Which antiepileptic drug is listed as potentially inappropriate and should be used with caution in older adults?

• A. Levetiracetam
• B. Lamotrigine
• C. Topiramate
• D. Carbamazepine

Answer: (D)

Carbamazepine is flagged in the Beers Criteria as a potentially inappropriate antiepileptic for older adults because of safety concerns that are especially problematic in seniors. It can cause hyponatremia (SIADH), which in older patients may present as confusion, dizziness, weakness, and an increased risk of falls. It also has strong hepatic enzyme–inducing effects, leading to numerous drug interactions that are common in older adults who are often taking multiple medications. In addition, it can produce CNS side effects like sedation and ataxia, further increasing fall risk and cognitive disturbance. Because of these risks, its use in older adults is typically avoided or undertaken only with close monitoring and clear justification; when possible, alternatives with more favorable safety profiles—such as levetiracetam or lamotrigine—are preferred.