Carisoprodol	Avoid
Chlordiazepoxide (alone or in combination with amitriptyline or clidinium)	Avoid
Chlorpheniramine	Avoid; has strong anticholinergic properties
Chlorpromazine	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties
Chlorpropamide	Avoid
Chlorzoxazone	Avoid
Cilostazol	Avoid for most patients; Use with caution in patients with heart failure
Cimetidine	Reduce dose if CrCl <50 mL/min; avoid in patients with delirium
Ciprofloxacin	Reduce dose if CrCl <30 mL/min
Citalopram	Use with caution
Clemastine	Removed from 2023 versiom - per 2019, Avoid; has strong anticholinergic properties
Clidinium-chlordiazepoxide	Avoid; has strong anticholinergic properties
Clomipramine	Avoid; has strong anticholinergic properties
Clonazepam	Avoid
Clonidine for first-line treatment	Avoid as an antihypertensive
Clorazepate	Avoid
Clozapine	Avoid*, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties
Colchicine	Reduce dose if CrCl <30 mL/min and monitor
Cyclobenzaprine	Avoid; has strong anticholinergic properties
Cyproheptadine	Avoid; has strong anticholinergic properties
Dabigatran	Use with caution for treatment of VTE or atrial fibrillation in adults ≥75 years; Avoid; dose adjustment advised when CrCl >30 mL/min in the presence of drug-drug interactions
Dapagliflozin	Use with caution. Monitor patients for urogenital infections and ketoacidosis.
Darifenacin	Has strong anticholinergic properties
Desiccated thyroid	Avoid
Desipramine	Avoid; has strong anticholinergic properties
Desmopressin	Avoid for nocturia or nocturnal polyuria
Desvenlafaxine	Use with caution
Dexbrompheniramine	Avoid; has strong anticholinergic properties
Dexchlorpheniramine	Removed from 2023 versiom - per 2019, Avoid; has strong anticholinergic properties
Dexlansoprazole	Avoid scheduled use for >8 weeks for most patients
Dextromethorphan/quinidine	Use with caution
Diazepam	Avoid
Diclofenac	Avoid chronic use
Dicyclomine	Has strong anticholinergic properties; Avoid in men with lower urinary tract symptoms, benign prostatic hyperplasia
Dicyclomine Homatropine (excludes opthalmic)	Avoid
Diflunisal	Avoid chronic use
Digoxin	Avoid as first line therapy for atrial fibrillation and for heart failure; if used for atrial fibrillation or heart failure, avoid dosages >0.125 mg/day; Avoid as first-line therapy for heart failure
Diltiazem	Avoid for most patients; Use with caution in patients with heart failure
Dimenhydrinate	Avoid; has strong anticholinergic properties
Diphenhydramine (oral)	Avoid; has strong anticholinergic properties
Dipyridamole, oral short acting	Avoid
Disopyramide	Removed from 2023 versiom - per 2019, Avoid; has strong anticholinergic properties
Diuretics	Use with caution
Dofetilide	Reduce dose if CrCl 20-59 mL/min; Avoid if CrCl <20 mL/min
Doxazosin	Avoid use as an antihypertensive; Avoid in patients with syncope and in females with urinary incontinence
Doxepin (>6 mg / day)	Avoid; has strong anticholinergic properties
Doxylamine	Avoid; has strong anticholinergic properties
Dronedarone	Avoid in individuals with permanent atrial fibrillation or some types of heart failure; Use caution in patients with HFrEF with less severe symptoms (NYHA class I or II)
Duloxetine	Use with caution; Avoid if CrCl <30 mL/min
Edoxaban	Reduce dose if CrCl 15-50 mL/min; Avoid if CrCl <15 or >95 mL/min
Emplaglifozin	Use with caution. Monitor patients for urogenital infections and ketoacidosis.
Enoxaparin	Reduce dose if CrCl <30 mL/min
Ergoloid mesylates (dehydrogenated ergot alkaloids)	Avoid
Ertuglifozin	Use with caution. Monitor patients for urogenital infections and ketoacidosis.
Escitalopram	Use with caution
Esomeprazole	Avoid scheduled use for >8 weeks for most patients
Estazolam	Avoid
Estrogens with or without progestins	Avoid systemic estrogen - consider deprescribing among older women already using this medication; Vaginal cream or vaginal tablets: acceptable to use low-dose intravaginal estrogen for some patients
Eszopiclone	Avoid
Etodolac	Avoid chronic use
Famotidine	Reduce dose if CrCl <50 mL/min; Avoid in patients with delirium
Fenoprofen	Removed from 2023 versiom - per 2019, Avoid chronic use
Fesoterodine	Has strong anticholinergic properties
Flavoxate	Has strong anticholinergic properties
Fluoxetine	Use with caution
Fluphenazine	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Flurazepam	Removed from 2023 versiom - per 2019, Avoid
Fluvoxamine	Use with caution
Fondaparinux	Avoid if CrCl <30 mL/min
Gabapentin	Reduce if CrCl <60 mL/min
Glimepiride	Avoid
Glyburide (also known as glibenclamide)	Avoid
Growth hormone	Avoid, except for some patients with growth hormone deficiency
Guanabenz	Avoid other CNS alpha-agonists as listed
Guanfacine	Avoid other CNS alpha-agonists as listed
Haloperidol	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Homatropine (excludes ophthalmic)	Has strong anticholinergic properties; Avoid in men with lower urinary tract symptoms, benign prostatic hyperplasia
Hydroxyzine	Avoid; has strong anticholinergic properties
Hyoscyamine	Avoid; has strong anticholinergic properties
Ibuprofen	Avoid chronic use
Iloperidone	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Imipramine	Avoid; has strong anticholinergic properties
Indomethacin	Avoid
Insulin, sliding scale	Avoid
Isoxsuprine	Avoid
Ketoprofen	Removed from 2023 versiom - per 2019, Avoid chronic use
Ketorolac, includes parenteral	Avoid
Lansoprazole	Avoid scheduled use for >8 weeks for most patients
Levetiracetam	Reduce dose if CrCl ≤80 mL/min
Levomilnacipran	Use with caution
Lorazepam	Avoid
Loxapine	Removed from 2023 versiom - per 2019, Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties
Lumateperone	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Lurasidone	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Meclizine	Avoid
Meclofenamate	Removed from 2023 versiom - per 2019, Avoid chronic use
Mefenamic acid	Removed from 2023 versiom - per 2019, Avoid chronic use
Megestrol	Avoid
Meloxicam	Avoid chronic use
Meperidine	Avoid
Mephobarbital	Avoid
Meprobamate	Avoid
Mesoridazine	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Metaxalone	Avoid
Methocarbamol	Avoid
Methscopolamine	Removed from 2023 versiom - per 2019, Avoid; has strong anticholinergic properties
Methyldopa	Avoid other CNS alpha-agonists as listed
Methyltestosterone	Avoid unless indicated for symptomatic hypogonadism
Metoclopramide	Avoid, unless for gastroparesis use less than 12 weeks for most cases; Avoid in patients with Parkinson Disease
Milnacipran	Use with caution
Mineral oil, given orally	Avoid
Mirtazapine	Use with caution
Molindone	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Nabumetone	Avoid chronic use
Naproxen	Avoid chronic use
Nifedipine, immediate release	Avoid
Nitrofurantoin	Avoid in individuals with creatinine clearance <30 mL/min or for long-term suppression
Nizatidine	Reduce dose if CrCl <50 mL/min; Avoid in patients with delirium
Nortriptyline	Avoid; has strong anticholinergic properties
Olanzapine	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties
Omeprazole	Avoid scheduled use for >8 weeks for most patients
Omeprazole / sodium bicarbonate	Avoid scheduled use for >8 weeks for most patients
Orphenadrine	Avoid; has strong anticholinergic properties
Other 1st and 2nd Generation Antipsychotics	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Other PPIs	Avoid scheduled use for >8 weeks for most patients
Other SNRIs	Use with caution
Other SSRIs	Use with caution
Other TCAs	Use with caution
Oxaprozin	Avoid chronic use
Oxazepam	Avoid
Oxcarbazepine	Use with caution
Oxybutynin	Has strong anticholinergic properties
Paliperidone	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Pantoprazole	Avoid scheduled use for >8 weeks for most patients
Paroxetine	Avoid; has strong anticholinergic properties
Pentobarbital	Avoid
Perphenazine	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties
Phenobarbital	Avoid
Pimavanserin	Avoid*, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Pioglitazone	Avoid for most patients; Use with caution in patients with heart failure
Piroxicam	Avoid chronic use
Prasugrel	Use with caution in adults ≥75 years - If prasugrel is used, consider a lower dose (5 mg) for those 75 years old and older
Prazosin	Avoid use as an antihypertensive; Avoid in patients with syncope and in females with urinary incontinence
Pregabalin	Reduce if CrCl <60 mL/min
Probenecid	Avoid if CrCl <30 mL/min
Prochlorperazine	Avoid in patients with Parkinson Disease
Prochlorperazine	Has strong anticholinergic properties; Avoid in men with lower urinary tract symptoms, benign prostatic hyperplasia
Promethazine	Avoid; has strong anticholinergic properties
Propantheline	Avoid; has strong anticholinergic properties
Protriptyline	Removed from 2023 versiom - per 2019, Avoid; has strong anticholinergic properties
Pyrilamine	Avoid; has strong anticholinergic properties
Quazepam	Removed from 2023 versiom - per 2019, Avoid; has strong anticholinergic properties
Quetiapine	Avoid*, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Rabeprazole	Avoid scheduled use for >8 weeks for most patients
Ranitidine	Reduce dose if CrCl <50 mL/min; Avoid in patients with delirium
Reserpine (>0.1 mg/day)	Avoid other CNS alpha-agonists as listed
Risperidone	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Rivaroxaban	Avoid for long-term treatment of atrial fibrillation or VTE in favor of safer anticoagulant alternatives - see also criteria regarding DOACs; Avoid if CrCl <15 mL/min and reduce the dose if CrCl is 15–50 mL/min following manufacturer dosing recommendations based on indication-specific dosing
Rosiglitazone	Avoid for most patients; Use with caution in patients with heart failure
Scopolamine (excludes ophthalmic)	Avoid; has strong anticholinergic properties
Secobarbital	Avoid
Sertraline	Use with caution
Solifenacin	Has strong anticholinergic properties
Spironolactone	Avoid if CrCl <30 mL/min
Sulindac	Avoid chronic use
Temazepam	Avoid
Terazosin	Avoid use as an antihypertensive; Avoid in patients with syncope and in females with urinary incontinence
Testosterone	Avoid unless indicated for symptomatic hypogonadism
Thioridazine	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties
Thiothixene	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Ticagrelor	Use with caution, particularly in adults 75 years old and older. If prasugrel is used, consider a lower dose (5 mg) for those 75 years old and older.
Tolmetin	Avoid chronic use
Tolterodine	Has strong anticholinergic properties
Tramadol	Use with caution; If CrCl <30 mL/min, may require reduction with immediate release or avoid with extended release
Triamterene	Avoid if CrCl <30 mL/min
Triazolam	Avoid
Trifluoperazine	Removed from 2023 versiom - per 2019, Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy); has strong anticholinergic properties
Trihexyphenidyl	Avoid; has strong anticholinergic properties
Trimethoprimsulfamethoxazole	Use with caution in patients on ACEI or ARB or ARNI and decreased creatinine clearance; Reduce dosage if CrCl is 15–29 mL/min and avoid if CrCl <15 mL/min
Trimipramine	Removed from 2023 versiom - per 2019, Avoid; has strong anticholinergic properties
Triprolidine	Avoid; has strong anticholinergic properties
Trospium	Has strong anticholinergic properties
Venlafaxine	Use with caution
Verapamil	Avoid for most patients; Use with caution in patients with heart failure
Warfarin	Avoid starting warfarin as initial therapy for the treatment of nonvalvular atrial fibrillation or VTE unless alternative options (i.e., DOACs) are contraindicated or there are substantial barriers to their use. For older adults who have been using warfarin long-term, it may be reasonable to continue this medication, particularly among those with well-controlled INRs (i.e., >70% time in the therapeutic range) and no adverse effects. See also criteria regarding DOACs.
Zaleplon	Avoid
Ziprasidone	Avoid, except in some situations (e.g. bipolar disorder, schizophrenia, short-term chemotherapy)
Zolpidem	Avoid

*Exceptions: clozapine, pimavanserin, and quetiapine appear to be less likely to precipitate the worsening of Parkinson disease than other antipsychotics

This table is not intended as a replacement for or comprehensive summary of the whole or of any part of the AGS 2023 Beers Criteria. For a full and complete listing of medications, along with recommendations, rationale and grading, please refer to the full text Beers Criteria guideline here .

American Geriatrics Society Quality and Strength of Evidence

Quality and Strength of Evidence
*Quality of Evidenc*e
High	Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes (≥2consistent, higher-quality randomized controlled trials or multiple, consistent observational studies with no significant methodologic flaws showing large effects).
Moderate	Evidence is sufficient to determine effects on health outcomes, but the number, quality, size, or consistency of included studies; generalizability to routine practice; or indirect nature of the evidence on health outcomes (≥1 higher-quality trial with >100 participants; ≥2 higher-quality trials with some inconsistency; ≥2 consistent, lower-quality trials; or multiple, consistent observational studies with no significant methodologic flaws showing at least moderate effects) limits the strength of the evidence.
Low	Evidence is insufficient to assess effects on health outcomes because of limited number or power of studies, large and unexplained inconsistency between higher-quality studies, important flaws in study design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes.
*Strength of Recommendation*
Strong	Benefits clearly outweigh risks and burden, or risks and burden clearly outweigh benefits. Panel judged the evidence and determined that the benefits clearly outweighed harms or the potential harms clearly outweighed the benefits.
Weak	Benefits finely balanced with risks and burden. Panel judged the evidence to be in favor of these interventions, but the current level of evidence or potential risks of the treatment did not support a strong recommendation.
Insufficient	Insufficient evidence to determine net benefits or risks. Panel judged the evidence as warranting a recommendation statement to be made, but weighed the evidence as being insufficient to determine the net risks and benefits.
Not Applicable	No recommendation made. Panel determined that no recommendation could be made, that is, a statement could not be made either for or against a clinical practice.

Document Overview

Document Title: AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Authoring Society: American Geriatrics Society

Document Publication Date: May 3, 2023

Page Last Reviewed/Updated: Feb 24, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18372

Source Citation: By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023 May 4. doi: 10.1111/jgs.18372. Epub ahead of print. PMID: 37139824.

American Geriatrics Society Beers Criteria® Alternatives Panel, M. A. Steinman, T. P. Semla, K. M. Akgün, et al., “ Alternative Treatments to Selected Medications in the 2023 American Geriatrics Society Beers Criteria®,” Journal of the American Geriatrics Society (2025): 1–21, https://doi.org/10.1111/jgs.19500.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: With more than 90% of older people using at least one prescription and more than 66% using three or more in any given month, the AGS Beers Criteria® plays a vital role in helping health professionals, older adults, and caregivers work together to ensure medications are appropriate. The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults is widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a regular cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2023 update, an interprofessional expert panel reviewed the evidence published since the last update (2019) and based on a structured assessment process approved a number of important changes including the addition of new criteria, modification of existing criteria, and formatting changes to enhance usability. The criteria are intended to be applied to adults 65 years old and older in all ambulatory, acute, and institutionalized settings of care, except hospice and end-of-life care settings. Although the AGS Beers Criteria® may be used internationally, it is specifically designed for use in the United States and there may be additional considerations for certain drugs in specific countries. Whenever and wherever used, the AGS Beers Criteria® should be applied thoughtfully and in a manner that supports, rather than replaces, shared clinical decision-making.

Scope: Management, Prevention, Treatment

Diseases/Conditions (MeSH)

D008508 - Medication Errors

D000067561 - Potentially Inappropriate Medication List

D054539 - Medication Therapy Management

Keywords: Beer's, Beer's Criteria, Beers Criteria, beer criteria, beers, beers list, medication use

Target Patient Population: Older adults taking one or more medications

Target Provider Population: All healthcare providers that care for older patients

Inclusion Criteria: Male, Female, Older Adult

Health Care Settings: Ambulatory, Home Health, Hospital, Long Term Care, Outpatient

Intended Users: Community Pharmacist, Health Systems Pharmacist, Healthcare Business/Administration, Nurse, Nurse Practitioner, Pharmacy Technician, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 36

Literature Search Start Date: Wednesday, May 31, 2017

Literature Search End Date: Monday, May 30, 2022

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: No

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Disclaimer for the 2023 American Geriatrics Society Updated Beers Criteria Guideline Summary

Drug-Disease or Drug-Syndrome Interactions That May Exacerbate the Disease or Syndrome

Drug-Drug Interactions That Should Be Avoided in Older Adults

Medications/Criterion Added, Removed or Modified Since 2019

Select Highlights for Medications to Avoid, Adjust Dosage for or Use with Caution

Drug Table 2023

Additional Comment

Alternative Treatments to Selected Medications

American Geriatrics Society Quality and Strength of Evidence

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology