Medication & Falls Risks for Over 60s

Some drugs are more likely to be associated with falls. This chart will help you identify those drugs that may cause problems in the elderly. 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. A medication review can play an important part in falls prevention.

High Risk (Red)

ANTIDEPRESSANTS

Used to lift mood

Tricyclic (TCAs) & related antidepressants: amitriptyline, clomipramine, dosulepin, duloxetine, lofepramine, imipramine and mirtazepine.

SSRIs: fluoxetine, paroxetine, citalopram, sertraline, fluvoxamine.

Others: venlafaxine

TCAs may cause drowsiness & blurred vision. SSRIs slightly less sedating. May also cause blurred vision

ANTIPSYCHOTICS

INCLUDING ATYPICALS

Used to treat or help control symptoms of schizophrenia,

manic depression, paranoia.

‘Typicals’: haloperidol, trifluoperazine, sulpiride

Atypicals: amisulpiride, aripiprazole, clozapine, olanzapine, risperidone, quetiapine, zotepine

Prochloperazine is frequently prescribed for dizziness due to postural instability and is the most frequently implicated drug in causing drug-induced Parkinson’s disease.

ANTI-MUSCARINIC DRUGS (Anti-Cholinergics)

Used in the treatment of incontinence and in Parkinson’s disease.

Oxybutynin may cause acute confusion in the elderly, especially those with pre-existing cognitive impairment. Review ongoing need for incontinence drugs at 3-6 months.

Moderate Risk (Amber)

ACE INHIBITORS / ANGIOTENSIN II ANTAGONISTS

Used to treat hypertension, heart failure and following a heart attack.

captopril,enalapril, lisinopril, ramipril, perindopril, quinapril, fosinopril, trandolapril, losartan, valsartan. irbesartan, candesartan, eprosartan, telmisartan.

Greater risk of hypotension if taking a diuretic, the incidence of dizziness varies.

ALPHA-BLOCKERS

Used to treat hypertension, heart failure and following a heart attack.

Alfuzosin, doxazosin, indoramin, prazosin, tamulosin, terazosin.

Doses used for treating prostate problems are less likely to cause hypotension and dizziness than those required to treat hypertension.

ANTI-ARRHYTHMICS

Drugs used to control how the heart beats and to help keep its rhythm.

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

*Prepared by Malcolm Steward, Head of Pharmacy, Derbyshire Community Health Services Feb 2011