What Drugs Increase the Risk of Falls?

Older adults are already at a higher risk of falling due to common issues like sensory impairment, gait and balance issues, living in environments with fall hazards, and orthostatic hypotension (a sudden drop in blood pressure when standing), says Cara McDermott, PhD, an assistant professor in medicine in geriatrics at the Duke University School of Medicine in Durham, North Carolina, and taking certain medications can make falls even more likely to happen.

Aging itself can reduce the body’s ability to mount an appropriate response to a fall so that you can catch yourself from a stumble, says Dr. McDermott. When you combine that with a drug that impacts your perception, balance, or coordination, you further increase the risk of falls, she says. Here are 10 types of drugs that can contribute to fall risk in older adults.

1. Z-Drugs

2. Benzodiazepines

Combining these drugs with alcohol or other sedatives magnifies these effects because both substances impact the central nervous system, notes Shaver. “You definitely don’t want to drink while taking a benzo,” she says.

3. Antidepressants

Antidepressant drugs such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are both linked to increased fall risk in older adults.

4. Antipsychotics

5. Antihypertensives

However, sometimes blood pressure can fall too low when taking these drugs, especially when people become lightheaded when standing and lose balance. “This is especially common when people are first put on the drugs, before their body has gotten acclimated to them,” says Shaver.

6. Dopaminergic Drugs

Dopaminergic drugs, or drugs that affect the level of the neurotransmitter dopamine in the brain, are often used to treat conditions like Parkinson’s disease and have been linked to falls.

7. Anticonvulsants

8. Opioids

These drugs can be particularly risky when combined with other drugs, especially benzodiazepines, sedatives, anticonvulsants, and muscle relaxers, adds Shaver.

9. Muscle Relaxants (Muscle Relaxers)

“In older adults, muscle relaxants can lead to impaired coordination in part because the benefit you're getting with their effect on your muscles could then also impair your ability to move and the way you’re expecting to move,” says Shaver.

10. Anticholinergics

If you’re currently taking an anticholinergic drug — either prescription or over the counter — talk to your healthcare provider about switching medications, as there are alternatives that don’t typically cause falls, says Shaver.

How to Lower Your Fall Risk if You’re Taking These Drugs

To reduce your risk of medication-related falls, the following tips can help, from talking to your doctor to avoiding drugs and alcohol.

Talk to your doctor about all the drugs you’re taking. Discuss all the drugs you’re taking with your doctor and whether any of them are known to cause falls or have interactions with other drugs that may cause falls. “Check in with your doctor regularly to make sure the medicine list is correct and always ask if they are all necessary,” says John Batsis, MD, an associate professor of medicine and geriatrician at the University of North Carolina School of Medicine in Chapel Hill. You can also ask your doctor about changing or reducing the dosage of your medications to reduce your fall risk, Dr. Batsis adds.

Be wary of drugs that make you feel dizzy or sleepy. Anything that causes these side effects raises your fall risk, says Katherine Ward, MD, a geriatrician with Stanford Senior Care in Palo Alto, California.

Avoid using recreational drugs or alcohol when you’re taking prescription medications. This is especially true when you’re taking medications known to cause falls, says Dr. Ward. “When a medication goes through the approval process, they don’t test the medication on a person on recreational drugs or alcohol. So you’re venturing into a no-man’s-land,” she says.

Make sure your home is clean, clear, and well lit. This can help further reduce your risk of falls, says Batsis.

Know your personal fall risk. Before starting any new medication, talk to your doctor about your personal fall risk. “Decisions about medications should be made in conjunction with your prescriber, taking into account personal preferences, comorbidities, and past history of falling,” says McDermott.

The Takeaway

• Falls are a serious and growing health risk for older adults, and many commonly used medications can make that risk worse by causing side effects like dizziness, drowsiness, or slower reflexes.
• Sedatives, muscle relaxers, and antidepressants can increase your risk of falling because of side effects such as impaired coordination and sleepiness.
• Talk to your doctor about whether the medications you’re taking can increase your risk of falls, and regularly review your medication list with your healthcare provider or pharmacist to see if safer alternatives or dose adjustments are possible.