Which drugs cause falls in the elderly?
Many can, but some do more than others. Therefore, prescribing the tablets below in the frail elderly, needs to be done with some thought and caution.
“A fall in the frail elderly can have much worse consequences (e.g. #NOF) than the disease the drug is trying to prevent.”
All the drugs below significantly increase the risk of falls. This issue should be taken into consideration when undertaking a medication review and/or when prescribing new medicines.
Also, of the patient has falls, each should be considered for stopping, or replacing with a less fall-associated alternative.
So. What medication increases the risk of falls?
- Alpha blockers: Alfluzosin, doxazosin, indoramin, prazosin, tamsulosin, terazosin
- Angiotensin converting enzyme (ACE) inhibitors: Captopril, enalapril, lisinopril, perindopril, rampiril, trandolapril]
- Antianginals: Glyceryl trinitrate, isosorbide mononitrate, nicorandil
- Antiepileptics: Carbamazepine, phenobarbitone, phenytoin
- Anti-psychotics: Chlorpromazine, fluphenazine, haloperidol, olanzapine, quetiapine, risperidone
- Benzodiazepines
- Beta blockers: Atenolol, bisoprolol, carvedilol, metoprolol, propranolol, sotalol, timolol eye drops
- Centrally acting alpha 2 receptor agonists: Clonidine, moxonidine
- Dopamine agonists: Pramipexole, ropinirole
- Monoamine oxidase inhibitors: Isocarboxazid, phenelzine, tranylcypromine
- Monoamine oxidase B inhibitors: Selegiline
- Opioids
- Sedating antidepressants: Amitriptyline, clomipramine, dosulepin, doxepin, imipramine, lofepramine, mianserin, mirtazapine, nortriptyline, trazodone, trimipramine
- Serotonin reuptake inhibitors: Duloxetine, venlafaxine
- Thiazide diuretics: Bendroflumethiazide, chlorthalidone, metolazone
- Z drugs: Zopiclone/ zolpidem.
Summary
We have described which types of drugs increase the risk of falling. We hope it has been helpful.
Other resources
Prescribing in the elderly (BNF)
NHS Wales’ advice on reducing polypharmacy (deprescribing) in the frail elderly.
