Medicines and falls risk

Some medicines, or combinations of medicines may have side effects which can increase the risk of falls. Ask your doctor or pharmacist to check all of your medicines regularly and ask if any of them have side effects such as dizziness or drowsiness.

How can medicines increase the risk of falls?

Some medicines have side effects that can affect your balance and concentration and slow your reaction times. These things can increase your risk of falls. This risk is greater when a combination of these medicines is used together. Studies have shown that taking 5 or more medicines per day greatly increases falls risk. Other medicines that lower your blood glucose or blood pressure can also increase the risk of falls. 

Older adults also respond to medicines differently. As we age, our metabolism slows down, medicines stay in the body longer and the body becomes more sensitive to the effects of some medicines.

Side effects that put you at risk of falls

Side effect  Description 
Drowsiness
  • Drowsiness is a feeling of sleepiness and people may fall asleep at inappropriate times.
  • Medicines that cause drowsiness can affect your balance and slow your reaction times.
Dizziness
  • The term dizziness means different things to different people – some use it to describe feeling lightheaded or off balance, while others use it to describe a feeling that their surroundings are spinning.
Lightheadedness or fainting
  • These are caused by a temporary reduction in blood flow to the brain. It can be caused by a slow heart rate, and a fall in blood pressure when a person stands up.
Blurred vision
  • Blurred vision makes things appear out of focus or hazy.
  • This increases the risk of falls by bumping into furniture or doorways or misjudging shadows.
  • It can also be described as double vision or poor vision.
Confusion
  • Confusion can cause disturbances in your orientation, memory, attention and perception.
Movement disorder
  • Some medicines can affect the speed and ease of movement. This may involve excessive or involuntary movement or slowed movement.
Sleep disturbance
  • Sleep disturbances can include nightmares, restless leg syndrome, insomnia and changes in sleep pattern, which can cause lack of sleep.
  • This can lead to problems with memory and balance.  


Medicines that increase falls risk

The following is a list of some medicines that are known to increase the risks of falls. If you are taking any of these medicines and are worried about your risk of falls do not stop taking your medicine suddenly. Rather, discuss this with your doctor or pharmacist. Some medicines need to be stopped gradually, as sudden withdrawal can make the effects worse. Sometimes a more suitable alternative can be found.  

Category of medications Description and examples
Sleeping tablets
  • Causes drowsiness, loss of balance and slow reaction times.
  • Examples include zopiclone and benzodiazepines such as temazepam, nitrazepam, diazepam, lormetazepam, lorazepam, oxazepam, clonazepam. Read more about benzodiazepines
Sedating antihistamines
  • These are usually used for allergies such as hay fever, hives or urticaria, and itching. They may be used to help reduce feeling sick (nausea) and being sick (vomiting).
  • They can cause drowsiness, loss of balance and slow reaction times.
  • Examples include  chlorphenamine (Histafen®), dexchlorpheniramine (Polaramine®), doxylamine (Dozile®), promethazine (Phenergan®, Allersoothe®), alimemazine (Vallergan)
  • Read more about sedating antihistamines.
Antidepressants
  • Some antidepressants can cause drowsiness, impaired balance and slow reaction times. They can also cause light-headedness or fainting and a drop in blood pressure on standing.
  • Some antidepressants cause more drowsiness and have a higher falls risk than others.
  • Read more about antidepressants.
 Antipsychotics
  • These can cause drowsiness, impaired balance and slow reaction times. They can also cause light-headedness or fainting and a drop in blood pressure on standing. 
  • Examples include chlorpromazine, haloperidol, fluphenazine, risperidone, quetiapine, olanzapine 
  • Read more about antipsychotics.
Opioid painkillers
  • Opioid painkillers are used to treat moderate to severe pain, such as after an operation or a serious injury, or pain from cancer. They are used when other weaker painkillers do not work well enough.
  • These can cause drowsiness, impaired balance and slow reaction times.
  • Examples include codeine, tramadol, morphine, oxycodone.  
  • Read more about opioid painkillers.
Anticholinergic medicines
  • These medicines are usually used as muscle relaxants to treat muscle spasms such as benztropine and orphenadrine or they may be used to treat bladder problems and incontinence such as oxybutynin, solifenacin, and tolterodine.
Antihypertensives
(medicines to treat high blood pressure) 
  • These medicines are used to treat high blood pressure (hypertension).
  • They can cause light-headedness and a drop in blood pressure on standing. This is often worse when you first start taking them and may settle with time.
  • Examples include ACE inhibitors, ARBs, beta-blockers, diuretics and calcium channel blockers.
Hypoglycaemics (medicines to treat diabetes)
  • Some medicines that are used for diabetes to lower your blood sugar level can also cause dizziness if your blood sugar drops too low. Read more about low blood glucose

Medicines that increase your risk of severe injury

Some medicines can increase your risk of severe injury after a fall.

Side effect Description
Increased fracture risk Some medicines can decrease bone density which can increase the risk of fracture when a person falls.
Examples include long-term use of corticosteroids such as prednisone. 
Increased risk of bleeding Some medicines such as blood thinners (also called anticoagulants or anti-platelets) increase your risk of bleeding. If you are taking these medicines and have a fall, you must see your doctor, even if you feel fine. You are at increased risk of severe bleeding.
Examples include warfarin, dabigatran, rivaroxaban, ticagrelor and clopidogrel.

See also: Tips to reduce your falls risk and falls prevention

References

  1. Reducing harms from falls Health Quality and Safety Commission New Zealand
  2. Stay independent Falls Prevention Toolkit BPAC   
  3. Medicine related falls risk assessment tool (MrFRAT) Health Hawkes Bay
Credits: Sandra Ponen, pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 22 Oct 2018