While the 2023 AGS Beers Criteria® remains the gold standard for identifying potentially inappropriate medications (PIMs), the American Geriatrics Society (AGS) released a significant new resource in late 2025: the AGS Beers Criteria® Alternatives List.
This 2025-2026 focus marks a shift in geriatric care. It’s no longer just about the “no-go” list; it’s about providing clinicians and patients with evidence-based pharmacologic and non-pharmacologic alternatives for over 20 common conditions.
Key Changes to Highlight for 2026
- The “Alternatives” Push: The latest guidance (published in JAGS in late 2025) provides specific substitutes for risky drugs used to treat insomnia, anxiety, delirium, and chronic pain.
- Focus on Non-Drug Solutions: There is now a much stronger emphasis on lifestyle and behavioral changes—such as sleep hygiene instead of sedative-hypnotics—reflecting an “overall approach of ‘less is more.'”
- Anticoagulation Priorities: The preference for Direct Oral Anticoagulants (DOACs) like apixaban over warfarin or rivaroxaban has become even more established in clinical practice throughout 2025 and 2026.
- Deprescribing Tools: The 2026 toolkit now includes more “patient-friendly” decision aids and handouts specifically designed to help families talk to doctors about stopping unnecessary medications (deprescribing).
Updated Table: Risks & 2026 Alternatives
The table below includes the “Concern” from the 2023 criteria and the “Alternative” focus from the 2025-2026 updates.
Category | Drug Example | 2026 Clinical Concern | Safer Alternative Focus |
Analgesics | Meperidine | Neurotoxicity, delirium. | Non-NSAID management; topical agents. |
Anticoagulants | Warfarin / Rivaroxaban | Higher major bleeding risk. | Apixaban (preferred for many). |
Antidiabetics | Sulfonylureas | Prolonged hypoglycemia. | SGLT2 inhibitors (with monitoring). |
Antipsychotics | Any antipsychotics | Stroke and cognitive decline. | Non-pharmacologic behavioral therapy. |
Anxiolytics | Benzodiazepines | Falls and cognitive impairment. | CBT-I (for sleep) or SSRIs (for anxiety). |
NSAIDs | Aspirin (Primary Prev.) | GI bleeding/perforation. | Deprescribing for primary prevention. |
CNS Agents | “Z-drugs” (Zolpidem) | Delirium, falls, fractures. | Sleep hygiene; Melatonin (in some cases). |
What Hasn’t Changed?
The core “Five Pillars” of the Beers Criteria remain the same. These continue to be the primary way the list is organized for 2026:
- Medications to avoid for most older adults.
- Medications to avoid with certain conditions (e.g., heart failure, history of falls).
- Medications to use with caution.
- Potentially harmful drug-drug interactions.
- Medications to avoid or dose-adjust based on kidney function.
Where to Find Tools in 2026
The AGS continues to host the most up-to-date versions of the criteria, the new Alternatives List, and the mobile app at GeriatricsCareOnline.org and public resources at HealthinAging.org.
2026 Quick-Glance: Common Medications to Review
The AGS Beers Criteria® contains nearly 100 medications, but these are the most common categories seen in daily practice. If you or a loved one are taking these, 2026 guidelines suggest discussing a “medication check-up” with your provider.
Brain & Mental Health
Medication Class | Example | The Risk | 2026 Action Step |
Antipsychotics | Haloperidol, Quetiapine | Increased risk of stroke and cognitive decline. | Focus on non-drug behavioral strategies first. |
Benzodiazepines | Alprazolam (Xanax), Lorazepam | Severe fall risk; “Brain fog” or memory issues. | Ask about a supervised “taper” to safely stop. |
Sleep Meds | Zolpidem (Ambien) | Increased risk of fractures and delirium. | Switch to Sleep Hygiene or CBT-I (Therapy). |
Antihistamines | Diphenhydramine (Benadryl) | Confusion, dry mouth, and constipation. | Use “non-drowsy” options like Loratadine. |
Heart & Blood Pressure
Medication Class | Example | The Risk | 2026 Action Step |
Alpha-blockers | Doxazosin | Dangerous drops in blood pressure upon standing. | Review safer BP alternatives with your doctor. |
Anticoagulants | Warfarin | High risk of internal bleeding. | Discuss “DOACs” (like Apixaban) for safer thinning. |
Aspirin | Daily Aspirin | GI bleeding (if used for primary prevention). | Ask if aspirin is still necessary for your specific risk. |
Pain & Inflammation
Medication Class | Example | The Risk | 2026 Action Step |
NSAIDs | Ibuprofen (Advil), Naproxen | Stomach ulcers and kidney strain. | Use topical gels or Acetaminophen (Tylenol). |
Muscle Relaxants | Cyclobenzaprine | High sedation and increased risk of falling. | Seek physical therapy or stretching routines. |
Strong Painkillers | Meperidine (Demerol) | Seizures and severe confusion (neurotoxicity). | This is now rarely recommended for older adults. |
Other Common Concerns
Medication Class | Example | The Risk | 2026 Action Step |
Diabetes Meds | Glyburide | Dangerously low blood sugar (hypoglycemia). | Discuss newer classes like SGLT2s or GLP-1s. |
Bladder Meds | Desmopressin | Hyponatremia (critically low salt in the blood). | Monitor sodium levels closely if use is required. |
Acid Reflux | Proton Pump Inhibitors | Bone loss and C. diff infections (if used long-term). | Ask about “deprescribing” or using H2 blockers. |
Important Reminder for 2026
Never stop taking a prescribed medication on your own. The Beers Criteria is a tool to start a conversation, not a set of “forbidden” drugs. Some medications on this list may still be the best choice for you based on your unique health history. Always consult with your healthcare team before making changes.
We hope this information is helpful to you in the important work you do as a family caregiver.
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