Medications with Fall Risk Precautions Antipsychotic Drugs Factors Contributing to Fall Risk Typical Antipsychotics (First Generation) Drowsiness, dizziness, confusion, hypotension (low Chlorpromazine (Thorazine®), Fluphenazine (Prolixin®), blood pressure), orthostatic hypotension (sudden drop Haloperidol (Haldol®), Loxapine (Loxitane®), Perphenazine in blood pressure when upright), syncope (fainting), (Trilafon®), Prochlorperazine ( Compazine®), Thioridazine ataxia (gait disturbance), blurred vision, disorientation, (Mellaril®), Thiothixene (Navane®), Trifluoperazine abnormal involuntary movements of the body, slowed (Stelazine®) body movements, tremors, muscle rigidity, muscle Atypical Antipsychotics (Second Generation) spasms, seizure risk, heart rate irregularities, risk of Aripiprazole (Abilify®), Asenapine (Saphris®), Clozapine delirium (Clozaril®), Iloperidone (Fanapt®), Lurasidone (Latuda®), Olanzapine (Zyprexa®), Paliperidone (Invega®), Quetiapine (Seroquel®), Risperidone (Risperdal®), Ziprasidone (Geodon®) Anti-Anxiety Drugs Factors Contributing to Fall Risk Long-acting Benzodiazepines Drowsiness, dizziness, weakness, confusion, Chlordiazepoxide (Librium®), Clorazepate (Tranxene®), orthostatic hypotension (sudden drop in blood pressure Diazepam (Valium®), Flurazepam (Dalmane®), Clonazepam when upright), disorientation, blurred vision, (Klonopin®) unsteadiness, ataxia (gait disturbance), tremor, risk of Intermediate to Short-acting Benzodiazepines seizures (with abrupt discontinuation), blurred vision, Alprazolam (Xanax®), Lorazepam (Ativan®), Oxazepam worsening of respiratory depression, risk of delirium (Serax®) Other Anxiolytics Buspirone (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®), Temazepam (Restoril®), upright), ataxia (gait disturbance), hangover effect, Triazolam (Halcion®) disorientation, syncope (fainting), blurred vision, tremor, Non-benzodiazepines agitation, bizarre behavior, worsening of respiratory Diphenhydramine (Benadryl®; Sominex®; Nytol®), Doxylamine depression, risk of delirium (Unisom®), Eszopiclone (Lunesta®), Zaleplon (Sonata®), Zolpidem (Ambien®; Intermezzo®) Antidepressant Drugs Factors Contributing to Fall Risk Tricyclics (TCAs) Drowsiness, dizziness, confusion, hypotension (low Amitriptyline (Elavil®), Clomipramine (Anafranil®), Desipramine blood pressure), orthostatic hypotension (sudden drop (Norpramin®), Doxepin (Sinequan®), Imipramine (Tofranil®), in blood pressure when upright), disorientation, Nortriptyline (Pamelor®) syncope (fainting), blurred vision, unsteadiness, Tetracyclics numbness in the extremities, weakness, fatigue, Maprotiline (Ludiomil®), Mirtazapine (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®), Paroxetine (Paxil®; Pexeva®), Sertraline (Zoloft®) TCAs have highest fall risk compared to other Serotonin-norepinephrine Reuptake Inhibitors (SNRIs) antidepressants. TCA special precautions: cardiac Desvenlafaxine (Pristiq®), Duloxetine (Cymbalta®), arrhythmias, tachycardia (increased heart rate), risk of Venlafaxine (Effexor®) stroke, cognitive impairment, seizure risk (with TCAs Other Antidepressants and Bupropion). Bupropion (Wellbutrin®; Zyban®), Nefazodone (Serzone®), SSRIs pose greatest fall risk during the first 2 weeks of Trazodone (Desyrel®; Oleptro®), Vilazodone (Viibryd®) initiation. Created by DADS Pharmacists January 2014. References: Drugs.com/professionals (FDA Professional Monograph) 1 Medications with Fall Risk Precautions Antimanic/Anticonvulsant Drugs Factors Contributing to Fall Risk Carbamazepine (Tegretol®), Ethosuximide (Zarontin®), Drowsiness, dizziness, unsteadiness, confusion, Gabapentin (Neurontin®), Lamotrigine (Lamictal®), Lithium blurred vision, some drugs may require periodic lab Carbonate (Eskalith®; Lithobid®), Levetiracetam (Keppra®), work to monitoring for toxic levels, hyponatremia (low Phenobarbital, Phenytoin (Dilantin®), Pregabalin (Lyrica®), blood sodium, fall risk) and electrolyte imbalances Primidone (Mysoline®), Tiagabine (Gabitril®), Topiramate (Topamax®), Valproic Acid/Divalproex Sodium (Depakene®; Some drugs may cause irregular heartbeat. Depakote®), Zonisamide (Zonegran®) Pain Relievers (Opioids & Synthetic Analgesics) Factors Contributing to Fall Risk Buprenorphine (Butrans® patch), Butalbital (Esgic®; Fioricet®; Sedation, drowsiness, confusion, disorientation, Fiorinal®), Butorphanol (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), opioid dose- Lortab®; Norco®; Vicodin®; Vicoprofen®), Hydromorphone related respiratory depression & irregular breathing (Dilaudid®; Exalgo®), Methadone (Dolophine®; Methadose®), with possible hypoxia (reduced blood oxygen) Morphine ( various tablet and liquid forms; Avinza®; Kadian®; MS Contin®; Oramorph®; Roxanol®), Oxycodone (OxyContin®; Tramadol may increase the risk of seizures. Percodan®; Percocet®; Tylox®), Oxymorphone (Opana®), Pentazocine (Talacen®; Talwin®), Tapentadol (Nucynta ER®), Some drugs may cause cardiac arrhythmias (e.g. Tramadol (Ultram®; Ultracet®) methadone). Muscle Relaxants Factors Contributing to Fall Risk Baclofen (Lioresal®), Carisoprodol (Soma®), Chlorzoxazone Sedation, drowsiness, dizziness, fatigue, weakness, (Parafon Forte®), Cyclobenzaprine (Flexeril®), Metaxalone impaired functional ability, confusion, hypotension (low (Skelaxin®), Methocarbamol (Robaxin®), Orphenadrine blood pressure), syncope (fainting), some have (Norflex®; Norgesic®), Tizanidine (Zanaflex®) seizure risk Anticholinergic/Antimuscarinic/Antispasmodic Drugs Factors Contributing to Fall Risk Antihistamines (Anti-itch and Anti-nausea/vertigo) Drowsiness, dizziness, sedation, fatigue, hypotension Dimenhydrinate (Dramamine®), Diphenhydramine (Benadryl®), (low blood pressure), disturbed coordination, Hydroxyzine (Atarax®;Vistaril®), Meclizine (Antivert®; Bonine®; confusion, disorientation, blurred vision, nervousness, Dramamine II®), Scopolamine (Transderm Scop®) restlessness, agitation, palpitations, increased risk of Drugs for Various Gastrointestinal Disorders delirium Atropine, Belladonna Alkaloids (Donnatal®), Cyproheptadine (Periactin®), Dicyclomine (Bentyl®), Diphenoxylate/Atropine Drugs with strong anticholinergic and antimuscarinic (Lomotil®), Glycopyrrolate (Robinul®), Hyoscyamine 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), Promethazine (Phenergan®), Trimethobenzamide (Tigan®) Drugs to Treat Movement Disorders (e.g. Parkinson’s or EPS) Benztropine (Cogentin®), Trihexyphenidyl (Artane®) Drugs to Treat Over-active Bladder Disorders Darifenacin (Enablex®), Fesoterodine (Toviaz®), Flavoxate (Urispas®), Mirabegron (Myrbetriq®), Oxybutynin (Ditropan®; Oxytrol® patch), Solifenacin (VESIcare®), Tolterodine (Detrol®), Trospium (Sanctura®) Created by DADS Pharmacists January 2014. References: Drugs.com/professionals (FDA Professional Monograph) 2 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 Acetazolamide (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, Amiloride (Midamor®), Spironolactone (Aldactone®), drowsiness, dizziness, muscle cramps, muscular Triamterene (Dyrenium®) fatigue, hypotension (low blood pressure), orthostatic Thiazide 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-adrenergic Receptor Antagonists (Central Acting) Hypotension (low blood pressure), orthostatic Clonidine (Catapres®), Guanfacine (Tenex®), Methyldopa hypotension (sudden drop in blood pressure when (Aldomet®) upright), lightheadedness, syncope (fainting), vertigo, Alpha-adrenergic Receptor Antagonists (Peripherally Acting) fatigue, weakness, possible tachycardia (increased Doxazosin (Cardura®), Prazosin (Minipress®), Terazosin heart rate), possible arrhythmias, palpitations, (Hytrin®) bradycardia (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®),