Written by Cherilyn Cecchini, MD | Reviewed by Katie E. Golden, MD Updated on March 16, 2023
Key takeaways:
- Falls become more common and more dangerous as people age. It’s important for older adults to know what things can increase the risk of falls.
- Research shows that some medications increase the risk of falls in older adults. Examples include antidepressants, sleep medications, muscle relaxants, and blood pressure medications.
- If you’re worried about your balance or risk for falls, review your medication list with your provider. Often, your healthcare provider can lower your medication dose or even stop it all together. This can help you stay on your feet more confidently as you age.
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For older adults, falls are a big deal. They can be a real source of worry — and for good reason. Falls increase the risk of hospitalization, disability, and even death. One way to minimize the risk of falls is to review your (or a loved one’s) medication list.
Certain medications can make you more likely to lose balance and fall. And taking multiple medications on a daily basis can make falling even more likely. Keep reading to learn more about nine types of medications that may increase your risk of falls.
1. Antidepressants
Certain antidepressants may increase fall risk more than others. Tricyclic antidepressants (TCAs) seem to carry a higher risk than other classes of antidepressants. Examples of TCA medications include:
- Amitriptyline (Amitril)
- Nortriptyline (Pamelor)
Another class of antidepressants — selective serotonin reuptake-inhibitors (SSRIs) — may also increase the risk of falls in older adults. Examples of SSRIs include:
- Escitalopram (Lexapro)
- Sertraline (Zoloft)
- Citalopram (Celexa)
If you or an older adult in your life needs an antidepressant but is at risk of falling, talk with your provider about different options. They can help you pick the one that is best for you.
2. Sleep medications
It probably comes as no surprise that medications used to treat insomnia or help with sleep can make falls more likely. Examples of popular medications for insomnia include:
- Zolpidem (Ambien)
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
The good news is that there are safer and more effective options to help with sleep over the long term. In fact, experts recommend behavioral therapy as first-choice treatment for insomnia.
Behavioral therapy helps you develop habits that can improve your sleep. Plus, it changes the way you think about sleep. And it spares you any potentially dangerous side effects.
3. Anti-anxiety medications
To help with anxiety and/or sleep, many Americans take benzodiazepine medications. But similar to the sleep medications above, these can also make falls more likely in older adults.
Examples of benzodiazepines are:
- Lorazepam (Ativan)
- Diazepam (Valium)
- Temazepam (Restoril)
- Alprazolam (Xanax)
These medications can be especially risky when used long term (more than 2 weeks). If you have been using these medications for a long period of time, talk to your provider about gradually decreasing the dose when you’re ready to stop taking them. This can help minimize your chances of falling.
4. Muscle relaxants
Similar to sleep and anxiety medications, muscle relaxants can cause serious side effects in older adults. Drowsiness and confusion in particular can increase the likelihood of falling.
Examples of muscle relaxants include:
- Diazepam (Valium)
- Methocarbamol (Robaxin)
- Cyclobenzaprine (Flexeril, Amrix)
- Metaxalone (Skelaxin)
- Chlorzoxazone (Lorzone, Parafone Forte)
- Orphenadrine (Norflex)
If you need a muscle relaxant, experts recommend only short-term use when possible. The good news is there are many safer ways to help your muscles relax. Older adults can also try:
- Hydrotherapy
- Low-impact exercise
- Physical therapy
5. Anti-seizure medications
Anti-seizure medications (anticonvulsants) often cause dizziness, confusion, and sedation as side effects in older adults. And these side effects can increase the chance of falling.
Examples of anti-seizure medications include:
- Carbamazepine (Tegretol)
- Valproic acid (Depakene)
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
- Topiramate (Topamax)
- Gabapentin (Neurontin)
While these medications are used to prevent seizures, they’re also sometimes used to reduce behavioral disturbances in older adults with dementia. If you or a loved one is taking any of the above medications, talk to your provider about whether it’s definitely needed.
6. Antipsychotics
Antipsychotic medications are also used to treat agitation in older adults with dementia. And common side effects include sedation, dizziness, and blurred vision. These can all contribute to instability and falls.
Examples of antipsychotics include:
- Haloperidol (Haldol)
- Fluphenazine (Prolixin)
- Perphenazine (Trilafon)
Talk with your provider if you or a loved one takes one of these medications. While it may not be possible to entirely avoid these medications, you may be able to change the dose to help decrease the risk of falls.
7. Pain medications
Opioid painkillers can also increase the risk of falls in older adults. Examples include:
- Oxycodone (Percodan, Percocet)
- Hydrocodone (Vicodin)
- Hydromorphone (Dilaudid)
- Fentanyl (Duragesic)
These medications have a lot of side effects — like constipation, slowed breathing, and drowsiness. So they should always be used at the lowest effective dose and for as short of a time as possible. In certain situations, they may be necessary — like after surgery or during cancer treatment.
But for less severe pain, non-opioid medications like acetaminophen (Tylenol) are good choices for older adults who are worried about falling. Avoiding NSAIDs (nonsteroidal anti-inflammatory drugs) like Advil and Aspirin may actually help older adults decrease their likelihood of falling, too.
8. Blood pressure medications
There are many different types of blood pressure medications, and any of them can increase the chances of an older person falling. So far, researchers haven’t found that one type of blood pressure medication increases the chance of falling more than another type.
But the risk is higher in people who have fallen before. And the chance of falling is more likely when changes are made to the medication, like when adjusting the dose.
9. Antihistamines
Older types of antihistamines commonly cause side effects that increase the risk of falling — particularly in older adults. These side effects include blurred vision, sleepiness, and confusion.
Examples of antihistamines include:
- Diphenhydramine (Benadryl)
- Dimenhydrinate (dramamine)
For these or any other medications on this list, talk to your provider to find out if they’re absolutely necessary. There may be a different, safer treatment option.
And remember that if you can’t decrease your dose or switch to a different option, there are some simple exercises that can help you improve your balance. You can do many of these while seated in a chair. A few minutes a day can go a long way to decreasing your risk of falls over the long term.
The bottom line
As you age, it’s common to feel less stable on your feet. An easy way to decrease the chance of falling is to review your medication list. There are several different kinds of medications that increase the likelihood of falling, especially in older adults. In most cases, your provider can help you make adjustments, like decreasing your dose or changing to a different option. Optimizing your medications can help you stay steadier longer.
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