Are Sertraline (selective serotonin reuptake inhibitor (SSRI)) and Temazepam (benzodiazepine) listed on the Beers Criteria?

Beers Criteria Status of Sertraline and Temazepam

Temazepam is listed on the Beers Criteria as a benzodiazepine to avoid in older adults, while sertraline is NOT listed as a medication to avoid. 1, 2

Temazepam (Benzodiazepine)

Temazepam should be avoided in older adults due to increased risks of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents. 2

Core Risks

• The American Geriatrics Society identifies all benzodiazepines, including temazepam, as high-risk central nervous system agents that cause clinically significant harm in older adults 2
• Benzodiazepines are associated with increased risk of death and falls in older populations 1
• These medications cause respiratory depression (especially when combined with opioids), cognitive impairment, and overdose risk 1

Disease-Specific Contraindications

• Absolutely avoid temazepam in patients with:
  • History of falls or fractures 2
  • Dementia or cognitive impairment 2
  • Delirium 2

Critical Drug Interactions

• Never combine temazepam with opioids due to severe respiratory depression and death risk 1, 2
• This drug-drug interaction was specifically added to the 2019 Beers Criteria update reflecting substantial harms occurring when benzodiazepines are used concurrently with opioids 1

Deprescribing Priority

• The American Geriatrics Society recommends prioritizing removal of benzodiazepines as they carry the highest morbidity and mortality risks 2
• Temazepam should be systematically identified and deprescribed at every care transition 2

Sertraline (SSRI)

Sertraline itself is NOT on the Beers Criteria list of medications to avoid. 1

Important Distinction

• While SSRIs as a class are mentioned in the Beers Criteria, they appear only in specific disease-context situations, not as medications to avoid outright 1
• SNRIs (not SSRIs like sertraline) were added to the list of antidepressants to avoid in persons with history of falls or fractures 1
• The 2019 update specifically added SNRIs to the fall/fracture criterion, but SSRIs remain acceptable alternatives in this context 1

Clinical Implication

• Sertraline can be used in older adults without the same level of concern as benzodiazepines 1
• However, monitor for hyponatremia, bleeding risk (especially with concurrent NSAIDs or anticoagulants), and serotonin syndrome with drug interactions 1

Common Pitfall to Avoid

Do not confuse SSRIs (like sertraline) with SNRIs when applying the Beers Criteria for fall risk. The 2019 update specifically distinguished between these classes, adding SNRIs but not SSRIs to the fall/fracture avoidance list 1. This distinction matters clinically when selecting antidepressants for older adults with fall history.