When you prescribe a new medication to adults age 65 and older, please keep in mind that many medications have a greater potential for side effects. Patients in this age group are twice as likely as those younger than age 65 to experience adverse drug events ? and almost seven times as likely to be hospitalized from them. The Centers for Medicare & Medicaid Services (CMS) has developed performance and quality measures to help Medicare beneficiaries make informed decisions regarding health and prescription drug plans. As part of this effort, CMS has developed a rating system to rank medications based on the risks of side effects in older adults. This is known as the HRM (high-risk medication) rate. Below are just a few of the more common HRMs: carisoprodol (Soma[^]?[]) cyclobenzaprine (Flexeril[^]?[]) diazepam (Valium[^]?[]) dicyclomine (Bentyl[^]?[]) diphenoxylate-atropine (Lomotil[^]?[]) estrogens (Premarin[^]?[]) hydroxyzine (Atarax[^]?[] or Vistaril[^]?[]) hyoscyamine (Levsin[^]?[]) nitrofurantoin (Macrobid[^]?[] or Macrodantin[^]?[]) promethazine-codeine (Phenergan[^]?[] with codeine) A complete list of HRMs from the National Committee for Quality Assurance (NCQA) is available at www.ncqa.org/ Portals/0/Newsroom/SOHC/Drugs_Avoided_Elderly.pdf. According to CMS, the drugs included on the list should be avoided or used with caution in older adults. Some of these drugs simply are not effective enough to be routinely used or are no longer recommended because newer, safer alternatives are now available. The list is based on the "Beers List," which is an internationally recognized list of drugs that may be inappropriate for use in the elderly due to the potential risk of adverse events. There is an even greater risk when a patient is on more than one medication considered an HRM. Careful and appropriate use of drugs in the senior population is a critical quality-of-care issue. For these reasons, we suggest that you use caution when prescribing one or more drugs on the NCQA list to patients age 65 and older.