Appendix 11
Medication which may increase the risk of falls
Note this is not an exhaustive list and any further advice and updates should be sought from pharmacists
and medical colleagues
CLASS/ TYPE
Antidepressants
EXAMPLES
TriCyclic Antidepressants (TCA)
e.g.Amitriptylline, Dosulepin
(Dothiepin), Imipramine,
Lofepramine.
POSSIBLE SIDE
EFFECTS
Drowsiness, blurred
vision, dizziness,
postural hypotension,
constipation,
retention of urine.
SSRIs e.g. Citalopram,
Fluoxetine.
Others Trazodone,
Mirtazepine, Venlafaxine.
Antipsychotic
Antiemetics
Sedatives and
Hypnotics
Medication for
Parkinson’s
Disease
Medication with
Anticholinergic
Side-effects
Chlorpromazine, Haloperidol,
Lithium, Promazine,
Trifluoperazine,
Quetiapine, Olanzapine,
Risperidone.
Prochlorperazine, Cyclizine,
Metoclopramide
Temazepam, Diazepam,
Lorazepam, Nitrazepam,
Zopiclone, Chlordiazepoxide,
Chloral Betaine, Clomethiazole
Cobeneldopa,
Cocareldopa,
Rotigotine, Ropinirole,
Pramipexole, Amantadine,
Entacapone, Selegiline,
Rivastigmine.
(Benzhexol), Prochlorperazine,
Oxybutynin, Tolterodine.
Postural hypotension,
confusion,
drowsiness.
Parkinsonian
symptoms
Postural hypotension,
Confusion,
drowsiness.
Parkinsonian
symptoms
SUGGESTED ACTIONS
Review appropriateness with
prescriber/ GP.
Stop if not required, may
need to withdraw slowly.
Consider changing a Tricyclic
(TCA) to a Serotonin Specific
Reuptake Inhibitor (SSRI)
Consider specialist referral if
further advice needed
Review appropriateness and
check if prescribed in line with
relevant protocols.
In long term use do not stop
without specialist opinion.
Avoid in management of
delirium, consider specialist
referral if further advice
needed.
Review appropriateness and
indication for use with
prescriber/ GP (often given
for “dizziness”)
Domperidone may be a
suitable alternative.
Drowsiness which
can last into the next
day, lightheadedness,
confusion, loss of
memory
Review appropriateness and
indication for use with
prescriber/ GP. Stop if
possible.
Long term use will need slow
withdrawal
No new initiation on transfer
of care – seek specialist
advice if required.
Sudden daytime
sleepiness,
dizziness,
insomnia, confusion.
Low blood pressure,
blurred vision.
May not be possible to
change. Do not change
without specialist
opinion.
Check for postural
hypotension
Dizziness, blurred
vision,retention of
urine,confusion,
Review appropriateness and
indication for use with
prescriber/ GP. Reduce dose
Cardiovascular
Medication
Analgesics
Anticonvulsants
drowsiness,
hallucinations.
or stop if possible.
ACE inhibitors / AngiotensinII
antagonists:
Ramipril, Lisinopril, Captopril,
Irbesartan, Candesartan.
Vasodilators:
Hydralazine Diuretics:
Bendroflumethiazide,
Bumetanide,
Indapamide, Furosemide,
Amiloride, Spironolactone,
Metolazone.
Betablockers:
Atenolol, Bisoprolol, Carvedilol,
Propranolol, Sotalol.
Alphablockers: Doxazosin,
Alfuzosin, Terazosin,
(Tamsulosin).
Opioids:
Codeine, Tramadol, Nefopam,
Dihydrocodeine, Buprenorphine,
Alfentanyl
Opiates: Morphine, Oxycodone.
Low blood pressure,
postural hypotension,
dizziness, tiredness,
sleepiness, confusion
Check lying and standing BP.
Review appropriateness and
indication for use with
prescriber/ GP (note
alphablockers are also used
for benign prostatic
hyperplasia).
Review dose.
May not be possible to stop.
Consider alternative to
alphablocker.
Drowsiness,
confusion,
hallucinations,
postural
hypotension.
Review dose.
• Use analgesic pain ladder to
avoid excess use.
• In older people start low and
go slow
Carbamazepine*, Sodium
Valproate*, Gabapentin,
Lamotrigine, Clonazepam,
Phenytoin*, Phenobarbitone*,
Primidone*.
Drowsiness,
dizziness,
blurred vision.
Consider indication (some are
also used for pain control or
mood stabilisation).
• May need specialist review
in problem cases.
• *Consider Vitamin D
supplements for
at risk patients on long-term
treatment with these drugs.
Guidelines for Good Prescribing in Older Patients
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Carry out a regular medication review and discuss and agree all changes with the
patient/carer. Make sure changes are highlighted in information to GP at Transfer of Care.
Stop any current drugs that are not indicated. Check with GP for long term
treatments e.g. antidepressants
Prescribe new drugs that have a clear indication. Make sure changes
(including the indication) are highlighted in information to GP at Transfer of Care.
If possible, avoid drugs that have known deleterious effects in older people, such as
benzodiazepines, and recommend dosage reduction when appropriate.
Use the recommended dosages for older patients
Use simple drug regimens and appropriate administration systems
Consider using once daily or once weekly formulations and using fixed dose
combinations when possible
Consider non pharmacological treatments if appropriate
Limit the number of people prescribing for each patient if possible
Where possible, avoid treating adverse drug reactions with further drugs