Medications Associated with Falls

Be alert to the effects of medications, as it could increase the chance of a sudden, unanticipated fall. Patients taking any one or more of these medications, along with a diuretic, may be at increased risk for falls. A pharmacist may help determine the role of medications in a fall event.

Medication Class Medication Names Effects on Fall Risk Analgesics, Opiates Codeine Fentanyl Sedation Hydrocodone Tramadol Slows reaction time Oxycodone Methadone Impairs balance Morphine Buprenorphine Delirium Hydromorphone Opium Bradycardia Oxymorphone Muscle relaxants Baclofen Dantrolene (Dantrium®, Ryanodex®) Sedation Decreased muscle tone Gait changes Antihistamines Chlorpheniramine (Chlor-Trimeton®) Hydroxyzine (Vistaril®, Atarax®) Drowsiness Diphenhydramine (Benadryl®) Promethazine (Phenergan®) Dizziness

Antipsychotics Haloperidol (Haldol®) Risperidone (Risperdal®) Orthostatic hypotension Fluphenazine Quetiapine (Seroquel®) Sedation Olanzapine (Zyprexa®) Slows reaction time Impaired balance Increased risk of arrhythmias (QT- prolongation) Anticonvulsants Carbamazepine (Tegretol®) Limited data on associations with falls: Sedation Phenytoin (Dilantin®) Lamotrigine (Lamictal®) Slows reaction time Phenobarbital Pregabalin (Lyrica®) Gait disturbances Valproic acid Levetiracetam (Keppra®) Ataxia (Depakote®/Depakene®) Topiramate (Topamax®) Gabapentin (Neurontin®) Benzodiazepines Clonazepam (Klonopin®) Midazolam (Versed®) Drowsiness Diazepam (Valium®) Temazepam (Restoril®) Slows reaction time Lorazepam (Ativan®) Impairs balance Non- Eszopiclone (Lunesta®) Zaleplon (Sonata®) Drowsiness benzodiazepine Ramelteon (Rozerem®) Zolpidem (Ambien®) Slows reaction time sedative-hypnotics Impaired balance Sleep walking Anti-Parkinson and Donepezil (Aricept®) Ropinirole (Requip®) Bradycardia Dementia agents Galantamine (Razadyne®) Selegiline (Emsam®, Zelapar®) Delirium Pramipexole (Mirapex®) Orthostatic hypotension Rivastigmine (Exelon®) Syncope Antidepressants Amitriptyline (Elavil®) Imipramine (Tofranil®) Orthostatic hypotension Clomipramine (Anafranil®) Mirtazapine (Remeron®) Drowsiness Doxepin (Silenor®) Nortriptyline Slows reaction time Trazodone Impaired balance Alpha-receptor Alfuzosin (Uroxatral®) Tamsulosin (Flomax®) Orthostatic hypotension blockers Doxazosin (Cardura®) Terazosin Prazosin (Minipress®) Clonidine Anti-hypertensives Lisinopril (Zestril®) Irbesartan (Avapro®) Hypotension (ACE-Inhibitors, Ramipril (Altace®) Losartan (Cozaar®) Orthostatic hypotension ARBs) Enalapril (Vasotec®) Olmesartan (Benicar®) Hyponatremiaaltered mental status Captopril Telmisartan (Micardis®) Fosinopril Isosorbide mononitrate (ImDur®) Quinapril (Accupril®) Isosorbide dinitrate (Isordil®) Candesartan (Atacand®) Anti-hypertensives Atenolol (Tenormin®) Amlodipine (Norvasc®) Bradycardia (Beta-blockers, Bisoprolol (Zebeta®) Felodipine Hypotension calcium channel Carvedilol (Coreg®) Nifedipine (Procardia®) Orthostatic hypotension blockers) Metoprolol (Lopressor®, Toprol XL®) Diltiazem (Cardizem®, Cartia XT®) Hyponatremiaaltered mental status Propranolol (Inderal®) Verapamil (Calan®, Verelan®) Vasovagal syndrome Anti-arrhythmics Amiodarone (Cordarone®, Flecainide Bradycardia Pacerone®) Sotalol (Betapace®) Other arrhythmias Digoxin (Digitek®, Lanoxin®)

April 2019