Some analgesics, especially opioids, can increase falls risk due to sedation, orthostatic hypotension and hyponatremia. Introduction of any analgesia should be done carefully to monitor for response and adverse effects.⁵

If paracetamol or non-steroidal anti-inflammatories are ineffective, or pain is severe, opioids may be considered with suitable safeguards in place. While strong opioids have more fall-increasing risk, there may be a disproportionately higher overall adverse risk to benefit ratio with weak opioids.^5,14

To avoid FRIDs in neuropathic pain, analgesic options may include serotonin norepinephrine reuptake inhibitors (SNRIs), gabapentinoids, or transdermal preparations containing lidocaine or capsaicin. Non-drug approaches include physiotherapy and cognitive behavioural therapy.⁵

In diabetes, sulfonylureas are more likely to result in hypoglycaemia (and subsequent fainting) than other oral hypoglycaemics.¹⁴

Critical first steps in medicines optimisation for falls prevention in Parkinson’s disease (PD) in specialist/hospital care should aim to maximise motor function and minimise side effects (such as dyskinesia and hypotension). However, the dopamine agonists ropinirole and pramipexole may cause delirium and orthostatic hypotension.^5,18

Cholinergic medicines, such as cholinesterase inhibitors, are being investigated for their potential in reducing falls in PD with potentially positive effects on gait but this will need to be balanced with non-fall adverse effects.^5,20,21