Falls-risk-increasing drugs are among the most modifiable causes of falls in older people. The main classes are sedatives and hypnotics, antidepressants, antipsychotics, opioids, gabapentinoids, anticholinergics, and drugs that lower blood pressure or cause orthostatic hypotension, including diuretics and alpha-blockers.
A structured review after a fall — or before one, in a patient at risk — identifies drugs to stop, reduce or replace. Lying and standing blood pressure belongs in the same assessment.
- List every medicine, including over-the-counter sleep aids and antihistamines.
- Look specifically for sedatives, opioids, gabapentinoids, antipsychotics and anticholinergics.
- Measure lying and standing blood pressure.
- Taper benzodiazepines, opioids and gabapentinoids gradually rather than stopping abruptly.
- Recheck at follow-up whether the change was made and whether falls recurred.
Why it matters
Medication changes are cheap, fast and among the few falls interventions entirely within the prescriber's control.
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