Could One of Your Medications Be Increasing Your Fall Risk?

A fall can happen in an instant. But sometimes the conditions that make a fall more likely have been building quietly for months — including the effects of medications you take every day.

Some medications can cause drowsiness, dizziness, confusion, impaired coordination, changes in blood pressure, or slower reactions. In older adults, those effects can matter more because balance and recovery from a fall may become harder with age.

That doesn’t mean a medication is “bad” or that you should stop taking it. Many medications that can increase fall risk are also important treatments.

The useful question is:

Could any of my medications — or the combination of them — be making me more likely to fall?

Some medications deserve a closer look

The American Geriatrics Society’s Beers Criteria, a widely used resource for medication safety in adults 65 and older, identifies several medication classes that can be problematic for older adults, particularly those with a history of falls or fractures.

Sleeping pills and sedatives

This is one of the clearest areas of concern.

Benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), and temazepam can increase the risk of cognitive impairment, delirium, falls and fractures in older adults.

Prescription sleep medications known as Z-drugs, including zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata), are also associated with falls and fractures in older adults. The Beers Criteria notes that their benefits for sleep are relatively modest.

Some antidepressants

Antidepressants aren’t all alike, and they shouldn’t simply be put on a “dangerous medications” list.

But the evidence linking some antidepressants with falls is strong enough that the Beers Criteria specifically recommends caution in older adults with a history of falls or fractures. This includes SSRIs, SNRIs and tricyclic antidepressants. The evidence for antidepressants is more mixed than it is for benzodiazepines, so the individual medication and circumstances matter.

Opioid pain medications

Opioids such as oxycodone, hydrocodone, morphine, fentanyl and tramadol can cause sedation and other effects that may contribute to falls.

The combination can be particularly important. The Beers Criteria recommends avoiding the combination of opioids and benzodiazepines in older adults because of serious adverse effects. It also warns about combining opioids with gabapentin or pregabalin because of severe sedation-related risks.

Gabapentin and pregabalin

Gabapentin (Neurontin) and pregabalin (Lyrica) are often used for nerve pain and other conditions. They belong to a broader group of medications that can affect the central nervous system.

They deserve particular attention when combined with other medications that cause sedation.

Muscle relaxants

Drugs such as cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and carisoprodol (Soma) can cause sedation and anticholinergic effects.

The Beers Criteria says these medications are generally poorly tolerated by older adults and are associated with increased fracture risk.

Some older antihistamines — including Benadryl

Here’s one that may surprise people.

First-generation antihistamines include:

• Diphenhydramine (Benadryl)
• Doxylamine
• Chlorpheniramine
• Hydroxyzine
• Meclizine
• Promethazine
• Dimenhydrinate

Many have strong anticholinergic effects. The cumulative use of medications with these properties is associated with increased risk of falls, delirium and dementia.

And some of these medications are available over the counter, which makes them particularly easy to overlook during a medication review.

That doesn’t mean you should never use one. For example, the Beers Criteria specifically notes that diphenhydramine can be appropriate in some situations, such as treating a severe allergic reaction. The point is to understand the tradeoff rather than assume an OTC medication is automatically harmless.

Sometimes the combination matters more than one medication

This may be the most important thing to know.

The Beers Criteria identifies a specific concern when an older adult takes three or more medications that affect the central nervous system.

These include combinations of:

• Antidepressants
• Antiepileptics, including gabapentin and pregabalin
• Antipsychotics
• Benzodiazepines
• Z-drugs
• Opioids
• Muscle relaxants

Using three or more of these types of medications concurrently is associated with increased risk of falls and fractures.

So the question isn’t always:

“Is this particular medication dangerous?”

It can be:

“What happens when several medications with similar effects are combined?”

That’s an important distinction.

What about blood-pressure medications?

This is where things get more complicated.

It would be misleading to say that blood-pressure medications simply “cause falls.”

Blood-pressure treatment has important health benefits, and research hasn’t found a simple relationship between taking these medications chronically and falling. However, dizziness or low blood pressure can contribute to falls, and some research suggests the risk can be higher shortly after starting, changing or increasing treatment.

So if you’ve recently started or changed a blood-pressure medication and you’re experiencing:

• Lightheadedness when standing
• Dizziness
• Weakness
• Unsteadiness
• Near-fainting

that’s worth discussing with your healthcare professional.

Don’t stop a blood-pressure medication on your own.

What about water pills?

Diuretics — sometimes called “water pills” — include medications such as furosemide (Lasix), hydrochlorothiazide and chlorthalidone.

A 2023 systematic review and meta-analysis of 15 studies found that diuretic use was associated with a higher risk of falling in older adults. The researchers estimated the odds of falling were about 18.5% higher among older adults taking diuretics, although this type of evidence cannot establish that the medication itself caused the falls.

Possible contributors include changes in fluid balance, blood pressure and electrolytes — as well as simply having to get up more often during the night.

Again, that doesn’t make diuretics “bad medications.” They can be essential treatments.

It means they’re worth considering when evaluating the whole picture.

A medication review can be surprisingly revealing

Think about everything you take — not just prescriptions.

That includes:

• Prescription medications
• Over-the-counter drugs
• Sleep aids
• Allergy medications
• Pain relievers
• Vitamins and supplements

Then ask your doctor, pharmacist or other healthcare professional:

Could any of these make me dizzy or drowsy?

Could any lower my blood pressure too much?

Could two or more of them be producing similar effects?

Do I still need every medication I’m taking?

Could an over-the-counter medication be adding to the problem?

Has anything changed recently — a new medication, a higher dose, or a new combination?

A pharmacist can be particularly useful here because medication reviews are part of their expertise.

Don’t make one dangerous mistake

If you recognize one of your medications on this list, don’t suddenly stop taking it because you read that it can increase fall risk.

Some medications need to be tapered. Others may be treating a condition where stopping treatment creates a different and potentially greater risk.

The goal isn’t to eliminate every medication that might contribute to falling.

The goal is to find the right balance of benefits and risks for you.

The Senior Life Watchdog takeaway

We tend to think of falls as accidents.

Sometimes they are.

But sometimes something has quietly made the accident more likely — and medication can be one of those factors.

The good news is that this is something you can actually investigate.

If you’re taking several medications, recently started a new one, had a dose increased, or have begun experiencing dizziness, drowsiness or unsteadiness, a medication review may be worth putting on your list.

You don’t necessarily need fewer medications.

You need to know what each one is doing, what its potential side effects are, and what happens when they all meet inside the same body.

And that’s a conversation worth having before a fall happens.