Some commonly used medicines may raise blood pressure, cause fluid retention, affect heart rhythm, or increase complications in older adults. Learn which medications deserve extra caution and what safer options to discuss with your doctor.
As we get older, medications can become an important part of staying healthy. Blood-pressure tablets, pain relievers, sleeping medicines, stomach medicines, and cold remedies can all serve useful purposes.
But there is another side that is easy to overlook: some medicines can become riskier with age, particularly when a person has heart disease, high blood pressure, kidney problems, or heart failure.
The 2023 American Geriatrics Society Beers Criteria specifically identifies medications that may be inappropriate or require additional caution in adults aged 65 and older. It also emphasizes that these recommendations should support—not replace—individual medical decisions.
That does not mean every older person should stop these medicines. In many cases, a medication may be completely appropriate when prescribed for the right reason and monitored properly.
The key is knowing which medicines deserve a medication review.
1. NSAID Painkillers
Common examples include ibuprofen, naproxen, diclofenac, indomethacin, meloxicam, and ketorolac.
These medicines are widely used for arthritis, back pain, muscle aches, headaches, and other painful conditions.
The problem is that regular oral NSAID use can increase blood pressure and contribute to kidney injury. In older adults, these medicines can also increase the risk of gastrointestinal bleeding.
For someone already dealing with heart failure, NSAIDs are particularly concerning because they can contribute to fluid retention and worsen the condition.
What may be safer?
Depending on the person’s condition, a doctor may consider:
- Acetaminophen/paracetamol for appropriate types of pain
- Physical therapy
- Exercise appropriate for the person’s ability
- Heat or cold therapy
- Topical treatments
- Topical NSAIDs in selected situations
The American Heart Association has also advised people with cardiovascular disease to be cautious with oral NSAIDs and notes that topical NSAIDs or acetaminophen may be alternatives in appropriate circumstances.
Important: “Safer” does not mean automatically safe. Paracetamol, for example, can be dangerous in excessive doses or with certain liver conditions.
2. Certain Decongestants
Many people reach for cold and sinus medicines without realizing that some contain ingredients such as pseudoephedrine or phenylephrine.
These drugs can constrict blood vessels and may raise blood pressure or cause palpitations in susceptible people.
For an older adult with hypertension or cardiovascular disease, that can be an unnecessary source of stress.
A gentler option
For simple nasal congestion, options such as saline nasal spray or saline rinses may provide relief without the same cardiovascular effects associated with systemic decongestants.
The American Heart Association specifically recommends caution with decongestants in people concerned about cardiovascular health.
Always check the active ingredients of combination cold medicines rather than assuming every “cold and flu” product is harmless.
3. Certain Tricyclic Antidepressants
Examples include:
- Amitriptyline
- Imipramine
- Clomipramine
- Nortriptyline
- Doxepin at higher doses
These medicines can be useful for specific conditions, but some have strong anticholinergic and sedating effects.
In older adults, they can contribute to dizziness, sedation and orthostatic hypotension—meaning blood pressure may drop when a person stands up.
That can increase the risk of falls and other complications.
A better approach
If an older adult has been taking one of these medications for years, the answer isn’t necessarily to stop it.
Instead, a physician can review:
- Why it was originally prescribed
- Whether it is still effective
- Whether the dose remains appropriate
- Kidney and liver function
- Other medications being taken
- Whether another treatment would have fewer adverse effects
Never abruptly stop an antidepressant without medical advice.
4. Some Muscle Relaxants
Muscle relaxants such as cyclobenzaprine, methocarbamol, carisoprodol and similar drugs can cause sedation and anticholinergic effects.
The AGS Beers Criteria notes that these medications are generally poorly tolerated by older adults and may increase the risk of fractures and other problems.
For an older person who already feels dizzy or unsteady, adding a sedating medicine can be especially problematic.
Alternatives worth discussing
Depending on the cause of the muscle pain, a doctor may recommend:
- Physical therapy
- Gentle stretching
- Heat
- Strengthening exercises
- Treatment of the underlying joint or nerve problem
- A different medication when genuinely necessary
Treating the cause is often more useful than simply adding another sedating pill.
5. Certain Sleeping Pills
Sleep problems are extremely common among older adults, but some sleeping medicines can create a difficult cycle of sedation, dizziness and falls.
Examples include the so-called Z-drugs, such as zolpidem, zaleplon and eszopiclone.
Older adults can be particularly sensitive to medicines that affect the central nervous system. The Beers Criteria recommends caution because of the increased risk of adverse effects and falls.
What can help instead?
Before automatically reaching for a sleeping pill, physicians may recommend:
- A consistent sleep schedule
- Limiting caffeine later in the day
- Reducing evening screen exposure
- Treating pain or nighttime urination
- Addressing sleep apnea
- Cognitive behavioral therapy for insomnia
Sometimes the best treatment for insomnia is actually treating the problem that is preventing sleep.
6. Certain Antipsychotic and Sedating Medicines
Antipsychotic medications can be essential for specific psychiatric or neurological conditions, but they should not be treated as ordinary sleeping pills or calming medications.
In older adults, some can contribute to sedation, dizziness, low blood pressure and other serious complications.
The AGS criteria specifically highlights medication risks related to falls, syncope and other problems in older adults.
That is why these medications should be used only when there is a clear medical reason and with appropriate monitoring.
The safer path
If an older person becomes increasingly sleepy, dizzy, confused or unsteady after starting a medication, the prescribing clinician should review the medication list.
Sometimes simply reducing unnecessary medicines can make a major difference.
7. Some Medicines That Can Worsen Existing Heart Failure
This category is particularly important.
Certain medicines can aggravate existing heart failure, even though they may not cause heart disease in an otherwise healthy person.
The 2023 Beers Criteria identifies several medications or drug classes that may worsen heart failure, including NSAIDs, certain calcium-channel blockers such as diltiazem and verapamil in heart failure with reduced ejection fraction, and certain other medications.
This is why a medication that is perfectly reasonable for one person may be inappropriate for another.
The important lesson
The question shouldn’t simply be:
“Is this medicine dangerous?”
A better question is:
“Is this medicine appropriate for this person, at this dose, with these medical conditions and these other medications?”
That distinction matters enormously in older adults.
The Hidden Problem: Taking Too Many Medicines
Sometimes the greatest danger isn’t one individual pill.
It is the combination of several medicines.
An older adult may take one medicine for blood pressure, another for arthritis, one for sleep, another for reflux, and an over-the-counter cold remedy.
Each may seem reasonable on its own.
Together, however, they can produce dizziness, low blood pressure, kidney problems, bleeding, excessive sedation or dangerous drug interactions.
The American Heart Association emphasizes that polypharmacy, frailty and multiple medical conditions require individualized medication decisions in older adults with heart failure.
Never Stop Heart Medication Suddenly
This is one of the most important warnings.
If you see your medicine listed in an article like this, do not automatically stop taking it.
Some medications are prescribed because the benefits clearly outweigh their risks for a particular patient.
Stopping certain heart, blood-pressure, anticoagulant, antidepressant or other medications suddenly can itself be dangerous.
Instead, ask your doctor or pharmacist for a medication review.
Bring every medication you use, including:
- Prescription medicines
- Over-the-counter painkillers
- Vitamins
- Herbal products
- Sleep aids
- Cold medicines
- Supplements
Don’t forget medicines you take only occasionally.
7 Questions Seniors Should Ask Before Taking a New Medicine
Before starting a new medication, consider asking:
- Why do I need this medicine?
- Is it still necessary for me?
- Could it raise my blood pressure?
- Could it cause fluid retention?
- Could it affect my kidneys or heart rhythm?
- Does it interact with any of my other medicines?
- Is there a safer alternative for someone my age?
These simple questions can help prevent medication-related problems.
Protecting Your Heart After 65
Medication safety is only one part of protecting cardiovascular health.
Other important steps include:
- Monitoring blood pressure regularly
- Managing cholesterol and diabetes
- Staying physically active according to your doctor’s advice
- Avoiding tobacco
- Maintaining a healthy weight
- Getting adequate sleep
- Following prescribed heart-failure treatment when applicable
- Keeping regular medical appointments
- Reviewing medications periodically
Most importantly, don’t assume that an older person’s symptoms are simply “part of aging.”
New shortness of breath, swelling of the legs, chest pressure, fainting, severe weakness, sudden confusion or a rapid/irregular heartbeat can require prompt medical attention.
The Bottom Line
Some common medications deserve extra caution in older adults—not because they are universally dangerous, but because aging changes the way the body handles medicines and because heart, kidney and blood-pressure problems become more common.
NSAID painkillers, certain decongestants, sedating medicines, some antidepressants, muscle relaxants, sleeping medicines and medications that can aggravate existing heart failure are among the categories worth reviewing with a healthcare professional.
The safest strategy isn’t to fear every pill.
It’s to regularly review every pill and make sure each one still has a clear purpose.
A medication that was appropriate five years ago may not be the best choice today.
A simple medication review with a doctor or pharmacist could be one of the most valuable steps an older adult takes to protect both heart health and overall well-being.