Prevention of Falls: Medication and the Risk of Falls in the Elderly

Prevention of falls: Medication and the risk of falls in the elderly

Pharmacy fact sheet

Patients on four or more medications are at greater risk of having a fall. Some drugs are more likely to be associated with falls and this chart helps to identify those drugs.

Please consider this information when doing a medicine use review (MUR)

The drugs are rated to their contribution to a fall

Produced by the East Staffs CCG Medicine Management team Version1 july-15

Acknowledgement to Maria Smith Pharm MR Pharms Berkshire falls prevention and Derbyshire Coummitiy health service Antidepressants Tricyclic (TCAs) & related antidepressants: amitriptyline, clomipramine,dosulepin, duloxetine, lofepramine, imipramine and mirtazapine SSRIs: fluoxetine, paroxetine, citalopram, sertraline, fluovaxamine Others: venlafaxine. TCAs may cause drowsiness & blurred vision. SSRIs slightly less sedating.May also cause blurred vision. Antipsychotics including typical’s: haloperidol, trifluoperazine, sulpiride atypicals Atypicals: amisulpiride, aripiprazole, clozapine, olanzapine, risperidone,quetiapine, Prochloperazine is frequently prescribed for dizziness due to postural instability and the most frequently implicated drug in causing drug induced Parkinson’s disease Anti-muscarinic drugs Oxybutynin, tolterodine, orphenadrine, procyclidine, trihexyphenidyll, (anti-cholinergics) Oxybutynin may cause acute confusion in the elderly, especially those with pre-existing cognitive impairment

Benzodiazepines & Benzodiazepines: Diazepam, nitrazepam, temazepam, chlordiazepoxide hypnotics (anxiety or Others: zolpidem, zopiclone, sleeping tablets) May cause hangover effects next morning. May cause unsteadiness if getting up in the night.

Dopaminergic drugs Dopamine-boosting drugs: Amantadine, bromocriptine, levodopa, pergolide, selegline . ,

ACE Inhibitors captopril,, enalapril, lisinopril, ramipril, perindopril, quinapril, fosinopril, /angiotensin II trandolapril ,losartan, valsartan. irbesartan, candesartan, eprosartan, antagonists telmisartan Greater risk of hypotension if also taking a diuretic, incidence of . dizziness varies

Alpha-blockers doxazosin, indoramin, prazosin, terazosin Doses used for the treatment of prostate problems are less likely to causehypotension and dizziness than those required to treat hypertension. Anti-arrhythmics digoxin, amiodarone, flecainide, Dizziness and drowsiness are possible signs of digoxin toxicity Flecainide has a high risk for drug interactions and can also cause dizziness

Beta-blockers atenolol, bisoprolol, metoprolol, nebivolol, acebutolol oxprenolol, propranolol, carvedilol, sotalol Reports of dizziness may be due to postural hypotension

Diuretics Used to treat hypertension, heart failure and fluid retention. bendroflumethiazide, chlortalidone, cyclopenthiazide, indapamide, metolazone, furosemide, bumetanide. amiloride, triamterene, spironolactone. Can cause dehydration, dizziness, confusion and postural hypotension.

Anti-epileptics carbamazepine, clonazepam, gabapentin, lamotrigine, phenobarbital, (anticonvulsants) phenytoin, sodium valproate, topiramate, vigabatrin. Phenytoin side effects such as dizziness, blurred vision etc. may be signs of drug related toxicity. Carbamazepine incidence of dizziness, drowsiness and blurred vision are dose related side effects

Anti-histamines Those most likely to cause drowsiness include: chlorphenamine,& promethazine, Produced by the East Staffs CCG MedicineOthers Management include: team loratidine, desloratidine, cetirizine, cinnarizine Version1 july-15 Risk of hypotension with cinnarizine is a dose related, short term Acknowledgement to Maria Smith Pharm useMR Pharms where Berkshire possible. falls prevention and Derbyshire Coummitiy health service

Opiate analgesics morphine, buphenorphine, codeine, co-codamol, co-dydramol, diamorphine, dihydrocodeine, morphine, tramadol. Drowsiness and sedation common when starting treatment. Confusion

Other factors to also consider :

Balance disorders Visual impairment Previous fall Hearing impairment Cognitive impairment Polypharmacy ie 4 or more drugs Psychotropic drug use Orthostatic hypotension Alcohol >1 unit/day Poor mobility/ gait

Produced by the East Staffs CCG Medicine Management team Version1 july-15

Acknowledgement to Maria Smith Pharm MR Pharms Berkshire falls prevention and Derbyshire Coummitiy health service