Strategies for Replacing Potentially Inappropriate Medications in Older Adults According to the Beers Criteria

Vollständiger Abstract

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INTRODUCTION. In geriatrics, the practice of empirical symptomatic use of medications without establishing a definitive diagnosis has become entrenched, while clinical guidelines are focused on specific disease entities. The updated document “Alternatives to Specific Medications According to the American Geriatrics Society Beers Criteria (2023)," published in 2025 by the American Geriatrics Society, provides recommendations with a high level of evidence. However, their direct transfer into Russian clinical practice is limited by the registration status of certain medications in Russia. AIM. To assess the feasibility and propose a strategy for implementing the list of alternative medications for common clinical conditions in older adults, developed by the American Geriatrics Society expert panel, into Russian clinical practice. MATERIALS AND METHODS. An analysis of the 2025 American Geriatrics Society recommendations was performed, with an assessment of the compliance of medicinal products with the State Register of Medicines and with the clinical guidelines of the Russian Federation. RESULTS. The expert panel of the American Geriatrics Society selected 30 criteria for which alternative medications were proposed for the treatment of 21 conditions in older adults: allergic rhinitis, pruritus, pain, diabetes mellitus, weight loss, atrial fibrillation, venous thromboembolism, heart failure, arterial hypertension, insomnia, anxiety, delirium, Parkinson’s disease, tardive dyskinesia, gastroesophageal reflux disease, gastroparesis, intestinal cramping, diarrhea, constipation, nocturia, genitourinary syndrome of menopause, and recurrent urinary tract infections. Of the recommended international nonproprietary names of medicinal products, 80% are registered in the Russian Federation. For medicinal products not approved for use in Russian clinical practice, therapeutic equivalents that comply with Russian clinical guidelines were identified, and their use in geriatric patients was justified for insomnia, tardive dyskinesia, constipation, and menopausal syndrome. CONCLUSIONS. Most alternative medications recommended by the American Geriatrics Society in 2025 are approved for use in the Russian Federation. For the unregistered medicinal products used to treat insomnia, tardive dyskinesia, constipation, and menopausal syndrome in older adults, replacement with therapeutic equivalents that have proven efficacy and a favorable safety profile is recommended in accordance with Russian clinical guidelines.