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Posted: July 15, 2008

Some Common Drugs Increase Risk of Elderly Falling

Researchers have developed a list of prescription drugs that increase the risk of falling for seniors who take four or more medications on a regular basis. The drugs all share a common trait in that they depress the central nervous system, making reaction times slower.

 

Drugs in the list created by pharmaceutical researchers at the University of North Carolina at Chapel Hill seem to have this “wobbly” effect on patients aged 65 and older.

 

“Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and older, and research suggests that those taking four or more medications are at an even greater risk than those who don’t -- perhaps two to three times greater,” said Susan Blalock, Ph.D., an associate professor at the UNC Eshelman School of Pharmacy.

 

Blalock is the principal investigator of an ongoing study of a falls-prevention program she and fellow researchers developed for pharmacists to implement. Both the list of prescription drugs and some of the study’s finding were published in the American Journal of Geriatric Pharmacotherapy.

 

“What we’ve done as part of our study is to identify specific prescription drugs that are most likely to contribute to the falls,” she said. The medications on the list cover a wide range of common prescription antidepressants, seizure medications, painkillers and more. The common denominator among them is that they all work to depress the central nervous system, which can make patients less alert and slower to react.

 

Stefanie Ferreri, Pharm.D., lead author of the paper and a clinical assistant professor in the pharmacy school, warns that aging patients need to be wary of more than just prescription medications, as many over-the-counter medications can also contribute to falls.

 

“Some allergy medications, sleep aids and some cold and cough remedies can have the same effects as prescription drugs,” Ferreri said. “Always let your doctor know what over-the-counter medications you are taking and be sure to read the labels. Anything that can cause drowsiness can put you at increased risk of falling.”

 

The researchers offered the following advice to patients and practitioners:

 

For Patients: If patients see a drug they are taking on the list, they should not stop taking it. Next time they see their doctor, talk about the risk of falling and possible alternative medications.

 

For Doctors: Physicians should look for medications that have been proven safe and effective in older adults and look for medicines that have less of a sedating effect. Physicians should be especially wary of anticholinergics, a class of drugs that affect nerve cells used to treat a wide range of conditions.

 

For Pharmacists: Pharmacists should be alert for patients 65 and older who are taking four or more drugs and be sure the patients know about the additional risk of falling created by their medications.

 

Here is the complete list of drugs compiled by the North Carolina researchers for their report, listed here alphabetically by generic name, with brand name in parenthesis:

 

Alprazolam (Xanax)

Amitriptyline (Elavil)

Amobarbital (Amytal)

Amoxapine (Asendin)

Aripiprazole (Abilify)

Baclofen (Lioresal)

Bupropion (Wellbutrin, Wellbutrin SR)

Buspirone (Buspar)

Butabarbital

Carbamazepine (Tegretol, Tegretol XR, Carbatrol)

Chloral hydrate

Chlorazepate (Tranxene)

Chlordiazepoxide (Librium, Limbitrol, Librax)

Chlorpromazine (Thorazine)

Citalopram (Celexa)

Clidinium-chlordiazepoxide (Librax)

Clomipramine (Anafranil)

Clonazepam (Klonopin)

Clozapine (Clozaril)

Codeine (Tylenol with Codeine)

Desipramine (Norpramin)

Diazepam (Valium)

Digoxin (Lanoxin)

Disopyramide (Norpace)

Divalproex sodium (Depakote, Depakote ER)

Doxepin (Sinequan, Zonalon, Prudoxin)

Duloxetine (Cymbalta)

Escitalopram (Lexapro)

Estazolam (Prosom)

Olanzapine (Zyprexa, Zyprexa Zydis)

Oxazepam (Serax)

Oxcarbazepine (Trileptal)

Oxycodone (Percocet)

Oxymorphone (Numorphan)

Paraldehyde (Paral)

Paroxetine (Paxil)

Pentobarbital (Nembutal)

Perphenazine (Trilafon)

Phenelzine (Nardil)

Phenobarbital

Phenytoin (Dilantin)

Pimozide (Orap)

Pregabalin (Lyrica)

Primidone (Mysoline)

Propoxyphene (Darvon, Darvocet)

Protriptyline (Vivactil)

Quazepam (Doral)

Ethosuximide (Zarontin)

Felbamate (Felbatol)

Fentanyl (Duragesic)

Fluoxetine (Prozac)

Fluphenazine (Permitil, Prolixin)

Flurazepam (Dalmane)

Fluvoxamine (Luvox)

Gabapentin (Neurontin)

Halazepam (Paxipam)

Haloperidol (Haldol)

Hydrocodone (Vicodin)

Hydromorphone (Dilaudid)

Imipramine (Tofranil)

Isocarboxazid (Marplan)

Levetiracetam (Keppra)

Levorphanol (Levo-Dromoran)

Lorazepam (Ativan)

Loxapine (Loxitane, Loxitane C)

Maprotiline (Ludiomil)

Mephobarbital

Meprobamate (Miltown, Equanil)

Mesoridazine (Serentil)

Methadone (Dolophine)

Methsuximide (Celontin)

Mirtazapine (Remeron)

Molindone (Moban)

Morphine (MS Contin)

Nefazodone (Serzone)

Quetiapine (Seroquel)

Risperidone (Risperdal)

Secobarbital (Seconal)

Sertraline (Zoloft)

Temazepam (Restoril)

Thioridazine (Mellaril)

Thiothixene (Navane)

Tiagabine (Gabatril)

Topiramate (Topamax)

Tranylcypromine (Parnate)

Trazodone (Desyrel)

Triazolam (Halcion)

Trifluoroperazine (Stelazine)

Trimipramine (Surmontil)

Venlafaxine (Effexor, Effexor XR)

Ziprasidone (Geodon)

Zolpidem (Ambien)

Zonisamide (Zonegran)

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