One of the most common causes of falls is one that’s largely preventable…medications and their side effects. For some people, learning that their balance issues are caused by the drugs they’re taking comes as welcome news, because the solution is as simple as switching medications to one that’s more tolerable. Unfortunately, that doesn’t work for everyone. Here’s what you should know.
Medications, Balance, and Age
Older people are particularly at risk of balance-related side effects from medications. One reason is that their vestibular systems…the intricate interplay between the sensory organs in the inner ear, the brain, the nerves, and the muscles…become less responsive as a natural part of aging. Thus some side effects which would not be so dangerous for a younger person could lead to a fall in someone of more advanced age. A second reason is that older people metabolize medications differently, so in many cases the side effects are magnified. These two factors in combination should make older adults cautious any time a new prescription is added to their medication regimen.
Polypharmacy
As the number of drugs a person is taking increases, so does their risk of balance problems and falls. That’s not merely because it increases the chances that one or more drugs on the list will be problematic in and of themselves, but because many drugs interact with each other in dangerous ways that are not always easy to predict.
The term “polypharmacy” refers to taking five or more different medications each day. That might sound like a lot, but for older people or those with certain medical conditions, it’s the norm. Polypharmacy, especially in combination with advanced age, calls for particular caution…yet many seniors struggle to keep track of their different medications, and they often fail to inform prescribing doctors about what they’re already taking.
How Medications Affect Balance
Not all balance-related side effects look the same. A medication can disrupt balance in these and other ways…
- Causing drowsiness
- Diminishing alertness and concentration
- Causing dizziness and lightheadedness
- Lowering blood pressure to the extent that the person becomes dizzy upon standing
- Slowing responsiveness to loss of balance
- Impairing judgment
- Blurring the vision
- Weakening the muscles
- Causing delirium
- Affecting the inner ear in ways that cause temporary or permanent balance issues
Vestibulotoxic medications. Drugs in the final category…those directly affecting the balance-related sensory organs in the inner ear…are identified as vestibulotoxic medications. Some of these cause damage to the fine hairs whose movements spur motion-related nerve signals, while others affect the nerve that carries those signals. Some also cause hearing loss.
Which Medications Affect Balance
Looking at the above list of ways that medications can affect balance, consider for a moment that just one of those impacts, “dizziness,” is listed as a side effect of more than 2,000 medications. Another 200 drugs are known to be vestibulotoxic. Thus, the following list of drugs affecting balance should unquestionably be taken only as a sample representation of some of the most commonly prescribed medications known to be associated with balance problems. The only way to be sure that a new drug doesn’t appear on this list is to ask your physician or pharmacist about it.
How to Protect Yourself
Keep a list of which medications you take, how much, and how often. If you need help with this, ask a loved one, a friend, or your doctor for help. Go through your list to see if any of your medications affect balance. If so, ask your doctor if it’s possible to find a substitute that won’t contribute to fall risk.
Use this Medications Checklist to keep track of the medications you take:
Keep every one of your doctors informed about all of the medications you take, including over-the-counter drugs and supplements, since these can interact negatively with prescription meds.
Always take your medications exactly as they’re prescribed. The balance-related side effects of many drugs become significantly more pronounced at higher dosages.
If you’re taking one or more drugs with balance-related side effects, slow down and be extra cautious. If you need to use a walking aid or to refrain from certain activities, that’s better than dealing with the possibly disastrous effects of a fall.
Whenever a doctor prescribes a new medication, ask these two questions:
- Is this drug known to increase fall risk?
- What about when it’s combined with other medications?
If possible, use the same pharmacy for all of your medications. That way, you can enlist the help of your pharmacist in identifying drugs or drug combinations that could increase your risk of falling.
