7 Medications That May Increase Fall Risk in Older Adults

Falls are a leading cause of injury and death in older adults, and research suggests that prescription drugs such as opioids and antidepressants may be fueling the trend.

A research review published in JAMA warns that the rising use of medications that impair balance or cause drowsiness may be contributing to a surge in fall-related deaths. Studies show that 65%-93% of the older adults who had a fall-related injury took at least one "fall risk-increasing drug" (FRID) at the time.

What Are 'Fall Risk-Increasing Drugs'?

Drugs that get labeled as "fall risk-increasing" typically affect the central nervous system, such as opioids and antidepressants. They may cause drowsiness and loss of balance.

The risk depends both on the drug's side effects and the health of the person taking it.

 “Someone may become drowsy but also not have the strength to avoid a fall,” said Nicole Brandt, PharmD, chair of geriatric pharmacotherapy at the University of Maryland School of Pharmacy.

Brandt added that taking multiple drugs that affect the brain, especially with alcohol or marijuana, can further increase fall risk.

“Not every medication in a category necessarily poses a fall risk for every person,” she said. “But it’s worth asking your doctor about all the medicines you take, especially if any fall into the categories below.”

1. Antidepressants

Examples: Cymbalta (duloxetine), Elavil (amitriptyline), and Paxil (paroxetine)

These medications may impair balance and coordination, cause a sudden drop in blood pressure, cause drowsiness and dizziness, putting you at risk of a fall.

2. Anticonvulsants

Examples: gabapentin

Anticonvulsants are used to prevent or control seizures, sometimes to relieve pain. However, they pose a fall risk because they can cause dizziness, sedation, confusion, and unsteadiness.

3. Blood Pressure-Lowering Medications

Examples: Norvasc (amlodipine) and HCTZ (hydrochlorothiazide)

Antihypertensives are used to reduce blood pressure, but they could cause “orthostatic hypotension,” a sudden drop in blood pressure when changing body positions, like standing up suddenly. Some of the drugs can also cause dizziness and tiredness.

4. Anti-Anxiety Medications

Examples: Ativan (lorazepam) and Xanax (alprazolam)

Benzodiazepines can be used to treat anxiety. They can cause sedation, impaired balance, slowed reaction times, and dizziness.

5. Opioids

Examples: oxycodone and morphine

Opioids can lead to sedation. They can also cause a drop in blood pressure, which can cause fainting. Some opioids can also cause a drop in sodium levels, which can increase dizziness and confusion.

6. Antispasmodics

Examples: Bentyl (dicyclomine) and Detrol (tolterodine)

Antispasmodics can be used to help relieve abdominal pain related to muscle cramps in your digestive system or urinary system, or to reduce excessive urges to go to the bathroom. They can increase fall risk by impairing balance, coordination, and mental alertness.

7. Older Antihistamines

Examples: Tylenol PM, Benadryl (diphenhydramine), and Chlor-Trimeton (chlorpheniramine)

Older-generation antihistamines such as Benadryl can cause drowsiness. Some over-the-counter cold medicines may also include the same active ingredient, diphenhydramine. You can switch to newer antihistamines such as Zyrtec (cetirizine) and Claritin (loratadine) to reduce the likelihood of drowsiness.

'Deprescribing' Drugs for Older Adults

Reducing unnecessary medication use could help reduce the risk of falls. Some experts advocate for "deprescribing," a process where healthcare providers work with patients to taper or discontinue drugs that are no longer beneficial or needed.

“But patients don’t have to wait for their doctor. They should initiate that conversation," said Jeffrey Kullgren, MD, an associate professor of internal medicine at the University of Michigan School of Public Health who has written about deprescribing.

Discussing medications that raise fall risk may lead a doctor to adjust the dose, switch the drug, or stop it altogether. Still, Kullgren noted, some drugs remain necessary despite the risk. In those cases, doctors work with patients and caregivers to lower the chance of falls. For example, they may recommend nighttime dosing, standing up slowly, or using a cane.

“Don’t stop taking a drug on your own without first talking to your doctor,” Kullgren said.