Pharmacists Are Using MTM to Catch Medication Safety Risks in Older Adults Before They Cause Harm

One of the goals of Healthy People 2030 is to reduce inappropriate medication use in older adults.¹ The American Geriatrics Society (AGS) Beers Criteria, commonly referred to as the Beers List, is a popular resource pharmacists use to evaluate medications that are inappropriate for adults 65 years and older.² Through medication therapy management (MTM), pharmacists can play an important role in identifying drugs that are inappropriate for older adults.

Identifying Inappropriate Medications and MTM

During comprehensive medication reviews (CMRs), pharmacists can help identify prescription and OTC medications that could be harmful for older adults. One top example is first-generation antihistamines such as diphenhydramine (Benadryl; Kenvue). These medications have strong anticholinergic properties, which is especially problematic in patients 65 years and older.² Adverse effects include confusion, dry mouth, dizziness, and constipation, as well as increased fall risk. Newer second-generation antihistamines are safer options for allergy relief in older adults because they typically do not cause drowsiness and other anticholinergic adverse effects.² These OTC options include cetirizine (Zyrtec; Kenvue), loratadine (Claritin; Bayer), and fexofenadine (Allegra; Sanofi).

There are a variety of stand-alone and combination products that contain diphenhydramine. Pharmacists should educate patients to read the Drug Facts label on the back of OTC products, which can help them identify the active ingredients in OTC medications.³ Combination cough and cold products may contain medications that can cause more adverse effects in older adults. Counseling patients about safely selecting OTC products in the pharmacy aisle is important during MTM consults. Pharmacists can also screen for any interactions between patients’ OTC and prescription medications to identify any safety concerns.

In 2025, the AGS released recommendations for alternate treatments to medications on the Beers List.⁴ Pharmacists can use this guidance for educating patients and other health care professionals. For instance, proton pump inhibitors (PPIs) should not be used for longer than 8 weeks.⁴ Long-term use can cause a variety of adverse effects, especially in older adults. Increased fracture risk, vitamin B12 deficiency, pneumonia, chronic kidney disease, and Clostridioides difficile are top concerns.⁴ Only patients with high-risk conditions, such as chronic nonsteroidal anti-inflammatory drug use and erosive esophagitis, should take PPIs long-term.⁴

There are also a variety of alternative options for insomnia in older adults. Benzodiazepine and nonbenzodiazepine medications can cause sedation and anticholinergic adverse effects in patients 65 and older.⁴ Cognitive behavioral therapy for insomnia is recommended as a first-line treatment.⁴ Pharmacists can also educate patients about sleep hygiene, such as avoiding caffeine in the evening and limiting screen time before bed. If pharmacotherapy is needed for insomnia, low-dose doxepin (Silenor; Viatris) can be a safer medication option in older adults.⁴ 

Deprescribing PPIs in patients that no longer need them is an important role for pharmacists.⁴ Lifestyle modifications can also be recommended to help manage gastroesophageal reflux disease symptoms. Avoiding triggering foods, elevating the head of the bed, and avoiding eating 2 to 3 hours before bedtime are a few strategies.⁴ If patients need pharmacotherapy for relief, histamine-2-receptor blockers are safer options for older patients. 

MTM Spotlight

In email interviews with Pharmacy Times, Maygen Cardona, PharmD, BCPS, ACE, a clinical pharmacy manager at Kadlec Regional Medical Center in Richland, Washington, and Celia Potts, PharmD, BCSCP, BCGP, a clinical pharmacist at Carl Vinson Veterans’ Administration Medical Center Community Living Center in Dublin, Georgia, discussed the pharmacist’s role in MTM for older adults.

“It is always important to reiterate to the patient and other pharmacists/prescribers that the Beer’s List is just a guide, not an absolute yes or no, and if appropriate, we should try alternate medications or non-medication approaches first, but that these medications are still available to the patient,” Cardona said.

One recent clinical intervention Cardona made involved an 80-year-old patient taking multiple sedating OTC allergy medications. “I quickly acted on removing the duplicate therapies and reducing the dose of a single agent,” Cardona explained.

Potts conducts monthly CMRs in which she manages pharmacotherapy for a variety of chronic health conditions, such as anticoagulation, hypertension, heart failure, and bone health. Additionally, Potts teaches a Beers List lecture to medical and pharmacy residents. “My teaching approach focuses on building a strong physiologic and pharmacologic foundation before reviewing specific medication recommendations found in the Beers Criteria,” Potts said.

Additionally, Potts has made a variety of clinical interventions at her practice. For instance, one 82-year-old patient was taking the anticholinergic drug oxybutynin (Ditropan; Janssen) for overactive bladder and developed acute delirium. Potts recommended switching the patient to mirabegron (Myrbetriq; Astellas), and cognitive impairment did not reoccur. 

About the Author

Jennifer Gershman, PharmD, CPh, PACS is a drug information pharmacist and Pharmacy Times contributor who resides in South Florida.

REFERENCES

1. Reduce the proportion of older adults who use inappropriate medications – OA-02. Health People 2030. Accessed March 29, 2026. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/older-adults/reduce-proportion-older-adults-who-use-inappropriate-medications-oa-02

2. 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;71(7):2052-2081. doi:10.1111/jgs.18372

3. The over-the-counter drug facts label. FDA. Updated October 25, 2024. Accessed March 29, 2026. https://www.fda.gov/drugs/understanding-over-counter-medicines/over-counter-drug-facts-label

4. American Geriatrics Society Beers Criteria Alternatives Panel, Steinman MA. Alternative treatments to selected medications in the 2023 American Geriatrics Society Beers Criteria. J Am Geriatr Soc. 2025;73(9):2657-2677. doi:10.1111/jgs.19500