“Version 3 of the STOPP/START criteria is a welcome addition to geriatric pharmacotherapy,” write authors of a commentary. “The START criteria are a unique tool that addresses potential underuse of medications in older adults. In contrast, the STOPP criteria are complementary to the AGS Beer’s criteria in identifying potential inappropriate medications, but both have enough differences to support their use in tandem to optimize care of older adults.”
The new guidance includes 57 START and 133 STOP criteria. “One START criterion recommends warfarin for atrial fibrillation, which contradicts the STOPP criterion that recommends restricting its use to a limited number of patients in favor of direct oral anticoagulants,” the authors explain. “In addition, given the rising concerns about the use of gabapentinoids especially in combination with other CNS drugs, more discussion about their use in addition to or in place of topical lidocaine patch in post-herpetic neuralgia would have been helpful. In contrast, the panel [is] to be commended for including a unique listing of drugs of choice for numerous chronic conditions as well as prevention with the use of vaccines in the most recent criteria. The vaccine section focuses on age-based recommendations, which includes influenza, pneumococcal, zoster, and SARS-CoV2 vaccines for older adults. One age-based recommended vaccine missing is tetanus–diphtheria–pertussis (Tdap or Td). Also notable are new criteria for the use of SGLT-2 inhibitors along with sacubitril/valsartan in heart failure representing emerging data. This is consistent with the 2022 US guidelines.”