Response to Dalleur and Colleagues


  • Todd P. Semla MS, PharmD,

    1. National Pharmacy Benefits Management Services, U.S. Department of Veterans Affairs, Hines, Illinois
    2. Northwestern University, Chicago, Illinois
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  • Donna M. Fick PhD, RN, FAAN

    1. School of Nursing and College of Medicine, Pennsylvania State University, University Park, Pennsylvania
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To the Editor:

We are grateful for the comments of Dalleur et al.[1] on the 2012 American Geriatrics Society (AGS) Beers criteria. We appreciate and recognize the differences in applying the updated criteria in countries outside of the United States.

Lack of evidence that a drug was uniquely harmful to elderly adults usually prompted the removal of medications still marketed. This was the case for fluoxetine and the long-term use of stimulant laxatives. Previous versions of the Beers criteria included fluoxetine and warfarin because of the potential for drug interactions that are not unique to elderly adults. Fluoxetine, along with the other selective serotonin reuptake inhibitors, is to be avoided in individuals with a history of falls or fractures. Chronic use of stimulant laxatives was removed because of lack of evidence that they lose their effectiveness or result in unacceptable adverse events.[2] High-sodium drugs were removed because so few are marketed.

We believe the 2012 AGS Beers criteria to be complementary to the Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria, with the Beers criteria being intentionally more explicit.[3] A detailed comparison of the 2012 AGS Beers criteria and 2006 STOPP criteria was recently published.[4] It is our understanding that the European Union Geriatric Medicine Society is currently revising the STOPP and START criteria.

The AGS intends to update the Beers criteria regularly and is in the planning stages of what to include in the next edition (e.g., drug dose adjustments in renal impairment, drug–drug interactions) that was not addressed in the 2012 update because of time constraints. We encourage our colleagues around the world to submit comments and suggestions that would expand the international application of the Beers criteria. Please submit comments to Christine Polite at


The opinions expressed are the author's and are not necessarily those of the Department of Veterans Affairs.

Conflict of Interest: Our conflicts of interest have not changed since the 2012 AGS Beers Criteria were published. Dr. Fick is partially supported by the National Institutes of Health through National Institute of Nursing Research Grants R01 NR011042 and R01NR012242. Dr. Semla receives honoraria from the AGS for his contribution as an author of Geriatrics at Your Fingertips and for serving as a Section Editor for the Journal of the American Geriatrics Society. He is a past President and Chair of the AGS Board of Directors. His spouse is an employee of Abbott Laboratories. He serves on the Omnicare Pharmacy and Therapeutics Committee (long-term care). He is an author and editor for Lexi-Comp, Inc.

Author Contributions: Both authors contributed to this response letter.

Sponsor's Role: None.