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

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.

1. Cesari M, Canevelli M, Zhang W, et al. Enhancing the methodology of clinical trials in older people: A scoping review with global perspective. J Nutr Health Aging. 2025;29(6):100582. https://doi.org/10.1016/j.jnha.2025.100582

2. Haertter S, Mallalieu NL, Saleh S, et al. Representation of older adult patients in clinical trials. Clin Transl Sci. 2025;18(11):e70407. https://doi.org/10.1111/cts.70407

3. Al-Rajavi A, Zyryanov SK, Ushkalova EA, et al. Prevalence of potentially inappropriate medications among elderly patients in clinical practice. Good Clinical Practice. 2019;(1):65–73 (In Russ.). https://doi.org/10.24411/2588-0519-2019-10064

4. 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):2052–81. https://doi.org/10.1111/jgs.18372

5. 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):2657–77. https://doi.org/10.1111/jgs.19500

6. Żełabowski K, Pichowicz W, Skowron I, et al. The efficacy of melatonergic receptor agonists used in clinical practice in insomnia treatment: Melatonin, tasimelteon, ramelteon, agomelatine, and selected herbs. Molecules. 2025;30(18):3814. https://doi.org/10.3390/molecules30183814

7. Kato K, Hirai K, Nishiyama K, et al. Neurochemical properties of ramelteon (TAK-375), a selective MT1/MT2 receptor agonist. Neuropharmacology. 2005;48(2):301–10. https://doi.org/10.1016/j.neuropharm.2004.09.007

8. Maruani J, Reynaud E, Chambe J, et al. Efficacy of melatonin and ramelteon for the acute and long-term management of insomnia disorder in adults: A systematic review and meta-analysis. J Sleep Res. 2023;32(6):e13939. https://doi.org/10.1111/jsr.13939

9. Cruz-Sanabria F, Bruno S, Crippa A, et al. Optimizing the time and dose of melatonin as a sleep-promoting drug: A systematic review of randomized controlled trials and dose-response meta-analysis. J Pineal Res. 2024;76(5):e12985. https://doi.org/10.1111/jpi.12985

10. Marupuru S, Arku D, Campbell AM, et al. Use of melatonin and/on ramelteon for the treatment of insomnia in older adults: A systematic review and meta-analysis. J Clin Med. 2022;11(17):5138. https://doi.org/10.3390/jcm11175138

11. Tissen IYu, Lebedev AA, Bychkov ER, et al. Orexins and the brain reinforcing systems. Reviews on Clinical Pharmacology and Drug Therapy. 2019;17(4):5–18 (In Russ.). https://doi.org/10.17816/RCF1745-18

12. Pavlova TA, Telepina MA, Perelygin VV, et al. Modern antidepressants: a comparative analysis of efficacy and safety, prospects for studying new drugs. Pharmacy Formulas. 2025;7(2):10–25 (In Russ.). https://doi.org/10.17816/phf686915

13. Fagiolini A, Barone P, Bellomo A, et al. Diagnosis and management of tardive dyskinesia: From research to clinical practice. Riv Psichiatr. 2025;60(2):51–60. https://doi.org/10.1708/4487.44874

14. Matthews D. From assessment to intervention: Evidence-based approaches in tardive dyskinesia. CNS Spectr. 2025;30(1):e25. https://doi.org/10.1017/s1092852925000082

15. Solmi M, Fornaro M, Caiolo S, et al. Efficacy and acceptability of pharmacological interventions for tardive dyskinesia in people with schizophrenia or mood disorders: A systematic review and network meta-analysis. Mol Psychiatry. 2025;30(3):1207–22. https://doi.org/10.1038/s41380-024-02733-z

16. Pervaya DV. Diagnosis and therapy of tardive dyskinesias. Current Therapy of Mental Disorders. 2024;(4):77–84 (In Russ.). EDN: XOIUUK

17. Keely SJ, Barrett KE. Intestinal secretory mechanisms and diarrhea. Am J Physiol Gastrointest Liver Physiol. 2022;322(4):G405–20. https://doi.org/10.1152/ajpgi.00316.2021

18. Bordin DS, Indeikina LKh, Vinnitskaya EV, et al. Lactulose: The advantages and place of the drug in clinical recommendations. Effective Pharmacotherapy. 2023;19(35):42–9 (In Russ.). https://doi.org/10.33978/2307-3586-2023-19-35-42-49

19. AlBarakat MM, Feras AlSamhori J, Abdelaziz A, et al. Efficacy and safety of fezolinetant for vasomotor symptoms in postmenopausal women: A comprehensive systematic review and meta-analysis of randomized controlled trials. Proc (Bayl Univ Med Cent). 2025;38(4):535–46. https://doi.org/10.1080/08998280.2025.2491894

20. Derwin KA, Anand C, Rose SL, Dweik R. Conflicts of interest in clinical practice: Cleveland clinic policy and experience. J Law Med Ethics. 2024;52(3):734–42. https://doi.org/10.1017/jme.2024.143

21. Thompson GA, Elshewy M, Zaher A. Directional PICO framing and unsupported conclusions in prosthodontic systematic reviews: A methodological analysis. J Prosthodont. 2026. https://doi.org/10.1111/jopr.70111

22. Xiang M. Guideline-directed medical therapy in heart failure: Is the guideline-practice gap narrowing? JACC Asia. 2025;5(6):796–8. https://doi.org/10.1016/j.jacasi.2025.03.004