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Home , Ethosuximide, Flavoxate, Nadolol

Medications with Fall Risk Precautions

Antipsychotic Drugs Factors Contributing to Fall Risk Typical Antipsychotics (First Generation) Drowsiness, dizziness, confusion, hypotension (low (Thorazine®), (Prolixin®), ), orthostatic hypotension (sudden drop (Haldol®), (Loxitane®), in blood pressure when upright), syncope (fainting), (Trilafon®), ( Compazine®), (gait disturbance), blurred vision, disorientation, (Mellaril®), Thiothixene (Navane®), abnormal involuntary movements of the body, slowed (Stelazine®) body movements, , muscle rigidity, muscle Atypical Antipsychotics (Second Generation) spasms, seizure risk, rate irregularities, risk of (Abilify®), (Saphris®), delirium (Clozaril®), (Fanapt®), (Latuda®), (Zyprexa®), (Invega®), (Seroquel®), (Risperdal®), (Geodon®) Anti-Anxiety Drugs Factors Contributing to Fall Risk Long-acting Drowsiness, dizziness, weakness, confusion, Chlordiazepoxide (Librium®), (Tranxene®), orthostatic hypotension (sudden drop in blood pressure (Valium®), Flurazepam (Dalmane®), when upright), disorientation, blurred vision, (Klonopin®) unsteadiness, ataxia (gait disturbance), , risk of Intermediate to Short-acting Benzodiazepines seizures (with abrupt discontinuation), blurred vision, Alprazolam (Xanax®), (Ativan®), Oxazepam worsening of respiratory depression, risk of delirium (Serax®) Other Anxiolytics (Buspar®), Meprobamate (Equanil®; Miltown®) Sedative Hypnotic Drugs Factors Contributing to Fall Risk Short-acting Benzodiazepines Daytime drowsiness, dizziness, confusion, orthostatic Alprazolam (Xanax®), Estazolam (Prosom®), Lorazepam hypotension (sudden drop in blood pressure when (Ativan®), Oxazepam (Serax®), (Restoril®), upright), ataxia (gait disturbance), hangover effect, Triazolam (Halcion®) disorientation, syncope (fainting), blurred vision, tremor, Non-benzodiazepines agitation, bizarre behavior, worsening of respiratory (Benadryl®; Sominex®; Nytol®), depression, risk of delirium (Unisom®), (Lunesta®), (Sonata®), (Ambien®; Intermezzo®) Drugs Factors Contributing to Fall Risk Tricyclics (TCAs) Drowsiness, dizziness, confusion, hypotension (low (Elavil®), (Anafranil®), blood pressure), orthostatic hypotension (sudden drop (Norpramin®), (Sinequan®), (Tofranil®), in blood pressure when upright), disorientation, (Pamelor®) syncope (fainting), blurred vision, unsteadiness, Tetracyclics numbness in the extremities, weakness, fatigue, (Ludiomil®), (Remeron®) agitation, restlessness, risk of delirium, risk for Selective Serotonin Reuptake Inhibitors (SSRIs) hyponatremia (low blood sodium, fall risk) Citalopram (Celexa®), Fluvoxamine (Luvox®), Fluoxetine (Prozac®), (Paxil®; Pexeva®), Sertraline (Zoloft®) TCAs have highest fall risk compared to other Serotonin- Reuptake Inhibitors (SNRIs) . TCA special precautions: cardiac Desvenlafaxine (Pristiq®), Duloxetine (Cymbalta®), , tachycardia (increased ), risk of Venlafaxine (Effexor®) stroke, cognitive impairment, seizure risk (with TCAs Other Antidepressants and Bupropion). Bupropion (Wellbutrin®; Zyban®), (Serzone®), SSRIs pose greatest fall risk during the first 2 weeks of (Desyrel®; Oleptro®), Vilazodone (Viibryd®) initiation.

Created by DADS Pharmacists January 2014. References: Drugs.com/professionals (FDA Professional Monograph)

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Medications with Fall Risk Precautions

Antimanic/ Drugs Factors Contributing to Fall Risk (Tegretol®), Ethosuximide (Zarontin®), Drowsiness, dizziness, unsteadiness, confusion, (Neurontin®), (Lamictal®), Lithium blurred vision, some drugs may require periodic lab Carbonate (Eskalith®; Lithobid®), (Keppra®), work to monitoring for toxic levels, hyponatremia (low , (Dilantin®), (Lyrica®), blood sodium, fall risk) and electrolyte imbalances (Mysoline®), (Gabitril®), (Topamax®), Valproic Acid/Divalproex Sodium (Depakene®; Some drugs may cause irregular heartbeat. Depakote®), (Zonegran®) Pain Relievers ( & Synthetic Analgesics) Factors Contributing to Fall Risk (Butrans® patch), Butalbital (Esgic®; Fioricet®; Sedation, drowsiness, confusion, disorientation, Fiorinal®), (Stadol® nasal spray), Codeine (various dizziness, fatigue, hypotension (low blood pressure), pain relievers/cough medicines in tablet and liquid forms), syncope (fainting), shortness of breath (more Fentanyl (Actiq®; Duragesic® patches), Hydrocodone (Lorcet®; noticeable in ambulatory individuals), dose- Lortab®; Norco®; Vicodin®; Vicoprofen®), Hydromorphone related respiratory depression & irregular breathing (Dilaudid®; Exalgo®), Methadone (Dolophine®; Methadose®), with possible hypoxia (reduced blood oxygen) ( various tablet and liquid forms; Avinza®; Kadian®; MS Contin®; Oramorph®; Roxanol®), Oxycodone (OxyContin®; may increase the risk of seizures. Percodan®; Percocet®; Tylox®), Oxymorphone (Opana®), (Talacen®; Talwin®), Tapentadol (Nucynta ER®), Some drugs may cause cardiac arrhythmias (e.g. Tramadol (Ultram®; Ultracet®) methadone). Muscle Relaxants Factors Contributing to Fall Risk (Lioresal®), Carisoprodol (Soma®), Sedation, drowsiness, dizziness, fatigue, weakness, (Parafon Forte®), (Flexeril®), Metaxalone impaired functional ability, confusion, hypotension (low (Skelaxin®), Methocarbamol (Robaxin®), blood pressure), syncope (fainting), some have (Norflex®; Norgesic®), (Zanaflex®) seizure risk /Antimuscarinic/ Drugs Factors Contributing to Fall Risk Antihistamines (Anti- and Anti-/vertigo) Drowsiness, dizziness, sedation, fatigue, hypotension (Dramamine®), Diphenhydramine (Benadryl®), (low blood pressure), disturbed coordination, (Atarax®;Vistaril®), (Antivert®; Bonine®; confusion, disorientation, blurred vision, nervousness, Dramamine II®), (Transderm Scop®) restlessness, agitation, palpitations, increased risk of Drugs for Various Gastrointestinal Disorders delirium , Belladonna Alkaloids (Donnatal®), (Periactin®), Dicyclomine (Bentyl®), Diphenoxylate/Atropine Drugs with strong anticholinergic and antimuscarinic (Lomotil®), Glycopyrrolate (Robinul®), activity will have additive effects with other drug (Anaspaz®; Levbid®; Levsin®; NuLev®), Metoclopramide classes that have CNS (central nervous system) (Reglan®), Prochlorperazine (Compazine®; Compro® action. suppositories), (Phenergan®), Trimethobenzamide (Tigan®) Drugs to Treat Movement Disorders (e.g. Parkinson’s or EPS) Benztropine (Cogentin®), (Artane®) Drugs to Treat Over-active Bladder Disorders (Enablex®), (Toviaz®), Flavoxate (Urispas®), (Myrbetriq®), (Ditropan®; Oxytrol® patch), (VESIcare®), (Detrol®), Trospium (Sanctura®)

Created by DADS Pharmacists January 2014. References: Drugs.com/professionals (FDA Professional Monograph)

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Medications with Fall Risk Precautions

Diuretics (Drugs Treating Fluid Retention/blood Pressure) Factors Contributing to Fall Risk Carbonic Anhydrase Inhibitors Excessive diuresis leading to dehydration, electrolyte (Diamox®), Methazolamide (Neptazane®) depletion, blood volume reduction with circulatory Loop Diuretics collapse Bumetanide (Bumex®), Furosemide (Lasix®), Torsemide (Demadex®) These medications require periodic lab work to monitor Potassium-sparing Diuretics for electrolyte imbalances. Watch for signs of weakness, (Midamor®), Spironolactone (Aldactone®), drowsiness, dizziness, muscle cramps, muscular (Dyrenium®) fatigue, hypotension (low blood pressure), orthostatic Diuretics hypotension (sudden drop in blood pressure when Chlorothiazide (Diuril®), Hydrochlorothiazide (HydroDIURIL®; upright), tachycardia (increased heart rate) or Microzide®; Esidrix®), Indapamide (Lozol®), Methyclothiazide arrhythmias, blurred vision, vertigo. (Enduron®), Metolazone (Zaroxolyn®) Antihypertensives (Blood Pressure Lowering Drugs) Factors Contributing to Fall Risk Alpha- Receptor Antagonists (Central Acting) Hypotension (low blood pressure), orthostatic (Catapres®), (Tenex®), hypotension (sudden drop in blood pressure when (Aldomet®) upright), lightheadedness, syncope (fainting), vertigo, Alpha- Antagonists (Peripherally Acting) fatigue, weakness, possible tachycardia (increased (Cardura®), (Minipress®), heart rate), possible arrhythmias, palpitations, (Hytrin®) (slowed heart rate), numbness or tingling in Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors) the extremities, blurred vision Benazepril (Lotensin®), Captopril (Capoten®), Enalapril (Vasotec®), Fosinopril (Monopril®), Lisinopril (Prinivil®; Some drugs in this category will require periodic lab Zestril®), Moexipril (Univasc®), Perindopril (Aceon®), work to monitor for electrolyte imbalances. Quinapril (Accupril®), Ramipril (Altace®), Trandolapril (Mavik®) Angiotensin II Receptor Blockers (ARBs) Candesartan (Atacand®), Irbesartan (Avapro®), Losartan (Cozaar®), Olmesartan (Benicar®), Telmisartan (Micardis®), Eprosartan (Teveten®), Valsartan (Diovan®) Beta Blockers (Sectral®), (Tenormin®), (Zebeta®), (Coreg®), (Trandate®), Tartrate (Lopressor®), Metoprolol Succinate ER (Toprol-XL®), Nadolol (Corgard®), (Bystolic®), (Visken®), (Inderal®), Calcium Channel Blockers (Norvasc®), (Cardizem®; Dilacor®), (Plendil®), (Dynacirc®), (Adalat CC®; Procardia®), (Sular®), (Calan®; Covera-HS®; Isoptin®; Verelan®) Renin Inhibitors Aliskiren (Tekturna®) Vasodilators & Drugs Used to Treat Hydralazine (Apresoline®), Isosorbide Dinitrate (Isordil®), Isosorbide Mononitrate (Ismo®; Imdur®; Monoket®), Nitroglycerin (Nitro-Bid®; Nitrostat®; Nitrolingual Pumpspray®; Nitro-Dur patch®; Transderm-Nitro®), (Ranexa®)

Created by DADS Pharmacists January 2014. References: Drugs.com/professionals (FDA Professional Monograph)

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Medications with Fall Risk Precautions

Drugs to Treat Cardiac Arrhythmias (Irregular Heart Rate) Factors Contributing to Fall Risk (Cordarone®; Pacerone®), (Lanoxin®; Bradycardia (slowed heart rate), syncope (fainting), Digitek®), (Norpace®), (Multaq®), vision disturbances or impairment, dizziness Some (Tambocor®), (Mexitil®), drugs may require periodic lab work to monitor for toxic (Rythmol®), (Betapace®) levels and electrolyte imbalances. All drugs in this category have the potential to cause or worsen arrhythmias. Dopaminergic Drugs to Treat Parkinson’s Disease Factors Contributing to Fall Risk Amantadine (Symmetrel®), (Parlodel®), Drowsiness, dizziness, dyskinesia (abnormal body Carbidopa/Levodopa (Sinemet®), movements), sudden sleep onset, hypotension, Carbidopa/Entacapone/Levodopa (Stalevo®), Entacapone orthostatic hypotension, syncope (fainting), confusion, (Comtan®), (Mirapex®), (Requip®), fatigue Rasagiline (Azilect®) Diabetic Drugs That Cause Hypoglycemic Effect Factors Contributing to Fall Risk Insulin (all types, short and long acting) Insulin and some oral agents (stimulating insulin secretion) have the potential to lower blood sugar below 70 mg/dL. Hypoglycemia may cause: blurred vision, Oral drugs with risk: (Glucotrol®), Glyburide shaking/trembling, cognitive impairment, weakness, (DiaBeta®; Micronase®), (Amaryl®) fainting, possible seizure risk Oral drugs with low potential: (Starlix®), (Prandin®) Drugs to Treat Urinary/Prostate Disorders (BPH) Factors Contributing to Fall Risk (Uroxatral®), Doxazosin (Cardura®), Prazosin Orthostatic hypotension (sudden drop in blood pressure (Minipress®), (Rapaflo®), (Flomax®), when upright), dizziness, vertigo, syncope (fainting) Terazosin (Hytrin®) Laxatives (Stimulant Laxatives) Factors Contributing to Fall Risk Bisacodyl (Dulcolax®), Magnesium citrate Solution, Milk of Urgency to void may cause a risk when moving to the Magnesia (in high doses), Senna or Sennosides (Senokot®), toilet. Electrolyte imbalances due to excessive or rapid Polyethylene Glycol 3350 (in various high dose types of loss of body fluid may lead to potential dehydration, prescription bowel prep mixtures) orthostatic hypotension, and confusion.

Created by DADS Pharmacists January 2014. References: Drugs.com/professionals (FDA Professional Monograph)

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