Falls are more fatal than you may realize. Falling is the second leading cause of unintentional injury deaths worldwide, according to the World Health Organization.
Globally, about 684,000 people die from falls every year. Those most at risk are adults over the age of 60. Even in falls that aren’t deadly, 20% to 30% of older people in the U.S. who fall sustain moderate to severe injuries like bruises, hip fractures or head trauma.
Certain medications can make the risk of falling even worse.
Following are a handful of medications and medication groups that increase fall risk — you may recognize a few of them.
Oxybutynin
Purpose: Oxybutynin is used to treat overactive bladder symptoms, which it does by decreasing bladder muscle spasms that can cause a frequent urge to go to the bathroom.
Brand names include: Ditropan, Ditropan XL
A study published in the Neurourology and Urodynamics journal concluded that consistent use of oxybutynin is associated with a “significantly increased” risk of falls and fractures. Within the first 30 days of starting the medication, participants had a 1.07% incidence rate of falling and/or fractures.
Researchers analyzed four years of data that included more than 103,000 adults over the age of 66 newly prescribed the medication, and most participants on oxybutynin took less than 15 milligrams per day.
One side effect of the medication is dizziness, which is a risk factor for falling all on its own.
Zolpidem
Purpose: Zolpidem is used to treat insomnia by slowing activity in the brain.
Brand names include: Ambien, Ambien CR, Edluar, Intermezzo and Zolpimist
Potential side effects of zolpidem, which is commonly used in an inpatient setting, are decreased balance and increased risk of falls, which shouldn’t be taken lightly. A study published in The Journal of Hospital Medicine says that falls among hospitalized patients have a significant risk of death, as well as increased health care costs.
Researchers found that among hospitalized patients, those who were prescribed and took zolpidem had a 3.04% incidence rate of falls, compared with a 0.71% fall rate among those who were prescribed but did not receive zolpidem.
The study ultimately concluded, “Zolpidem use was a strong, independent, and potentially modifiable risk factor for inpatient falls.”
Quetiapine
Purpose: Quetiapine is used to treat schizophrenia and bipolar disorder by affecting the activity of neurochemicals dopamine and serotonin in the brain.
Brand names include: Seroquel, Seroquel XR
A study published in the journal Psychiatry Research writes that psychiatric medications like quetiapine “may be the drugs with the highest risk of falls.” Quetiapine ranked first in a category of 13 reviewed psychiatric medications associated with a risk of falls.
Another study published in the Journal of Clinical Pharmacy and Therapeutics says that sleepiness and dizziness, which are associated with falling, are common side effects of the medication.
Antihistamines
Purpose: Antihistamines are a type of medication used to treat allergies or symptoms of allergies.
Medications of this type include:
First-generation antihistamines, such as dimenhydrinate (Dramamine), diphenhydramine (sold under many brand names, including Benadryl) and doxylamine (Unisom, Vicks NyQuil, Tylenol Cold and Cough Nighttime)
Second-generation antihistamines, such as cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (Claritin)
A systematic review of multiple scientific studies found that use of antihistamines, particularly first-generation antihistamines, is associated with a “significantly increased risk of injurious falls.”
Antihistamines cause drowsiness, which is why they’re also used in sleep medications. This drowsiness is one possible reason behind their association with increased fall risk.
It’s also easier for first-generation antihistamines to make patients drowsy since they can more easily cross the blood-brain barrier — a layer of cells around the brain that protects it from bacteria, viruses and other harmful substances.
Diuretics
Purpose: Diuretics are a type of medication primarily used to treat high blood pressure by reducing fluid buildup in the body.
Medications of this type include:
Thiazide diuretics, such as chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide and metolazone
Loop diuretics, such as bumetanide (Bumex), ethacrynic acid (Edecrin), furosemide (Lasix) and torsemide (Soaanz)
Potassium-sparing diuretics, such as amiloride (Midamor), eplerenone (Inspra), spironolactone (Aldactone, Carospir) and triamterene (Dyrenium)
Diuretics could be one of the main risk factors for falls in the elderly, according to a review of diuretics published in the journal Geriatric Nursing. Researchers found that older adults who used diuretics were 18.5% more likely to experience falls than those not using such medication.
Additionally, the American Heart Association noted in its 2022 scientific statement about preventing falls that a specific type of diuretic, known as a loop diuretic, is known to contribute to falls due to inducing low blood pressure (hypotension) and orthostatic hypotension (a drop in blood pressure after standing up).
Benzodiazepines
Purpose: Benzodiazepines are primarily used to treat anxiety and other mental health conditions, as well as seizures, by slowing down activity in the brain and nervous system.
Medications of this type include:
Alprazolam (Xanax, Xanax XR)
Clonazepam (Klonopin)
Diazepam (Valium)
Lorazepam (Ativan)
Midazolam (Nayzilam)
Increased risk of falling is a known side effect of benzodiazepines. One study published in the International Journal of Environmental Research and Public Health delves a little deeper.
Researchers reviewed the data of older community-dwelling adults (as opposed to those living in institutional care facilities) using long-acting benzodiazepines like diazepam, aka Valium. They concluded that risk of falls or fall fractures increased by more than two times after taking long-acting benzodiazepines, and risks were higher the longer patients were prescribed the medication.
Tricyclic antidepressants
Purpose: Tricyclic antidepressants are used to treat major depressive disorder but are often prescribed for off-label uses, such as to treat conditions like chronic pain and insomnia.
Medications of this type include:
Amitriptyline (Elavil, Vanatrip)
Amoxapine (Asendin)
Desipramine (Norpramin)
Doxepin (Silenor, Sinequan)
Imipramine (Tofranil, Tofranil-PM)
Nortriptyline (Aventyl, Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil)
The same study published in the International Journal of Environmental Research and Public Health that reviewed the effects of benzodiazepines on the risk of falling also reviewed the effects of tricyclic antidepressants.
Dizziness is a side effect of this medication as well. Like benzodiazepines, falls were two times as likely in patients taking tricyclic antidepressants — and the risk grew the longer they were prescribed the medication.
It’s important to note that you must talk to your health care provider about any potential risks from taking medications. To learn more about health risks from medication, see “7 Ways Sleep Medications Are Hazardous to Health (and What Experts Say to Do Instead).”
