Drug - PSNC

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Drugs that can contribute to falls and confusion in the elderly
Doncaster Central PCT
Note: The effects of alcohol can increase the risk of falls and confusion in the elderly when taken with some medicines
Drug
Amitripytline
Atropine (eye drops)
Bromocriptine
Chlorpheniramine
Dantrolene
Diazepam
Dicycloverine
Diphenydramine
Dosulepin (dothiepin)
Doxepin
Hydroxyzine
Imipramine
Oxybutynin
Procyclidine
Promethazine
Propantheline
Tolterodine
Trazadone
Citalopram
Co-beneldopa
Co-careldopa
Fluoxetine
Indomethacin
Paroxetine
Sertraline
Cimetidine
Flupentixol
Type of drug
TCA*
Antimuscarinic
Anit-Parkinsons
Antihistamine
Muscle relaxant
TCA*
Anti-spasmodic
Antihistamine
TCA*
Antidepressant
Antihistamine
TCA*
Antimuscarinic
Antimuscarinic
Antihistamine
Antispasmodic
Antimuscarinic
Antidepressant
SSRI antidepressant*
Anti- Parkinsons
Anti-Parkinsons
SSRI antidepressant*
Analgesic
SSRI antidepressant*
SSRI antidepressant*
Reduces stomach
acid
Antipsychotic
Olanzapine
Antipsychotic
Quetiapine
Antipsychotic
Side-effect of drug
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Antimuscarinic
Confusion
Confusion
Confusion
Confusion
Confusion
Confusion
Confusion
Confusion (usually if
kidney/liver impaired)
Drug induced
Parkinson’s Disease
Drug induced
Parkinson’s Disease,
Drug induced
Drug
Type of drug
Risperidone
Antipsychotic
Metoclopramide
To treat nausea
Prochlorperazine
Nausea/dizziness
Carbamazepine
Anti-epileptic,
Pain control
Anti-epileptic
Phenytoin
Amlodipine
Atenolol
Bendroflumethazide
Captopril
Clonidine
Diltiazem
Dipyrimadole
Doxazosin
Enalapril
Felodipine
Furosemide(frusemide)
Hydralazine
Lisinopril
Methyldopa
Nifedipine
Nitrates
Pergolide
Prazosin
Propranolol
Ramipril
Selegilene
Notes on the use of colour
Red = drugs that have antimuscarinic effects (see notes at end)
Blue = drugs that can lower the blood pressure
Black = drugs which do not specifically fit in any of the above categories
Ca channel blocker*
Beta blocker
Diuretic
ACE inhibitor
Antihypertensive,
migraines
Ca channel blocker*
Anti-platelet
Alpha blocker
ACE Inhibitor
ACE Inhibitor
Diuretic
Vasodilator
ACE inhibitor
Antihypertensive
Ca channel blocker*
Vasodilator
Anti-Parkinsons
Alpha blocker
Beta blocker
ACE Inhibitor
Anti-Parkinsons
Side-effect of drug
Parkinson’s Disease,
Drug induced
Parkinson’s Disease,
Drug induced
Parkinsons Disease
Drug induced
Parkinsons Disease
Lack of control of
movements
Lack of movement
control
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Low BP
Green = drugs that can cause sedation (see notes at end)
Magenta = drugs which have a relatively high risk of causing
confusion
Thanks to© RUSHCLIFFE PRIMARY CARE TRUST
This document is also available from http://medicinesmanagement.doncasterpct.nhs.uk/
Drugs that can contribute to falls and confusion in the elderly
Doncaster Central PCT
Note: The effects of alcohol can increase the risk of falls and confusion in the elderly when taken with some medicines
Drug
Timolol (inc eye drops)
Verapamil
Baclofen
Type of drug
Beta blocker
Ca channel blocker*
Muscle relaxant
Fludrocortisone
Prednisolone
Chlordiazepoxide
Chlormethiazole
Chlorpromazine
Co-codamol
Codeine
Co-proxamol
Cyclizine
Dihydrocodeine
Nitrazepam
Phenobarital
Promazine
Temazepam
Tramadol
Trifluoperazine
Zopiclone
Methocarbamol
Steroid
Steroid
Benzodiazepine
Sleeping tablet
Antipsychotic
Analgesic
Analgesic
Analgesic
Nausea/dizziness
Analgesic
Benzodiazepine
Anti-epileptic
Antipsychotic
Benzodiazepine
Analgesic
Antipsychotic
Sleeping tablet
Muscle relaxant
Haloperidol
Antipsychotic
Morphine
Analgesic
Digoxin (usually
associated with
toxicity)
Benzhexol
To treat heart failure
Antimuscarinic
Side-effect of drug
Low BP
Low BP
Muscle spasticity,
dizziness
Osteoporosis
Osteoporosis
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation
Sedation, confusion,
dizziness
Sedation, Drug
Induced Parkinson’s
Disease
Sedation, low BP,
muscle rigidity
Visual disturbances,
Drowsiness,
confusion, dizziness
Visual impairment
TCA* – Tricyclic Antidepressant
Ca channel blocker* – Calcium Channel blocker used to treat
cardiovascular problems
SSRI* - Selective Serotonin Reuptake Inhibitor (a type of
antidepressant)
Notes on the chart
This is a general guide; the list is not comprehensive and shows examples
only. Many drugs will have a number of side effects, only the main ones have
been listed. Further information should always be sought. Brand names have
not been included. The drug name is usually apparent on the box or strip of
medication. The chart contains information derived from the BNF, studies on
the relationship between drugs and falling, the “Beer Criteria” and North-East
Derbyshire Primary Care Trust.
Drugs that cause sedation
Any drug which cause sedation can worsen a pre-existing or create a new
state of confusion in the elderly. It is one of the most common causes of
drug-induced falls. However, almost any of the commonly used drugs can
cause confusion in the elderly as adverse effects in these people tend to
present with confusion as the main symptom.
Drugs with antimuscarinic effects
These are drugs which block muscarinic receptors in the nervous system.
Actions of these drugs include relaxation of smooth muscle, decreased
secretion of saliva, sweat and digestive juices and dilation of the pupil of the
eye. Side-effects include drowsiness and blurred vision. Toxicity is common
and can result in confusion. Toxicity is often the cumulative effect of several
medicines with antimuscarinic effects.
Drugs which affect the central nervous system
These include antipsychotics, antidepressants, sleeping tablets and
benzodiazepines. They can cause confusion, sedation, impaired balance
and low BP, especially on standing and often also have antimuscarinic
Notes on the use of colour
Red = drugs that have antimuscarinic effects (see notes at end)
Blue = drugs that can lower the blood pressure
Black = drugs which do not specifically fit in any of the above categories
Green = drugs that can cause sedation (see notes at end)
Magenta = drugs which have a relatively high risk of causing
confusion
Thanks to© RUSHCLIFFE PRIMARY CARE TRUST
This document is also available from http://medicinesmanagement.doncasterpct.nhs.uk/
Doncaster Central PCT
Drugs that can contribute to falls and confusion in the elderly
Note: The effects of alcohol can increase the risk of falls and confusion in the elderly when taken with some medicines
effects. Some drugs can also cause symptoms of Parkinson’s Disease such
as tremor and abnormal body movements. It should be remembered that
these drugs are often prescribed for conditions which in themselves can
cause confusion and sedation such as depression.
Multiple drugs
The greater the number of drugs an older person takes, the greater the
likelihood is of then falling, especially if these drugs affect the central nervous
or cardiovascular systems.
Notes on the use of colour
Red = drugs that have antimuscarinic effects (see notes at end)
Blue = drugs that can lower the blood pressure
Black = drugs which do not specifically fit in any of the above categories
Green = drugs that can cause sedation (see notes at end)
Magenta = drugs which have a relatively high risk of causing
confusion
Thanks to© RUSHCLIFFE PRIMARY CARE TRUST
This document is also available from http://medicinesmanagement.doncasterpct.nhs.uk/
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