The Hidden Danger in the Medicine Cabinet
Falls are a leading cause of injury among older adults, and medications are a significant contributing factor [1.6.6, 1.4.3]. As people age, changes in the liver and kidneys can alter how drugs are metabolized, potentially leading to a buildup in the body and more pronounced side effects [1.4.2]. The phenomenon of taking multiple medications, known as polypharmacy, further elevates this danger, as drug interactions can create unforeseen problems [1.4.4]. Research indicates that taking as few as four medications can increase the risk of falling by 75% [1.4.5]. The most common culprits are drugs that act on the central nervous system (psychotropics), those that affect blood pressure, and those that can cause sudden drops in blood sugar [1.4.1, 1.4.6]. Side effects like dizziness, sedation, confusion, blurred vision, and orthostatic hypotension (a sudden drop in blood pressure upon standing) are direct mechanisms through which these medications contribute to instability and falls [1.3.1, 1.4.1].
Medications Affecting the Central Nervous System (CNS)
Drugs that depress or alter the central nervous system are among the most frequently implicated in medication-related falls [1.4.6]. These medications can slow reaction time, impair judgment, and cause drowsiness and unsteadiness [1.4.2].
- Benzodiazepines and Sedative-Hypnotics: Prescribed for anxiety and insomnia, drugs like lorazepam (Ativan), diazepam (Valium), and "Z-drugs" like zolpidem (Ambien) slow down brain activity [1.3.2, 1.4.1]. This sedative effect is a primary reason for an increased risk of falls, both with new prescriptions and long-term use [1.3.2].
- Antidepressants: Certain types, including tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), are linked to a higher fall risk [1.3.3]. They can cause side effects such as sedation, orthostatic hypotension, and dizziness. The risk is often greatest during the first few weeks after starting the medication [1.3.1, 1.4.3].
- Antipsychotics: Used for conditions like schizophrenia and sometimes for behavioral issues in dementia, these drugs can cause sedation, cognitive impairment, and a significant risk of orthostatic hypotension [1.3.2, 1.4.1].
- Anticonvulsants (Antiepileptics): Medications used to treat seizures, such as gabapentin, can cause dizziness, sedation, and unsteadiness [1.2.4, 1.3.2]. They have been consistently associated with an increased risk of fall-related injuries [1.3.6].
- Opioids: Used for pain management, opioids like oxycodone and tramadol are powerful sedatives that can cause dizziness, confusion, and drops in blood pressure, all of which contribute to fall risk [1.3.2, 1.4.3].
Cardiovascular and Other High-Risk Medications
While CNS depressants are a major concern, other classes of medication also pose a significant threat to stability.
- Antihypertensives: Medications for high blood pressure are designed to lower it, but they can sometimes go too far, causing dizziness and lightheadedness. This is especially true upon standing (orthostatic hypotension), a common side effect that can easily lead to a fall [1.4.6]. The risk may be highest when first starting the medication [1.3.6].
- Muscle Relaxants: These drugs are used for muscle spasms but carry sedative effects that increase fall risk. Baclofen, in particular, has been associated with a high risk of falls [1.3.2].
- Anticholinergics: This broad class includes many over-the-counter drugs like diphenhydramine (Benadryl) and medications for overactive bladder. They can cause drowsiness, confusion, and blurred vision [1.3.3, 1.3.7].
- Diabetes Medications: Drugs that lower blood sugar can sometimes lead to hypoglycemia (low blood sugar), which causes weakness, dizziness, and confusion [1.4.1].
| Medication Class | Primary Fall-Risk Mechanism(s) | Common Examples |
|---|---|---|
| Benzodiazepines & Z-drugs | Drowsiness, confusion, impaired coordination [1.4.1] | Lorazepam (Ativan), Zolpidem (Ambien) [1.4.7] |
| Antidepressants (SSRIs, TCAs) | Sedation, dizziness, orthostatic hypotension [1.3.1] | Sertraline (Zoloft), Amitriptyline [1.3.7, 1.4.3] |
| Antipsychotics | Sedation, orthostatic hypotension, cognitive impairment [1.3.2] | Risperdal, Seroquel [1.3.7] |
| Anticonvulsants | Dizziness, sedation, unsteadiness [1.3.2] | Gabapentin, Hydantoins [1.2.4, 1.2.3] |
| Opioids | Sedation, dizziness, confusion [1.3.2] | Oxycodone, Tramadol [1.2.4] |
| Antihypertensives | Orthostatic hypotension (sudden blood pressure drop) [1.4.6] | Diuretics, ACE inhibitors, Beta blockers [1.2.3, 1.2.5] |
| Muscle Relaxants | Sedation, dizziness [1.3.2] | Baclofen, Cyclobenzaprine [1.3.2, 1.3.7] |
Managing Medication and Reducing Fall Risk
Proactive management is key to mitigating the risks associated with these medications. The CDC's STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative recommends a framework of stopping, switching, or reducing the dosage of high-risk medications whenever possible [1.5.3].
- Conduct a Medication Review: Regularly review all medications—including prescriptions, over-the-counter drugs, and supplements—with a doctor or pharmacist [1.5.2]. This helps identify potential interactions and side effects that increase fall risk [1.5.1].
- Ask Questions: When prescribed a new medication, ask why it's needed, what the side effects are, and if it could make you sleepy or dizzy [1.8.1].
- Incorporate Non-Pharmacological Strategies: Many conditions can be managed without high-risk drugs. For example, regular exercise like Tai Chi improves balance and strength, reducing fall risk [1.6.2]. Other strategies include home safety modifications (e.g., removing tripping hazards, improving lighting), regular vision checks, and wearing proper footwear [1.6.5].
- Understand the Beers Criteria®: The American Geriatrics Society (AGS) Beers Criteria® is a list of potentially inappropriate medications for older adults that helps clinicians identify drugs that may have more risks than benefits, including many that increase fall risk [1.7.2, 1.7.5].
Conclusion
A wide variety of common medications can substantially increase the risk of a fall, primarily by causing side effects like dizziness, drowsiness, and orthostatic hypotension. Medications that affect the central nervous system—such as sedatives, antidepressants, and opioids—are particularly high-risk. However, cardiovascular drugs, muscle relaxants, and even some over-the-counter products can also contribute. The most effective way to reduce this risk is through proactive medication management. This involves regular reviews with a healthcare provider to assess the necessity and dosage of each drug, exploring safer alternatives, and integrating non-pharmacological strategies like exercise and home safety modifications. By staying informed and communicative with healthcare professionals, individuals can significantly lower their risk of a medication-related fall. For more information on assessing and intervening to reduce fall risk, consult resources like the CDC's STEADI program.
