Falling is never pleasant, but for seniors it can be deadly. Among adults 65 and older, falls are the leading cause of injury-related death, according to the Centers for Disease Control and Prevention (CDC), which reported 41,000 fall-related fatalities in 2023. Research shows that prescription drugs — especially opioids and antidepressants — are major culprits.

A review cited by Verywell Health found that 65% to 93% of older adults who suffered a fall-related injury were taking at least one “fall risk-increasing drug” (FRID) at the time. Harvard Health warns that many medications can raise the risk, and the danger multiplies with the number of prescriptions a person takes. One common example: medications for high blood pressure. If blood pressure drops too low, a person may feel lightheaded when standing up, which can trigger a fall.

Dr. Leslie Kernisan, a board-certified geriatrician, notes that busy doctors don’t always warn patients about these risks. “It’s important to identify medications that might be increasing fall risk and try to reduce or eliminate their use,” she said. However, she emphasized that patients should never stop or taper off medications without consulting a physician.

Common Fall Risk-Increasing Drugs (FRIDs)

• Antidepressants. Medications for depression and anxiety — such as selective serotonin reuptake inhibitors (SSRIs) like Zoloft, Celexa, Prozac, and Paxil, as well as tricyclic antidepressants like Elavil — increase fall risk. The National Institutes of Health reports that nearly all antidepressants are linked to higher rates of collapsing, and prescriptions for these drugs are climbing.
• Anticonvulsants. Drugs like gabapentin, used to control seizures, may cause dizziness and unsteadiness.
• Benzodiazepines. Prescribed for anxiety or as sleep aids, drugs such as Xanax, Valium, and Ativan have been “associated with increased risk of falls, according to many clinical studies,” Kernisan said.
• Blood pressure medications. Drugs such as amlodipine (Norvasc) and hydrochlorothiazide (HCTZ) can trigger orthostatic hypotension — a sudden drop in blood pressure when standing up — which can cause dangerous falls.
• Prescription sedatives. Sleep aids like Lunesta, Sonata, and Ambien may also cause dizziness and instability.
• Diphenhydramine (Benadryl). Found in over-the-counter sleep aids such as Nyquil, Sominex, and Unisom, as well as pain relievers like Tylenol PM, Advil PM, Motrin PM, and Aleve PM, this anticholinergic drug blocks acetylcholine and is well known to increase fall risk in older adults.
• Bladder medications. Drugs prescribed for overactive bladder, such as Ditropan and Detrol, also raise the risk, notes Harvard Health.
• Narcotics and opioids. Pain medications including codeine and hydrocodone (Vicodin), Percodan and Percocet (oxycodone combinations), and fentanyl (Duragesic) are strongly linked to falls.

Safer Alternatives

The American Geriatrics Society Beers Criteria — a widely used guide to medications that may be inappropriate for older adults — highlights safer alternatives. The updated guidelines recommend non-drug therapies when possible, such as:

• Cognitive behavioral therapy (CBT) for insomnia.
• Exercise and physical therapy for mobility and balance.
• Psychological interventions and non-opioid options for pain management.