Falls Prevention Toolkit- Section 3 – MEDICATIONS
3rd edition – September 2015
Review: September 2017
Principal Authors:
Rob Morris
Karen King
Ellen McMahon
Beverley Brady
Pathway Lead Clinician for Older people
Practice Development Matron
Practice Development Matron
Matron
Additional contributors:
Fiona Branch
Emma Grace
Faye O’Callaghan
Kathryn Draper
Keith Knox
James Saxton
Dave Allen
Nicola Fountain
Nicky Lindley
Abbie Betts
Consultant Nurse, Nursing Documentation Group
Senior Pharmacist
Practice Development Matron
Practice Development Matron
Practice Development Matron
Datix manager
Information Support Officer
Patient Safety Administrator
Matron, Patient Safety
Medstrom Clinical Nurse Specialist
Section
Section 3
Medications
Content
rd
Page

Drugs Which May Increase the Risk of Falls
2

Good Practice Guidance on Prescribing for Older People
3
Falls Prevention Toolkit 3 Edition September 2015- Section 3 – MEDICATIONS
Page 1
Drugs Which May Increase the Risk of Falls
Drugs
Adverse Effects
Suggested Action
Class
 Review indication. Check with GP.
 Stop if possible. May need to withdraw
slowly.
 Consider changing a tri-cyclic (TCA) to a
Serotonin Specific Reuptake Inhibitor
(SSRI) (e.g. Citalopram).
 Consider specialist referral if further advice
needed.
Antidepressants
Tri-Cyclic Antidepressants
(TCAs): Amitriptyline, Dosulepin
(Dothiepin), Imipramine,
Lofepramine, Nortriptylline
SSRIs – Citalopram, Fluoxetine,
Sertraline.
Others - Mirtazepine, Trazadone,
Venlafaxine.
Drowsiness, blurred
vision, dizziness,
postural hypotension,
constipation, retention of
urine.
Antipsychotics
Chlorpromazine, haloperidol,
lithium, trifluoperazine, quetiapine,
olanzapine, risperidone,
amisulpiride.
Postural hypotension,
confusion, drowsiness,
Parkinsonian symptoms.
Antiemetics
Prochlorperazine, Cyclizine,
Metoclopramide
Postural hypotension,
confusion, drowsiness,
Parkinsonian symptoms.
Sedatives and
hypnotics
Temazepam, Diazepam,
Lorazepam, Nitrazepam,
Zopiclone, Chlordiazepoxide,
Clomethiazole.
Drowsiness which can
last into the next day,
light-headedness,
confusion, loss of
memory.
 Stop if possible. Check with GP
 Long term use will need slow withdrawal
 No new initiation on Transfer of Care.
Drugs for
Parkinson’s
Disease
Co-beneldopa, Co-careldopa,
Rotigotine, Ropinirole,
Pramipexole, amantadine,
entacapone, selegiline, rasagiline,
rivastigmine.
Sudden daytime
sleepiness, dizziness,
insomnia, confusion, low
blood pressure, blurred
vision.
 May not be possible to change.
 Do not change without specialist opinion.
 Check for postural hypotension
Drugs with anticholinergic side
effects
(Benzhexol), prochlorperazine,
oxybutynin, tolterodine,
solifenacin.
First generation (sedating)
antihistamines. TCAs (see above)
Dizziness, blurred vision,
retention of urine,
confusion, drowsiness,
hallucinations.
 Review indication.
 Reduce dose or stop if possible.
 For bladder instability, consider changing to
trospium (reduced central effects).
 Be aware of polypharmacy and cumulative
effects.
Low blood pressure,
postural hypotension,
dizziness, tiredness,
sleepiness, confusion.
 Check lying and standing BP.
 Review indication (alpha-blockers also
used for benign prostatic hyperplasia).
 Review dose.
 May not be possible to stop. Check with GP
 Consider alternative to alpha-blocker.
Drowsiness, confusion,
hallucinations, postural
hypotension.
 Review dose.
 Use analgesic pain ladder to avoid excess
use.
 In older people start low and go slow.
Drowsiness, dizziness,
blurred vision.
 Consider indication (some are also used for
pain control or mood stabilisation).
 May need specialist review in problem
cases.
 *Consider Vitamin D supplements for at risk
patients on long-term treatment with these
drugs.
Cardiovascular
drugs
Analgesics
Anticonvulsants
ACE inhibitors / Angiotensin-II
antagonists: Ramipril, Lisinopril,
Perindopril, losartan,
Candesartan. Irbesartan
Vasodilators: Hydralazine
Diuretics: Bendroflumethiazide,
Bumetanide, Indapamide,
Furosemide, Amiloride,
Spironolactone, Metolazone.
Beta-blockers: Atenolol,
Bisoprolol, Carvedilol,
Propranolol, Sotalol.
Alpha-blockers: Doxazosin,
Alfuzosin, Terazosin, (tamsulosin).
Opioids: Codeine, tramadol,
Nefopam, Dihydrocodeine,
Buprenorphine, Alfentanyl,
Fentanyl.
Opiates: Morphine, Oxycodone.
Neuropathic pain agents:
Gabapentin, Pregabalin, TCAs
(and see below)
Carbamazepine*, sodium
valproate*, gabapentin,
levetiracetam, lamotrigine,
clonazepam, phenytoin*,
phenobarbitone*, primidone*.
rd
 Review indication for use.
 In long term use do not stop without
specialist opinion.
 Avoid in management of delirium
 Review indication for use (often given for
“dizziness”)
 Domperidone may be a suitable alternative
but note cardiac side effects (QT
prolongation)
Falls Prevention Toolkit 3 Edition September 2015- Section 3 – MEDICATIONS
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Guidelines for Good Prescribing in Patients

Carry out a medication review, at least daily, and discuss and agree all changes with the
patient/carer and staff. Make sure changes are highlighted in the information to their GP
at Transfer of Care.

Stop any current drugs that are not indicated. Check with their GP for long term
treatments e.g. antidepressants

Avoid new prescriptions of sedative drugs but do not suddenly withdraw sedative drugs
given on long term prescription e.g. benzodiazepines.

Limit the use of psychotropic drugs – remember that analgesics, antidepressants and
antiemetic drugs are all psychotropic

Only prescribe new drugs that have a clear indication. Make sure changes (including the
indication) are highlighted in the information to the GP at Transfer of Care.

If possible, avoid drugs that have known deleterious effects in older people, such as
benzodiazepines, and recommend dosage reduction regimens when appropriate.

Use the recommended dosages for patients (this is particularly relevant for older
patients)

Use simple drug regimens and appropriate administration systems

Consider using once daily or once weekly formulations and using fixed dose
combinations when possible

Consider non-pharmacological treatments if appropriate

Limit the number of people prescribing for each patient if possible

Where possible, avoid treating adverse drug reactions with further drugs
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Falls Prevention Toolkit 3 Edition September 2015- Section 3 – MEDICATIONS
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