3 Medications That Increase Fall Risk

How medications contribute to falls

Medications can contribute to falls through different effects, including sedation, dizziness, impaired balance, slowed reaction time, orthostatic symptoms, and increased toileting. The degree of risk depends on the specific medicine, dose, combination of medicines, and patient.

Medication groups and possible effects

Several medication groups may increase fall risk, though the effects and degree of risk vary by medicine and patient.

• Sedative-hypnotics: Benzodiazepines and “Z-drugs” such as zolpidem can cause drowsiness, impaired coordination, and other effects associated with falls. Older adults may be especially sensitive to these effects.

• Other CNS-active medicines: Opioids, antidepressants, antipsychotics, and anticonvulsants, including gabapentinoids, may contribute to falls through effects such as sedation, dizziness, impaired balance, or slowed reaction time.

• Antihypertensives: These may contribute to dizziness or orthostatic hypotension.

• Diuretics: These can increase urgency and bathroom trips, and some may contribute to orthostatic symptoms.

Assess symptoms and support safe mobility

When an older adult reports drowsiness, dizziness, unsteadiness, or lightheadedness, assess the symptoms rather than assuming a single cause. Ask about recent falls and note when symptoms occur in relation to medication doses or position changes. For a patient reporting lightheadedness on standing while taking a diuretic, assess symptoms and orthostatic vital signs, and document the findings.

Support safe mobility and toileting when needed. For example, help the patient with safe transfers and bathroom trips if urgency or lightheadedness raises a mobility concern. Do not advise fluid restriction or recommend stopping a medicine without further assessment and an authorized plan.

Review medications and communicate concerns

A medication-related fall-risk review should include prescription, over-the-counter, and herbal products. Ask about dizziness, drowsiness, unsteadiness, and recent falls, and note symptom timing in relation to medication doses or position changes. Consider the products, possible adverse effects, timing, dose, indication, and the patient’s experience.

Document relevant symptoms and findings, and share concerns with the prescriber or pharmacist. Follow the authorized plan. Do not independently stop or change a prescribed medicine.

Consider effects of medication combinations

Concurrent use of CNS-active drugs can compound adverse effects. In the example of a patient who has fallen twice while taking an opioid, a benzodiazepine, and a gabapentinoid, assess alertness, gait, and recent falls, then promptly coordinate a medication review with the prescriber or pharmacist.

The AGS Beers Criteria identifies increased fall and fracture risk with concurrent use of three or more specified CNS-active medication classes. Review the full medication regimen and clinical situation. Do not abruptly discontinue medicines without an authorized plan.

Make medication changes through an authorized plan

A medication associated with falls should not automatically be discontinued. Weigh medication risk against the reason for treatment and the patient’s circumstances. A prescriber or pharmacist can consider whether a dose adjustment, gradual taper, alternative, or other risk-reduction strategy is appropriate. Patients should not change a medication without guidance.

• Medication reconciliation