The main medication groups associated with falls are those acting on the central nervous system, (particularly psychotropics such as antipsychotics, antidepressants and benzodiazepines, as well as antiepileptics and anticholinergics), and some classes of cardiovascular drugs (such as diuretics, alpha blockers, centrally acting antihypertensives, and vasodilators).^5,14

CNS medication falls risk can arise from sedative effects, anticholinergic and alpha-receptor properties, and orthostatic hypotension. Drug selectivity, receptor specificity or generation can also be factors.¹⁸

Tricyclics increase falls risk more than other antidepressants, while for antiepileptics, fall risk tends to be higher with older rather than newer classes, mainly due to sedative effects. Similarly, higher falls risk occurs with first-generation rather than second generation antihistamines, with sedative and anticholinergic effects implicated. Mono-amine oxidase inhibitors can cause severe orthostatic hypotension.^14,18

In general, higher anticholinergic activity increases fall risk more than lower-level anticholinergic activity; overactive bladder and urge incontinence medicines have an increased falls risk.¹⁴

Cardiovascular medicines that may be associated with fainting include antihypertensives, betablockers and diuretics. Among diuretics, loop diuretics have a higher falls risk than other types. With alpha blockers (eg for benign prostatic hyperplasia), non-selective types carry higher falls risk than selective types.^14,19