Medicines that may contribute to falls
PLEASE NOTE: This is a general guide only
Patients should always contact their own GP or Community Pharmacist for further
• Multiple Medicines
Patients on FOUR or more medicines, prescribed or bought, are at greater risk of having a fall. Allpatients over 75 should have an annual medication review.
• Medicines for mental health – psychotropic drugs
This group includes antidepressants, antipsychotics and benzodiazepines. The group isimplicated in falls, and should be used for specific indications for the minimum time necessary.
• Benzodiazepines increase the risk of falling
E.g. diazepam, lorazepam, temazepam. The higher the dose the greater the risk. To reduce theeffect change to diazepam, (see BNF) which has a range of dosages, or temazepam liquid5mg/5ml.
• Low Blood Pressure on standing
On standing blood pressure may fall very quickly causing dizziness. To screen for this risk factor blood pressure should be measured when the patient is lyingdown and standing up .A drop of systolic BP > 20mm Hg or diastolic >BP 10mm Hg is arisk factor. Compression or support stockings can help to prevent a fall in blood pressure onstanding.
• The risk of falls increases with the number of risk factors:
-previous fall -4 or more medicines -poor mobility/gait -balance disorder -psychotropic drug use -alcohol >1 unit /day -low blood pressure on standing -impaired thinking -impaired vision -impaired hearingPatients with 4 or more risk factors from these above are at greatest risk
• Calcium and vitamin D supplements can reduce the severity of injury following a fall Calcium and Vitamin D supplements can be prescribed for those at greatest risk i.e.
o Elderly patients either housebound or living in residential /nursing accommodation.
o Patients who have a low body weight (BMI <19 kg/m2)
o Patients who have been taking a corticosteroid e.g. prednisolone> 7.5mg daily for 6
o Patients who have had a diagnosis of osteoporosis and who cannot take biphosphonates.
Suitable products are AdCal D3 tablets 15p per day or CaCit D3 sachets (to make a flavoured drink) 26p per day. M e d i c i n e s t h a t m a y c o n t r i b u t e t o f a l l s C o n d i t i o n u s e d f o r C o m m o n d r u g n a m e s R i s k F a c t o r HIGH RISK DRUGS Antidepressants
Trazadone,Citalopram, Fluoxetine (Prozac),
Anti-muscarinic Benzodiazepines and
Diazepam (Valium), Chlordiazepoxide (Librium)
Lorazepam, Oxazepam, Nitrazepam (Mogadon)
Chloral Betaine (Welldorm), Chloral Hydrate
Drugs for Parkinson's disease
Co-beneldopa, Co-careldopa. Selegiline. Moderate Risk Drugs ACE inhibitors
Angiotensin II antagonists Alpha-blockers Anti-arrhythmics Anti-epileptics Anti-histamines
(Piriton),Diphenhydramine, Promethazine. Beta-blockers
Bumetanide, Amiloride, Spironolactone. Low Risk Drugs Calcium Channel Blockers Nitrates
Glyceryl trinitrate,Isosorbide Mononitrate,
Opiate analgesics Oral anti-diabetics Proton pump inhibitorsPPIs and H 2 antagonists
Parasite Resistance in US Cattle Donald H. Bliss1, PhD; Robert D. Moore2, MS; William G. Kvasnicka3, DVM 1Veterinary Parasitologist, MidAmerica Ag Research, 3705 Sequoia Trail, Verona, WI 53593 2College of Agriculture, Biotechnology & Natural Resources, University of Nevada, Reno, NV 89557 37131 Meadow View, Shawnee, KS 66227 Abstract s’ensuivre à l’insu des producteurs sa