What drugs are a fall risk? A Guide to Medication-Related Falls

According to the Centers for Disease Control and Prevention (CDC), falls are a major health concern, especially for older adults, and medication side effects are a leading contributing factor. This guide delves into what drugs are a fall risk and provides essential information for proactive medication management to enhance safety and well-being.

Quick Summary

Several classes of medications, including sedatives, antidepressants, blood pressure medications, and opioids, significantly increase the risk of falls, particularly in older adults, by causing dizziness, sedation, or orthostatic hypotension. Understanding which drugs pose a risk is the first step toward effective fall prevention through proactive medication review and management.

Key Points

• Psychotropic Medications: Drugs for mood, anxiety, and sleep (e.g., antidepressants, benzodiazepines, hypnotics) are high fall risks due to sedation and confusion.

• Orthostatic Hypotension: Blood pressure medications, including antihypertensives and diuretics, can cause dizziness and fainting when standing, increasing fall risk.

• Polypharmacy: Taking multiple medications significantly raises the chances of drug interactions and side effects that contribute to falls.

• Regular Review: All medications, including OTC drugs, should be regularly reviewed with a healthcare provider or pharmacist to identify and mitigate fall risks.

• Lifestyle Adjustments: Staying hydrated, eating a balanced diet, and modifying the home environment are important complementary strategies for fall prevention.

• Pharmacist Consultation: Pharmacists can provide expert guidance on potential drug interactions and safer alternatives, playing a critical role in fall prevention.

Understanding Medication-Related Fall Risks

For older adults, managing multiple medications is often a necessity, but it also increases the risk of side effects that can lead to a fall. Polypharmacy, or the use of five or more medications, is a major concern, as it amplifies the potential for drug interactions and adverse effects. A proactive approach to medication safety is crucial for minimizing these risks.

Common Drug Classes That Increase Fall Risk

Certain categories of drugs are more likely to cause dizziness, drowsiness, confusion, or balance issues, which are all significant fall hazards. Here are some of the most common culprits, identified by health experts:

• Psychotropic Medications: This broad category includes drugs that affect mood, perception, and behavior. Their sedative effects are a primary cause of falls.
  • Antidepressants: Especially tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can cause drowsiness and dizziness. The risk is highest when first starting or changing the dose.
  • Antipsychotics: Used for conditions like schizophrenia and bipolar disorder, these can cause sedation, confusion, and a significant drop in blood pressure.
  • Benzodiazepines and Hypnotic Sedatives: These are used to treat anxiety and insomnia. They are well-known for causing daytime drowsiness and impaired coordination. Examples include drugs like zolpidem (Ambien), diazepam (Valium), and lorazepam (Ativan).
• Cardiovascular Medications: These drugs are essential for heart health but can cause side effects that impact balance.
  • Antihypertensives: Medications for high blood pressure can cause orthostatic hypotension (a sudden drop in blood pressure when standing up), leading to lightheadedness and fainting.
  • Diuretics: Often called 'water pills,' these increase urination and can cause dehydration and electrolyte imbalances, contributing to weakness and dizziness.
• Pain Medications: Pain management drugs, particularly more potent ones, are associated with a high fall risk.
  • Opioids: These powerful pain relievers cause sedation, dizziness, and impaired judgment, which significantly increases fall risk.
  • NSAIDs: Nonsteroidal anti-inflammatory drugs can affect blood pressure and may increase the risk of internal bleeding, especially in older adults.
• Other Medications: Several other classes of drugs can increase the likelihood of a fall.
  • Anticholinergics: Found in some medications for incontinence, allergies (like diphenhydramine), and COPD, these drugs can cause dizziness, blurred vision, and confusion.
  • Muscle Relaxants: These drugs cause sedation and drowsiness, leading to a higher risk of unsteadiness and falls.
  • Antihistamines: Both prescription and over-the-counter allergy medications can cause drowsiness.

Why Do These Medications Increase Fall Risk?

It's not just the medication type but the specific side effects that contribute to falls. The most common mechanisms include:

• Sedation and Drowsiness: Many psychotropic and pain medications can make a person feel sleepy, impairing reaction time and awareness.
• Dizziness and Vertigo: A sensation of lightheadedness or spinning can cause a loss of balance. This is common with blood pressure medications and some antibiotics.
• Orthostatic Hypotension: The sudden drop in blood pressure when changing position can cause blackouts and is a key risk with antihypertensives.
• Confusion and Cognitive Impairment: Some drugs, particularly anticholinergics, can affect memory and judgment, making it harder to navigate safely.
• Blurred Vision: Side effects that impact vision can make it difficult to see obstacles, steps, or changes in flooring.

Comparison of Common Drug Risks

Drug Class	Examples	Common Side Effects	Fall Risk	Key Risk Factor
Antidepressants	TCAs, SSRIs	Drowsiness, dizziness, unsteadiness	High	Sedation, blood pressure effects
Benzodiazepines	Ativan, Valium	Sedation, impaired coordination	Very High	CNS depression, drowsiness
Antihypertensives	Diuretics	Orthostatic hypotension, dizziness	Moderate	Blood pressure fluctuations
Opioids	OxyContin, Codeine	Dizziness, sedation, confusion	High	Central Nervous System depression
Anticholinergics	Oxybutynin	Dizziness, confusion, blurred vision	Moderate	Cognitive impairment, vision changes

Managing and Preventing Medication-Related Falls

Prevention requires a multi-pronged approach involving both the patient and their healthcare team. Proactive communication and regular review are key.

1. Conduct a Medication Review: Regularly review all medications, including prescriptions, over-the-counter (OTC) drugs, vitamins, and supplements, with your doctor or pharmacist. The CDC's STEADI initiative provides excellent tools for this process.
2. Report Side Effects: Keep a log of any side effects you experience, such as dizziness or drowsiness, and discuss them with your doctor. Never stop or change a dose without medical supervision.
3. Explore Alternatives: Ask your healthcare provider if safer alternatives or non-pharmacological treatments are available, such as exercise for pain or cognitive behavioral therapy for insomnia.
4. Adjust Dosing Schedules: Sometimes, adjusting the time a medication is taken can reduce its impact on balance. For example, taking a sedative closer to bedtime might minimize daytime drowsiness.
5. Simplify Regimens: Ask your doctor if it's possible to simplify your medication schedule to reduce the chances of errors and interactions. Reducing the number of medications when clinically appropriate is a proven strategy.
6. Maintain Healthy Habits: Staying hydrated, eating a balanced diet, and engaging in light exercise can all help mitigate the side effects of medication and improve overall stability.
7. Environmental Modifications: Make sure your home environment is safe by removing trip hazards, ensuring adequate lighting, and installing grab bars where needed.

The Role of Your Pharmacist

Pharmacists are valuable partners in managing fall risk. They can perform a comprehensive medication therapy management (MTM) service to evaluate potential interactions and side effects. They can also work collaboratively with your doctor to make recommendations for safer medication regimens.

Conclusion

Medication-related falls are a significant and preventable public health issue. By understanding what drugs are a fall risk, engaging in regular medication reviews, and communicating openly with your healthcare providers, seniors and caregivers can take control of their health and significantly reduce the likelihood of a fall. The key is to be proactive and informed, ensuring that medications are working for your health, not against your safety. For more resources on preventing falls, consider exploring the CDC's STEADI program: CDC STEADI.

Frequently Asked Questions

Can over-the-counter medications increase fall risk?

Yes, many over-the-counter (OTC) medications can increase fall risk. For instance, some antihistamines, sleep aids, and pain relievers can cause drowsiness, dizziness, or blurred vision, which are major fall hazards. It is important to include these in your regular medication reviews with a healthcare professional.

What is polypharmacy and how does it relate to falls?

Polypharmacy typically refers to the use of five or more medications simultaneously. The more medications a person takes, the higher the risk of adverse drug events and interactions that can lead to side effects like dizziness, sedation, and confusion, all of which significantly increase the risk of falling.

How should I talk to my doctor about my fall risk due to medication?

When speaking with your doctor, be prepared with a complete list of all medications, including OTCs and supplements. Express your concerns about falls and any side effects like dizziness or unsteadiness. Ask if any of your medications are known fall risks and if there are safer alternatives or dose adjustments possible.

Are new medications more likely to cause a fall?

The risk of falls is often higher during the first few weeks of starting a new medication or changing a dose. The body needs time to adjust, and side effects can be more pronounced initially. Close monitoring during this period is essential.

Can medication-related falls be prevented?

Yes, medication-related falls are largely preventable. Regular medication reviews, open communication with your healthcare team, adjusting dosing when possible, and making smart lifestyle and environmental changes can all contribute to a significant reduction in fall risk.

Does taking multiple antidepressants increase my fall risk?

Yes, taking multiple medications from the same or different classes, such as multiple antidepressants or combining them with other sedating drugs, can have an additive effect on side effects like sedation and dizziness, further elevating the risk of a fall.

What should I do if I suspect my medication caused a fall?

If you experience a fall, first ensure you are not injured. Then, it's crucial to tell your doctor about the fall and any suspicions about your medication. Your doctor may perform an assessment and adjust your regimen. Never change your medication dose or stop taking it without consulting a healthcare provider.