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Medicines and falls risk

Key points about medicines and falls risk

Some medicines, or combinations of medicines, may have side effects that can increase the risk of falls.
Some medicines have side effects that can affect your balance and concentration and slow your reaction times.
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.

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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. The 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 your body longer and your body becomes more sensitive to the effects of some medicines.

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.
Light-headedness 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. All of these can cause a lack of sleep. This can lead to problems with memory and balance.

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®) that has been discontinued in Aotearoa New Zealand from July 2023, 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.

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, eg, anticoagulants, 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.

Some medicines can increase your risk of falling, especially as you get older and if the medicine makes you drowsy, dizzy, or affects your balance.

Below are some tips on how you can prevent falls when taking medicines.

Talk to your healthcare provider about your fall risk

Older adults may respond to medicines differently and they may become more sensitive to the effects of some medicines. Talk to your healthcare provider to see if any of the medicines you take can increase your risk of falling. Some medicines may cause you to feel faint or dizzy or to experience blurry vision or impaired judgment. Also some medicines can increase your risk of severe injury such as facture or bleeding, after a fall. These are all important side effects to note and discuss with your healthcare provider. In some cases, it may not be a specific medicine causing the side effect – it could be interactions between multiple medicines.

Get your medicines reviewed regularly

If you are taking multiple medicines and you are concerned about the risk of falls associated with the side effects of those medicines, get your medicines reviewed by your healthcare provider. This includes prescriptions, over-the-counter (OTC) and or herbal medicines. Do this at least once a year. Sometimes, under the guidance of your healthcare provider, some medicines can be stopped, or the dose lowered or you can be switched to a safer alternative. If you have had a fall, it is always useful to have your medicines reviewed to prevent further falls.

Be careful when starting a new medicine

When starting a new medicine ask your pharmacist if there any side effects that could put you at a risk of falling. Be careful when you first start a medicine until you know how the medicine affects you. Some side effects like dizziness or drowsiness may be worse when starting a new medicines and may improve as your body gets used to the new medicine.

Get up or stand up slowly

If you notice that your medicine causes dizziness or affects your balance, get up slowly out of bed or stand up slowly. Take a few minutes to sit on your bed or on a chair first. The dizziness should go away after a while. Use extra care if you use a cane, a walker, or crutches.

Check if your medicine interacts with alcohol

It can be dangerous to mix alcohol with some prescriptions, over-the-counter (OTC), or herbal medicines. Drinking alcohol can affect your balance, make you feel sleepy, drowsy or dizzy and it can worsen the side effects of some medicines. Always read the label of your medicine, including OTC and herbal medicines. If your medicine has a warning label to avoid alcohol, then it's best to avoid drinking alcohol while you are taking the medicine. If you are unsure, check with your pharmacist about the effects of alcohol with your medicines. Read more about alcohol and medicines.

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