Objectives We assessed the prevalence of potentially inappropriate medication (PIM) among older (≥ 65 years) people living with HIV (O‐PLWH) in the region of Madrid. Methods We analysed the dispensation registry of community and hospital pharmacies from the Madrid Regional Health Service (SERMAS) for the period between 1 January and 30 June 2017, looking specifically at PIMs according to the 2019 Beers criteria. Co‐medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. Results A total of 6 636 451 individuals received medications. Of these individuals, 22 945 received antiretrovirals (ARVs), and of these 1292 were O‐PLWH. Overall, 1135 (87.8%) O‐PLWH were taking at least one co‐medication, and polypharmacy (at least five co‐medications) was observed in 852 individuals (65.9%). A PIM was identified in 482 (37.3%) O‐PLWH. Factors independently associated with PIM were polypharmacy adjusted odds ratio (aOR) 7.08; 95% confidence interval (CI) 5.16–9.72 and female sex (aOR 1.75; 95% CI 1.30–2.35). The distribution of PIMs according to ATC drug class were nervous system drugs (n = 369; 28.6%), musculoskeletal system drugs (n = 140; 10.8%), gastrointestinal and metabolism drugs (n = 72; 5.6%), cardiovascular drugs (n = 61; 4.7%), respiratory system drugs (n = 13; 1.0%), antineoplastic and immunomodulating drugs (n = 10; 0.8%), and systemic anti‐infectives (n = 2; 0.2%). Five drugs accounted for 84.8% of the 482O PLWH with PIMs: lorazepam (38.2%), ibuprofen (18.0%), diazepam (10.2%), metoclopramide (9.9%), and zolpidem (8.5%). Conclusions Prescription of PIMs is highly prevalent in O‐PLWH. Consistent with data in uninfected elderly people, the most frequently observed PIMs were benzodiazepines and nonsteroidal anti‐inflammatory drugs . Targeted interventions are warranted to reduce inappropriate prescribing and polypharmacy in this vulnerable population.