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Inappropriate Drug Prescribing

James C. Maher, MD
JAMA. 1995;273(6):457. doi:10.1001/jama.1995.03520300025021.
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To the Editor.  —The article by Dr Willcox and colleagues1 requires a response. As a geriatrician, I agree that most of the drugs listed should not be prescribed for the elderly. I am struck, however, by the inclusion of amitriptyline, which unquestionably works better for chronic pain syndrome in low doses (10 to 25 mg) than other tricyclic drugs, and in those doses causes little anticholinergic or orthostatic change in the patients of my practice. I was also surprised at the failure to include voltaren, which has a risk of aplastic anemia that is probably comparable with phenylbutazone. I was also struck by the inclusion of propranolol, which in my experience causes few adverse effects (other than bronchospasm) in geriatric doses (20 to 80 mg per day) compared with other β-blockers and has the advantage of a shorter half-life. Data show that β-blockers are the most effective drugs available


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