Drugs That Increase the Risk of Falls

As people age, their risk of falling increases. Although falls do not always cause injuries, they often result in minor issues such as scrapes and bruises, and can lead to more serious injuries such as hip fractures or head injuries.[1] In fact, falls are the leading cause of injury and injury-related deaths among older adults in the United States.[2] Each year, at least a quarter of adults 65 or older report at least one fall, leading to approximately 3 million fall-related visits to the emergency room and about 1 million fall-related hospitalizations.[3] Falls in older adults also can contribute to a decreased quality of life and a higher likelihood of premature institutionalization.

The risk of falls increases with the number of risk factors a person has. Risk factors include a history of falls, difficulties with walking or foot pain, balance issues, muscle weakness, bad eyesight or hearing loss and cognitive impairment. Certain chronic health conditions are also risk factors, including arthritis, Parkinson’s disease, osteoarthritis of the knee, diabetes and cerebrovascular or cardiovascular disease.[4]

Another risk factor is the use of certain prescription and over-the-counter medications. In fact, many older adults who sustain injuries from a fall have used drugs known to increase fall risk.[5] In general, medications that can cause adverse effects such as sedation or drowsiness, fatigue, slowed reaction times, dizziness, blurred vision, fainting, loss of balance, confusion or orthostatic hypotension (sudden drop in blood pressure when standing up from a sitting or lying position) may increase the risk of falling.[6] The risk of falling is further increased when several of these medications are taken concomitantly (at the same time), or when medications or doses are changed.

This article discusses drug classes most associated with an increased risk of falls, specifically antidepressants, sedative-hypnotics, antipsychotics, antihistamines, antiseizure drugs, certain cardiovascular drugs, muscle relaxants and opioids.[7]

Antidepressants

One of the most common drug classes associated with an increased risk of falls is drugs prescribed for depression or anxiety disorders. Antidepressants can cause drowsiness, slow reaction times, impair balance and cause orthostatic hypotension, all of which can lead to an increased risk of falls.[8],[9] Examples of such drugs include tricyclic antidepressants such as amitriptyline (generic only) and selective serotonin reuptake inhibitors, including escitalopram (LEXAPRO and generics). See Table 1 (below) for additional examples of oral antidepressants that may increase fall risk.

Table 1. Examples of Oral Antidepressants That May Increase the Risk of Falls[10],[11]

*Designated as Limited Use by Public Citizen’s Health Research Group
**Low-dose paroxetine (BRISDELLE), approved only for treatment of hot flashes due to menopause, is designated as Do Not Use by Public Citizen’s Health Research Group.
***Designated as Do Not Use by Public Citizen’s Health Research Group

Benzodiazepines and Z-drugs

Benzodiazepines, such as alprazolam (XANAX and generics), chlordiazepoxide (LIBRIUM and generics), diazepam (DIAZEPAM INTENSOL, VALIUM and generics) and lorazepam (ATIVAN, LORAZEPAM INTENSOL, LOREEV XR and generics), are sedative-hypnotics generally approved to induce or maintain sleep and to treat acute anxiety.[12],[13],[14] Another class of hypnotics — often called Z-drugs — includes eszopiclone (LUNESTA and generics), zaleplon (generic only) and zolpidem (AMBIEN, EDLUAR and generics). Z-drugs are approved for short-term relief of insomnia and have similar but shorter-acting effects than benzodiazepines.[15] Because of the serious risks associated with these drugs, including abuse and addiction, Public Citizen’s Health Research Group classifies all benzodiazepines (except for alprazolam, which can be used to treat panic disorder) and Z-drugs as Do Not Use for people of any age.

Benzodiazepines and Z-drugs can lead to adverse effects such as slowed reactions, drowsiness and impaired balance, increasing fall risk.

Antipsychotics

Another class of prescription drugs that are associated with an increased risk of falls is antipsychotics, such as chlorpromazine (SONAZINE and generics), fluphenazine (generic only), haloperidol (generic only) and olanzapine (ZYPREXA and generics).[16],[17] These drugs can cause sedation, slowed reflexes, orthostatic hypotension or loss of balance.

Other drug classes

Other drug classes that can increase the risk of falls include antihistamines, such as diphenhydramine (BENADRYL and generics); antiseizure drugs, including gabapentin (GRALISE, NEURONTIN and generics); certain cardiovascular drugs, such as lisinopril (QBRELIS, ZESTRIL, and generics); muscle relaxants, such as baclofen (FLEQSUVY, OZOBAX DS and generics) and opioids, including oxycodone (OXYCONTIN, ROXICODONE, ROXYBOND, XTAMPZA ER and generics).[18],[19] See Table 2 for additional examples of oral drugs that may increase the fall risk.

Table 2. Additional Examples of Oral Drugs That May Increase the Risk of Falls[20],[21]

*Designated as Limited Use by Public Citizen’s Health Research Group
**Designated as Do Not Use by Public Citizen’s Health Research Group

Reducing the risk of falls

All risk factors that contribute to fall risk (discussed above) should be addressed,[22] although this may not always be possible. For example, even if a drug increases fall risk, its benefit may still outweigh the risks for some patients.[23] Nonetheless, there are effective means to prevent falls. Physical exercise can maintain or improve muscle strength and balance.[24] For people at high risk of falling and those with a history of falls, wearing nonslip footwear or using a cane or walker, if necessary, can help minimize risk.

Creating a safe home environment is another important strategy. To improve safety, remove clutter, loose cables, rugs or uneven steps that may lead to tripping or falling. Make sure the home is well-lit, install handrails or grab bars as needed, and use non-slip bath mats.

What You Can Do

If you have recently fallen or nearly fallen, discuss with your clinician what the contributing factors may have been. If you have fallen before, you are more likely to fall again.[25] Even if you have not fallen, especially if you are 65 or older, regularly discuss with your clinician whether the drugs or doses you are taking may increase your fall risk and if they can be modified. Do not stop taking any drug without talking to your clinician first.
 

References

[1] Kiel DP. Falls in older persons: Risk factors and patient evaluation. UpToDate. Updated January 21, 2026.

[2] Centers for Disease Control and Prevention. Older adult falls data. February 26, 2026. https://www.cdc.gov/falls/data-research/index.html. Accessed April 5, 2026.

[3] Centers for Disease Control and Prevention. Facts about falls. January 27, 2026. https://www.cdc.gov/falls/data-research/facts-stats/index.html. Accessed April 5, 2026.

[4] Kiel DP. Falls in older persons: Risk factors and patient evaluation. UpToDate. Updated January 21, 2026.

[5] Hart LA, Phelan EA, Yi JY, et al. Use of fall risk-increasing drugs around a fall-related injury in older adults: A systematic review. J Am Geriatr Soc. 2020;68(6):1334-1343.

[6] Mayo Clinic. Medicines that increase fall risk in older adults. January 30, 2025. https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/fall-risk/art-20572713. Accessed April 5, 2026.

[7] Centers for Disease Control and Prevention. Fact sheet: Medications linked to falls. 2017. https://www.cdc.gov/steadi/media/pdfs/STEADI-FactSheet-MedsLinkedtoFalls-508.pdf. Accessed April 5, 2026.

[8] National Health Service. Medication and falls: Key information for care home staff. https://www.ghc.nhs.uk/wp-content/uploads/F7.-Meds-that-can-cause-falls.pdf. Accessed April 5, 2026.

[9] Haddad YK, Kakara R, Marcum ZA. A comparative analysis of selective serotonin reuptake inhibitors and fall risk in older adults. J Am Geriatr Soc. 2022;70(5):1450-1460.

[10] Centers for Disease Control and Prevention. Medications can be linked to injuries as we age. 2023. https://www.cdc.gov/older-adult-drivers/media/pdfs/Medicine-Fact-Sheet.pdf. Accessed April 5, 2026.

[11] National Health Service. Medication and falls: Key information for care home staff. https://www.ghc.nhs.uk/wp-content/uploads/F7.-Meds-that-can-cause-falls.pdf. Accessed April 5, 2026.

[12] Centers for Disease Control and Prevention. Medications can be linked to injuries as we age. 2023. https://www.cdc.gov/older-adult-drivers/media/pdfs/Medicine-Fact-Sheet.pdf. Accessed April 5, 2026.

[13] National Health Service. Medication and falls: Key information for care home staff. https://www.ghc.nhs.uk/wp-content/uploads/F7.-Meds-that-can-cause-falls.pdf. Accessed April 5, 2026.

[14] American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.

[15] Drugs that can be dangerous for older adults. Worst Pills, Best Pills News. July 2024. https://www.worstpills.org/newsletters/view/1606. Accessed April 5, 2026.

[16] National Health Service. Medication and falls: Key information for care home staff. https://www.ghc.nhs.uk/wp-content/uploads/F7.-Meds-that-can-cause-falls.pdf. Accessed April 5, 2026.

[17] American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.

[18] Centers for Disease Control and Prevention. Medications can be linked to injuries as we age. 2023. https://www.cdc.gov/older-adult-drivers/media/pdfs/Medicine-Fact-Sheet.pdf. Accessed April 5, 2026.

[19] National Health Service. Medication and falls: Key information for care home staff. https://www.ghc.nhs.uk/wp-content/uploads/F7.-Meds-that-can-cause-falls.pdf. Accessed April 5, 2026.

[20] Centers for Disease Control and Prevention. Medications can be linked to injuries as we age. 2023. https://www.cdc.gov/older-adult-drivers/media/pdfs/Medicine-Fact-Sheet.pdf. Accessed April 5, 2026.

[21] National Health Service. Medication and falls: Key information for care home staff. https://www.ghc.nhs.uk/wp-content/uploads/F7.-Meds-that-can-cause-falls.pdf. Accessed April 5, 2026.

[22] Kiel DP. Falls: Prevention in community-dwelling older persons. UpToDate. Updated January 21, 2026.

[23] Mayo Clinic. Medicines that increase fall risk in older adults. January 30, 2025. https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/fall-risk/art-20572713. Accessed April 5, 2026.

[24] Patient education: Preventing falls in adults (The basics). UpToDate. October 14, 2022.

[25] Kiel DP. Falls in older persons: Risk factors and patient evaluation. UpToDate. Updated January 21, 2026.