Medication and Falls

Original Editors - Scott Buxton

Top Contributors -Scott Buxton and Evan Thomas  

What is Polypharmacy?

Polypharmacy is typically defined as the use of more than 3 or 4 medications[1][2], take a moment and think of the number of patients you have that are taking more than 3 medications. Thought also needs to be spent on which types of medications the patient is taking as different classes of drug influence the risk of falls differently.

Medications Associated with Increased Risk of Falls

As physiotherapists it is important to be aware of which medications can impact on our patients safety, medication is obviously not within a physiotherapist job role specifically however knowing what the potential impact of some medications can be very valuable. Additionally it is important to know about the medications if you work in a triage role, if you are concerned about the type or number of medications a patient is taking then spend time referring to you medical colleagues in the clinic, writing to their GP or discussing at and MDT meeting.

Psychotropic Drugs

Psychotropic Drugs and Falls Risk[3]
Medication Group Overall Risk Category Commonly Used Medications Effects on Risk
Sedatives

HIGH RISK

Can cause falls alone

Lorazepam, Temazepam, Nitrazepam

similar -epamsuffix

Drowsiness, slows reactions, impaired balance.
Sedating Antidepressants

HIGH RISK

Can cause falls alone

Amitriptyline, Nortriptyline Orthostatic hypotension, drowsiness, slow reactions. DOUBLE THE RATE OF FALLS
Monoamine Oxidase Inhibitors

HIGH RISK

Can cause falls alone

Phenelzine, Moclobemide Severe orthostatic hypotension
For Psychosis Agitation

HIGH RISK

Can cause falls alone

Haloperidol, Chlorpromazine, Olanzapine Orthostatic hypotension, slow reflexes, loss of balance
Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitor )SNRI)

MODERATE RISK

Can cause falls in combination

Fluoxetine, Sertaline, Paroxetine, Venlafaxine, Duloetine Increased risk of falls with fractures, orthostatic hypotension, bradycardia, impaired sleep quality
Opiate Analegsics

HIGH RISK

Can cause falls alone

Codeine, Morphine, Tramadol Sedates, slows reactions, impairs balance, delirium
Anti Epileptics HIGH RISK Phenytoin, Carbamazepine, Phenobarbitone Cerebellar damage, ataxia, slowed reactions
MODERATE RISK Sodium Valporate, Gabapentin Some association with falls risk
Parkinson's Disease - Dopamine Agonists HIGH RISK Roprinerole, Pramipexole Delirium, orthostatic hypotension
Parkinson's Disease - MAOI-B Inhibitors HIGH RISK Selegiline Orthostatic hypotension (Difficult to assess due to high falls risk in PD as the disease process)
Muscle Relaxant MODERATE RISK Baclofen Reduced muscle tone, sedative
Vestibular Sedative POSSIBLE CAUSES Prochlorperazine, Cinnarazine, Betahistine Prochlor... - Dopamine agonist which may cause movement disorder in long term, sedating
Anticholinergics acting on Bladder POSSIBLE CAUSES Oxybutinin, Solifenacin, Tolterodine, Solifenacin Known CNS effects.

 



Drugs Actings on the Heart and Circulation

Drugs Acting on the heart and Circulation[3]
Medication Group Overall Risk Category Commonly Used Medications Effect of Risk
Alpha Receptor blockers HIGH RISK Doxasozin, Tamsulosin, Indoramin Severe orthostatic hypotension, urinary retention
Centreally Acting Alpha-2-Receptor Agonsits HIGH RISK Clonidine, Moxonidine Severe orthostatic hypotension, sedating
Thiazide Diuretics HIGH RISK Bendroflumethiazide, Metolazone Weakness due to low potassium, hyponatraemia, orthostatic hypotension
Loop Diuretic MODERATE RISK Furosemide, Bumetanide Dehydration, hypotension, low potassium and sodium
Angiotensin Converting Enzyme Inhibitors (ACEIs) HIGH RISK Lisinopril, Ramipril -opril Rely upon kidney elimination and accumulate can cause failure, dehydration.
Angiotensin Receptor Blockers (ARBs) MODERATE RISK Losartan or similar -tan Hypotension
Beta Blockers HIGH RISK Atenolol, Propranolol, Sotalol Bradycardia, hypotension, carotid sinus hypersensitivity, vasovagal syndrome
Antianginals HIGH RISK Glyceryl Trinitrate (GTN), Isosorbide Mononitrate, Nico Sudden hypotension
Calcium Channel Blockers MODERATE RISK Amlodipine, Felodipine, Diltiazem, Verapamil Hypotension, bradycardia
Other Antidysrhythmics MODERATE RISK Digoxin, Flecainide, Amiodarone Bradycardia, arrythmias
Acetylcholinersterase Inhibitors (For Dementia) POSSIBLE CAUSES Rivastigmine, Donepezil, galantamine Bradycardia and syncope

Recent Related Research (from Pubmed)

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References

  1. Ziere G. Dieleman J. Hofman A. Pol A. van der Cammen T. Stricker B. Polypharmacy and Falls in the Middle Age and Elderly Population. British journal of clinical Pharmacology. 2005:61;218-223
  2. Evans J. Drugs and Falls in Later Life. Lancet. 2003; 361:448
  3. 3.0 3.1 Darowski A. Dwight J. Reynolds J. Medicines and Falls in Hospital: Guidance Sheet [ONLINE] available from https://www.rcplondon.ac.uk/sites/default/files/documents/medicines-and-falls2.pdf date accessed 14/01/2015