Below is a case scenario where clonidine is being used in the elderly. Clonidine is on the Beer’s list of potentially inappropriate medications in the elderly. Let’s break it down.
JS is an 87 year old female with a past medical history of hypertension, dementia, depression, weight loss, GERD, osteoarthritis, hypothyroidism, anxiety and anemia.
She is taking the following medications;
- Clonidine 0.1 mg BID
- Losartan 25 mg daily
- Mirtazapine 15 mg daily
- Alprazolam 0.25 mg BID prn
- Levothyroxine 125 mcg daily
- Omeprazole 40 mg daily
- Fentanyl 12 mcg patch every 72 hours
- Vitamin B12 1,000 mcg po daily
- Cal/D 600/400 BID
Let’s take a look at a couple of things…
With lots of other blood pressure medications to choose from, it is very curious as to why we are using clonidine in the elderly. Further assessment and identification of medications tried/failed would be important. A simple alternative based on the limited information here, might be to look at increasing the losartan. We’d want to take a look at lab work and vitals first of course.
Labs are going to be very important here as we have a lot going on that we need to monitor. CBC, TSH, kidney function, and electrolytes are the biggest ones that jump out to me. I wouldn’t highly suspect that weight loss is being caused by medications, but my first consideration would be to look at TSH and make sure we aren’t oversupplementing.
I’d like to look at pain management a little further. With this patient’s apparent ability to take oral medications, it’s interesting why fentanyl is being utilized and I would look at how much pain she is having and possible need for a prn agent.
Omeprazole is at a higher dose and can impair B12 absorption. I would look at possibly reducing this depending upon symptoms as well as risk for anemia/GI blood loss.
What else would you look at?
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