Which Tablets Cause Falls in Older People?

Which Tablets Cause Falls in Older People?

Falls are a leading cause of injury, hospitalisation, and loss of independence for older adults.

In clinical practice, we often find that “the risk of a fall in a frail patient can have worse consequences (such as a hip fracture or #NOF) than the condition the drug is intended to treat.”

Many medications—even those used for common conditions like high blood pressure or insomnia—can impair balance, cause dizziness, or lower blood pressure too quickly. This guide highlights the high-risk drug groups that require careful “deprescribing” or regular medication reviews.

Why Do Certain Drugs Increase Fall Risk?

Medications typically cause falls through three primary mechanisms:

1. Orthostatic Hypotension: A sudden drop in blood pressure when standing up, leading to dizziness.

2. Sedation and Cognitive Impairment: Drowsiness or confusion that affects spatial awareness.

3. Bradycardia: Slowing the heart rate, which can lead to fainting (syncope).

High-Risk Medication Groups (The “Falls List”)

If a patient is experiencing recurrent falls, the following drug classes should be reviewed by a GP or pharmacist for potential dose reduction or cessation.

1. Cardiovascular & Blood Pressure Drugs

These are the most common culprits for postural dizziness.

• Alpha-blockers: (e.g. Tamsulosin, Doxazosin) Often used for prostate issues or blood pressure; these are notorious for causing a drop in pressure upon standing.

• ACE Inhibitors: (e.g. Ramipril, Lisinopril, Enalapril).

• Beta-blockers: (e.g. Bisoprolol, Atenolol). Note: This includes Timolol eye drops, which can be absorbed systemically and slow the heart rate.

• Diuretics (Water Tablets): (e.g. Bendroflumethiazide, Furosemide) These can cause dehydration and low blood pressure.

• Anti-anginals: (e.g. GTN spray, Isosorbide Mononitrate).

2. Psychotropic & Brain-Acting Drugs

These drugs often cause “clouded” thinking or slowed reaction times.

• Benzodiazepines & “Z-Drugs”: (e.g. Diazepam, Temazepam, Zopiclone, Zolpidem) Used for anxiety or sleep, these significantly impair balance and are a leading cause of nighttime falls.

• Antipsychotics: (e.g. Risperidone, Quetiapine, Olanzapine, Haloperidol).

• Sedating Antidepressants: (e.g. Amitriptyline, Mirtazapine, Trazodone).

• SNRIs: (e.g. Duloxetine, Venlafaxine).

3. Neurological & Pain Medication

• Opioids: (e.g. Codeine, Morphine, Tramadol) These cause sedation and can affect the “inner ear” balance centres.

• Antiepileptics: (e.g. Carbamazepine, Phenytoin, Gabapentin).

• Parkinson’s Meds (Dopamine Agonists): (e.g. Pramipexole, Ropinirole) These frequently cause sudden drops in blood pressure.

Summary Table: Fall-Inducing Drugs