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Microsoft word - drugs and the risk of falling_se formatted_august 27_2009.doc

DRUGS AND THE RISK OF FALLING

Which drugs can increase the risk of falls?
In theory ANY drug that causes one of the following effects can increase the risk of falling:


As well, theoretically ANY drug that causes the following effects can increase the risk of a serious
outcome if the patient falls:

• Osteoporosis or reduced bone mineral density: Increased risk of fracture if a fall occurs • Bleeding risk: Increased risk of a cerebral hemorrhage if a fall occurs
What can be done if a patient is taking a drug that can increase the falls risk?
Individualize treatment. Drugs are just one of many factors that can increase the risk of falling.
Assessment: Is this patient at high risk? Has the patient had a slip, trip, near fall or fall in the last 6 months?
Is the patient taking a drug that can cause the effects listed above (see attached list of drugs)
Is the patient taking a high dose of the
Is the patient displaying any of the adve
rse effects listed above, such as drowsiness?
Is the patient elderly? Elderly patients ma
y be more sensitive to adverse drug effects because of alterations in the way that the body absorb Is the patient taking more than one drug
that increases the falls risk?
Is the patient at high risk of falling for other, non-drug reasons?
Is it difficult to monitor the patient for an adverse drug effect?
Consider intervention, especially if you have assessed the patient as high risk: • Consider risk/benefit ratio: Does the benefit of the drug outweigh a possible risk of falling? • Is there a safer drug or non-drug altern ative? • Is it possible to minimize the dose without losing the benefit of the drug? Barbara Cadario and BC Falls and Injury Prevention Coalition. Drugs and the Risk of Falling: Guidance Document. August 2009. Examples of drugs that can increase the risk of falling, or of a serious
outcome if a fall occurs (and possible mechanisms)
Falls are often caused by multiple factors. This list should be used in conjunction with other fall prevention strategies. A patient should not be denied beneficial or necessary drug therapy based on this list.
ACE Inhibitors (3)
Opiates/narcotics
Digoxin (mechanism
Eye drops (6)
Antipsychotics
Herbal and
Antidepressants
Natural health
Alcohol (1,5)
products
Natural sleep aids
Alpha Receptor
Natural products
Blockers (2,3,
for sexual
enhancement
(possible adulteration
Sedative/hypnotics
Benzodiazepines
Barbiturates (1,2,5)
Metoclopramide
Anticoagulants (8)
Muscle Relaxants
Corticosteroids,
Corticosteroids,
Anticonvulsants
Antihistamines,
inhaled, high-
Nitrates (2,3)
sedating (1)
Cold Medications
that contain
Thiazolidinediones
sedating
antihistamines

Possible mechanisms (often unclear): (1) Drowsiness; (2) Dizziness; (3) Hypotension; (4) Parkinsonian
effects; (5) Ataxia/gait disturbance; (6) Vision disturbance; (7) Osteoporosis or reduced bone mineral density
increases the fracture risk if a fall occurs; (8) Risk of serious bleeding if a fall occurs.

Drugs are listed by generic (chemical) name under each drug group. For Brand (manufacturer’s) names, check in
the CPS to find the generic name.
This list includes only those drugs for which there is evidence of increased risk of falls or their consequences.
There may be other drugs that increase this risk in certain patients.
Barbara Cadario and BC Falls and Injury Prevention Coalition. Drugs and the Risk of Falling: Guidance Document. August 2009.

Source: http://data.injuryresearch.bc.ca/admin/DocUpload/3_20100407_105321FINAL%20-%20Drugs%20and%20the%20Risk%20of%20Falling_August_2009.pdf