11 Types of Medications That Increase Fall Risk in Older Adults

For older adults, falls are a big deal. Falls increase the risk of hospitalization, disability, and even death. Medications are one of the most common causes of falls, especially in older adults. Fortunately, they’re also an easy risk factor to change. One way to minimize the risk of falls is to review your medication list. 

The list of medications below can increase your risk of falls. And taking multiple of these medications increases your risk even more. But you may be able to lower your dose, or stop the medication altogether. By learning more, we hope you’ll be better equipped to discuss your medication list with your healthcare team. 

1. Antidepressants

Certain antidepressants may increase fall risk more than others. Tricyclic antidepressants (TCAs) seem to carry a higher risk than other classes of antidepressants. Examples of TCA medications include:

• Amitriptyline (Amitril)

• Nortriptyline (Pamelor)

Another class of antidepressants — selective serotonin reuptake-inhibitors (SSRIs) — may also increase fall risks in older adults. Examples of SSRIs include: 

• Escitalopram (Lexapro) 

• Sertraline (Zoloft)

• Citalopram (Celexa)

If you need an antidepressant but are at risk of falling, talk with your healthcare professional about different options. There are many different types of antidepressants, and they can help you pick the one that’s best for you.

2. Sleep medications

It probably comes as no surprise that medications used to treat insomnia or help with sleep can make falls more likely. Examples of popular medications for insomnia include:

• Zolpidem (Ambien) 

• Eszopiclone (Lunesta)

• Zaleplon (Sonata) 

The good news is that there are safer and more effective options to help with sleep over the long term. In fact, experts recommend behavioral therapy as first-choice treatment for insomnia. 

EXPERT PICKS: WHAT TO READ NEXT

• Avoiding falls: Small changes to your routine and home environment can help prevent dangerous falls as you age.

• Improving balance: These eight exercises can help older adults improve their balance.

• Reining in medications: Geriatricians are experts in understanding how medications affect older people differently. They can help identify the risky ones.

Behavioral therapy helps you develop habits that can improve your sleep. Plus, it changes the way you think about sleep. And it spares you any potentially dangerous side effects.

3. Anti-anxiety medications

To help with anxiety and/or sleep, many people in the U.S. take benzodiazepine medications. But similar to the sleep medications above, these can also increase fall risk in older adults. 

Examples of benzodiazepines are:

• Lorazepam (Ativan) 

• Diazepam (Valium) 

• Temazepam (Restoril)

• Alprazolam (Xanax)

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These medications can be especially risky when used long term (more than 2 weeks). If you have been using these medications for a long period of time, talk with your healthcare team about gradually decreasing the dose when you’re ready to stop taking them. This can help minimize your chances of falling. 

4. Muscle relaxants

Similar to sleep and anxiety medications, muscle relaxants can cause serious side effects in older adults. Drowsiness and confusion in particular can increase the risk of falling. Examples of muscle relaxants include:

• Diazepam (Valium)

• Methocarbamol (Robaxin)

• Cyclobenzaprine (Flexeril, Amrix)

• Metaxalone (Skelaxin)

• Chlorzoxazone (Lorzone, Parafone Forte)

• Orphenadrine (Norflex)

If you need a muscle relaxant, experts recommend only short-term use when possible. The good news is there are many safer ways to help your muscles relax. Older adults can also try:

• Hydrotherapy

• Low-impact exercise

• Physical therapy 

5. Anti-seizure medications

Anti-seizure medications (anticonvulsants) often cause dizziness, confusion, and sedation in older adults. All of these side effects can increase the chance of falling. 

Examples of anti-seizure medications include:

• Carbamazepine (Tegretol) 

• Valproic acid (Depakene)

• Lamotrigine (Lamictal)

• Oxcarbazepine (Trileptal)

• Topiramate (Topamax)

• Gabapentin (Neurontin)

While these medications are used to prevent seizures, they’re also sometimes used to reduce behavioral disturbances in older adults with dementia. So if you or a loved one is taking any of the above medications, talk with a healthcare professional about whether it’s definitely needed. 

6. Antipsychotics

Antipsychotic medications are also used to treat agitation in older adults with dementia. And common side effects include sedation, dizziness, and blurred vision. These can all contribute to instability and increased fall risk. 

Examples of antipsychotics include:

• Haloperidol (Haldol)

• Fluphenazine (Prolixin)

• Perphenazine (Trilafon)

While it may not be possible to entirely avoid these medications, you may be able to change the dose to help decrease the risk of falls.

7. Pain medications

Opioid painkillers can also increase the risk of falls in older adults. Examples include:

• Oxycodone (Percodan, Percocet)

• Hydrocodone (Vicodin)

• Hydromorphone (Dilaudid)

• Fentanyl (Duragesic)

These medications have a lot of side effects, such as constipation, slowed breathing, and drowsiness. So they should always be used at the lowest effective dose and for as short of a time as possible. 

In certain situations, they may be necessary — like after surgery or during cancer treatment. But for less severe pain, nonopioid medications like acetaminophen (Tylenol) are good choices for older adults who are worried about falling. Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil and Aspirin may actually help older adults decrease their likelihood of falling, too.

8. Blood pressure medications

There are many different types of blood pressure medications, and any of them can increase the chances of an older person falling. So far, researchers haven’t found that one type of blood pressure medication increases the chance of falling more than another type. The risk can be seen in most types of blood pressure medications, like:

• Beta blockers, like carvedilol (Coreg)

• ACE inhibitors, like lisinopril 

• Thiazide diuretics, like hydrochlorothiazide  

But the risk is higher in people who have fallen before. And the chance of falling is more likely when changes are made to the medication, like when adjusting the dose.

9. Antihistamines

Older types of antihistamines commonly cause side effects that increase the risk of falling — particularly in older adults. These side effects include blurred vision, sleepiness, and confusion. 

Examples of antihistamines include:

• Diphenhydramine (Benadryl) 

• Dimenhydrinate (Dramamine)  

• Cetirizine (Zyrtec)

For these or any other medications on this list, talk with a healthcare professional to find out if they’re absolutely necessary. There may be a different, safer treatment option. 

10. Medications that lower blood sugar

Medications to treat diabetes are designed to lower blood sugar. Unfortunately, this means they also come with a risk of hypoglycemia, which is when someone’s blood sugar gets too low.

Common examples of diabetes medication that can do this include:

• Oral medications like glipizide

• Injectable medications like semaglutide (Wegovy, Ozempic)

• Insulin

Hypoglycemia can increase fall risk, making someone feel faint and more likely to pass out. And hypoglycemia episodes may become more common if someone has a decreased appetite and isn’t eating as much as they normally do — which can be common in older adults. Although this can happen with any medications that lower blood sugar, the risk is highest with insulin.

11. Anticholinergic medications

Anticholinergic medications are commonly used to treat bladder incontinence and tremors. In older adults, they can lead to delirium and confusion, increasing fall risk. Some common anticholinergic medications include:

• Oxybutynin 

• Benztropine

• Diphenhydramine (Benadryl), an antihistamine that also is an anticholinergic 

The risk of falls is greatest when two or more of these medications are taken together. 

What should you do if you or your relative is on these medications?

Just because you take one of these medications doesn’t mean you’re going to fall. There are things you can do to lower your risk. Here are a few tips for preventing falls:

• Talk with your healthcare team and pharmacist: They can help you simplify and make changes to your medication list to decrease fall risk. They may be able to recommend medications that you can discontinue, lower the dose, take less frequently, or take at different times in the day. 

• Stay active and exercise: This will help you build strength and stability.

• Try some simple exercises: These exercises can help you improve your balance. You can do many of these while seated in a chair. 

• Get an eye exam: This is to see if you need a new or updated prescription for eyeglasses. 

• Declutter: Make your home safer by eliminating clutter and things you can trip on. 

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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