When you think of fall risks in your home, loose rugs, dangling power cords, or unsteady stairs may come to mind. But some fall risks are unexpected, and experts say you need to look beyond the obvious to truly fall-proof your living space. To that end, there’s another fall risk you need to consider—and it’s tucked away in your medicine cabinet.
The Centers for Disease Control and Prevention (CDC) estimates that three out of four adults take at least one medication that can increase the risk of falling. That’s especially noteworthy since among Americans ages 65 years and up, falls are the leading cause of injury.
You should never stop taking a medication without talking with your healthcare provider first, but it’s important to understand the risks and interactions between certain medications to reduce your risk of dizziness, drowsiness, and other side effects that can lead to falls.
Start with our experts’ advice on which over-the-counter and common prescriptions can increase the risk of falling.
Jump to:
Sleep Aids and Anti-Anxiety Meds
Benzodiazepines that treat anxiety, such as lorazepam (Ativan) and diazepam (Valium), have similar mechanisms of action, says Ken Redcross, M.D., an internist based in New Rochelle, NY, and the attending physician at Sunrise Senior Living in Mount Vernon, NY. “These medications can calm the brain down, but they also slow reflexes which can throw off your balance,” he says. “If a person takes a sleep aid but then gets up in the middle of the night to use the bathroom, they won’t have as sharp of a reaction time, which could lead to a fall.”
The longer you take a benzodiazepine, the higher your fall risk may be. Research published in the International Journal of Environmental Research and Public Health looked at the risk of falls associated with long-acting benzodiazepines or tricyclic antidepressants in older adults and found that the more days a drug was prescribed for (more than 49 days for benzodiazepines and more than 56 days for tricyclic antidepressants), the greater the risk of falls or fall-related fractures. In fact, the risk of falls increased by more than two times after taking a long-acting benzodiazepine.
If you’re concerned about your fall risk, talk to your healthcare provider about taking a benzodiazepine with a shorter half-life (meaning the drug stays in your system for less time, like 12 hours as opposed to 40).
Over-the-Counter Antihistamines
Diphenhydramine, which is found in Benadryl and many over-the-counter (OTC) sleep aids like ZzzQuil or Advil PM, works by blocking acetylcholine, a neurotransmitter responsible for things like memory, learning, and muscle contractions throughout the body.
Acetylcholine also keeps your brain alert, so blocking it can make you feel drowsy, confused, and have problems with short-term memory. One study published in JAMA Internal Medicine found that taking diphenhydramine long-term can increase your risk of dementia.
Another thing to keep in mind is that each person metabolizes drugs differently, says Reshma Kapadia Patel, Pharm.D., a pharmacist in Richardson, TX, and founder of WiseMedRx, a company that aims to help caregivers make sense of their aging parents’ medication needs. As you age, your metabolism slows down, and it can take longer for medication to make its way through your system. “This means in the morning, you may still have medication in your system, increasing the side effects of that medication like dizziness and drowsiness. Plus, even if you feel OK when you wake up lying down, as you stand up you may be more unsteady.”
Bottom line: Use Benadryl to relieve allergy symptoms sparingly, keeping in mind that drowsiness and impaired coordination are known side effects.
Blood-Pressure Medications
“The biggest concern with blood pressure medication like antihypertensives and alpha blockers is that sometimes your blood pressure can get too low,” says Patel. This can cause orthostatic hypotension, a large drop in blood pressure that happens when you go from sitting to standing, making you feel lightheaded and dizzy—and thus more prone to falls.
Even if you’ve been taking a blood pressure medication for some time, if your doctor changes the dose, it may cause orthostatic hypotension, adds Dr. Redcross. Research in JAMA Internal Medicine looked at a sample of adults 70 years or older nationwide and found that antihypertensives were associated with an increased risk of serious fall injuries, especially in those who had a previous fall.
You should never stop taking blood pressure medication without consulting your healthcare provider, says Patel. “If you feel yourself getting dizzy and think it’s because of your medication, they will be able to help you find a solution. This might be changing the dose or taking it a different time of day.”
Diuretics
If you’re feeling bloated, you might head to your medicine cabinet and reach for a diuretic. Diuretics, or water pills, work by helping the kidneys remove salt and water through urine. “The body releases a lot of water when you are on a diuretic, increasing urinary frequency and changing the number of electrolytes in the body,” says Dr. Redcross. “This can make you feel dizzy or drowsy because you’re dehydrated.”
With diuretics you may also have to take more trips to the bathroom at night, he adds. This can increase your fall risk if you’re rushing to the bathroom while half-asleep.
A systematic review and meta-analysis in Geriatric Nursing looked at the relationship between diuretic use and risk of falls in older adults and found the probability of falls in older adults who used diuretics was 1.185 times higher than in those who did not.
Insulin and Certain Diabetes Medications
“Insulin and certain diabetes medications are used to control blood sugar,” says Patel. “You’re taking them because your blood sugar may be too high, and these drugs help lower it. However, if these medications lower blood sugar too much it can cause weakness, confusion, and dizziness, among other symptoms.”
When this happens it’s called hypoglycemia. In addition to the symptoms above, it can lead to blurred vision, difficulty walking, and in severe instances, fainting and/or losing consciousness.
Similar to blood-pressure medications, the time of day that you take insulin or other diabetes medications can affect how you feel. “If you take insulin or other medication too early before you eat anything, your blood sugar is going to get very low,” says Patel. “It’s important especially with diabetes medications that you take it with food so that your blood sugar levels stabilize.”
Another side effect of diabetes medications, particularly SGLT2 inhibitors (Jardiance, Farxiga) and GLP-1s (Ozempic, Wegovy), is muscle and body fat loss. Losing lean body mass can increase the risk of falls, per a study in Scientific Reports. The researchers looked at 471 participants with a median age of 64 over a two-year period and found that the use of SGLT2 inhibitors alone or combined with a GLP-1Ra increased the risk of falls. (GLP-1Ra taken alone was not associated with an increased fall risk.) The researchers state that muscle weakness as a result of these medications may be the cause of a higher fall risk.
Opioid Pain Medications
“Pain medications are synonymous with causing dizziness, drowsiness, sedation, impaired motor function, and confusion,” says Patel. “Plus, some can decrease blood pressure, increasing the risk of falls even more.”
That’s because opioids slow down activity in the brain, and as such can slow down reaction time and cause balance issues. Sedation is increased when combined with other central nervous system depressants like benzodiazepines (Xanax, Ativan, Valium), and because of that, taking these two prescription drugs together should be avoided if possible.
The Combination Effect
Sometimes, it’s not a single medication alone that is making you feel dizzy or drowsy, but rather, the cumulative effect of taking multiple medications together. “If one medication makes you a little drowsy and another a little lightheaded, together they will add up and make you feel much more unsteady than one alone would,” says Dr. Redcross.
“For example, imagine taking a diuretic and a blood pressure pill, then an over-the-counter sleep aid at bedtime,” says Dr. Redcross. “If you get up a 2 a.m. to use the bathroom or get a drink of water, you’re feeling dehydrated on top of your blood pressure dropping as you stand up. Plus, you’re feeling groggy from the sleep aid. This is a scenario where a fall could happen.”
The AGS Beers Criteria warns that taking three or more central nervous system (CNS)-active medications can increase the risk of falls and fractures. And it’s important to remember that certain medications, like blood thinners, can make falls more dangerous if there is a head injury.
FAQ
Sources
