Which Everyday Medications Increase Fall Risk in Older Adults?

By Simon Peter Lokomo, MPH — Public Health
Last reviewed: July 2026

The medications most often linked to falls in older adults are sleep and anxiety drugs (benzodiazepines and “Z-drugs”), some antidepressants and antipsychotics, opioid painkillers, certain blood-pressure medicines, and surprisingly common over-the-counter sleep and allergy aids. But here’s the part most articles skip: the research shows these drugs are strongly associated with falls, yet simply stopping them rarely reduces falls on its own. The right move is a professional medication review, not a solo clean-out of the medicine cabinet.

 

If a parent has started falling, their medicine cabinet is one of the first places worth a careful look because medication is one of the few fall risks you can actually change. Just not by yourself, and not overnight. Here’s what the evidence says, and how to act on it safely.

A note before we start: Nothing here is a signal to stop or change a medication on your own. Several of these drugs are dangerous to quit abruptly. Use this to have a better conversation with a doctor or pharmacist, that’s where the safe changes happen.

How do medications actually cause falls?

Mostly through four side effects that quietly undermine balance. Certain drugs cause drowsiness or slowed reaction time, some cause dizziness or a drop in blood pressure when standing up (called orthostatic hypotension), some cause confusion or blurred vision, and many do more than one of these at once. Stack two or three such drugs together which is common, and the effects compound. That’s why researchers group them under a single label: fall-risk-increasing drugs, or FRIDs.

 

The link is well documented. Across large reviews, roughly two-thirds of older adults who fall are taking at least one medication that a specialist would consider potentially inappropriate for their age most often a sedative, an opioid, a diuretic, or an antidepressant.

Which medication classes are most linked to falls?

The most consistent evidence points to drugs that act on the brain and nervous system, with blood-pressure drugs a more mixed picture. The table below lists the main classes flagged by fall-prevention research and expert tools like STOPPFall and the AGS Beers Criteria. Treat the examples as illustrations, not a checklist to act on alone.

Wait — over-the-counter sleep and allergy pills?

Yes, and this catches many families off guard. The most common over-the-counter sleep aids and older allergy pills contain diphenhydramine (the “PM” in Tylenol PM and Advil PM, and the active ingredient in Benadryl, ZzzQuil, and many Unisom products). Diphenhydramine is a strong anticholinergic: it causes sedation, next-day grogginess, confusion, and blurred vision in older adults, the exact profile that leads to falls. Because these are sold without a prescription, they rarely make it onto a “medication list,” which is exactly why they get missed. When you gather medications for a review, include everything from the bathroom cabinet and nightstand, not just the pharmacy bottles.

If these drugs cause falls, should we just stop them?

No — and this is the most important point in this article. Here’s the twist the marketing-style health sites skip: when researchers actually tested whether removing fall-risk drugs reduces falls, the benefit largely disappeared. A 2021 systematic review found that deprescribing these medications, on its own, “may result in little to no difference in the rate or risk of falls.” A 2022 review of medication reviews as a standalone intervention reached a similar, underwhelming conclusion.

That sounds contradictory, but it isn’t. The drugs are strongly associated with falls, but the people taking them are also often sicker, frailer, and more fall-prone to begin with so removing the drug doesn’t automatically remove the risk. It means medication review is worth doing, but it’s not a magic switch, and it works best as one part of a broader plan.

What should you actually do?

Get a focused medication review, and pair it with the interventions that genuinely prevent falls. Here’s the safe, evidence-aligned sequence:

1. Make one complete list. Gather every pill, patch, drop, supplement, and over-the-counter product in the house — the “brown bag” method. Include the sleep and allergy aids.
2. Ask for a falls-focused review. Book time with the prescriber or a pharmacist and say specifically: “Can we review these for anything that raises fall risk?” Pharmacists do this routinely and it’s often free.
3. Ask three questions about each drug. Is it still needed? Is the dose still right for their age? Is there a safer alternative? These are the questions clinical tools like the Beers Criteria and STOPPFall are built around.
4. Flag the OTC sleep and allergy aids explicitly. Ask whether a non-drowsy or non-drug alternative would work instead.
5. Do not change anything alone. Let the prescriber plan any taper.
6. Pair it with what works. Medication review helps most alongside the two interventions with the strongest fall-prevention evidence: balance and strength exercises and home safety changes. See our full guide if your parent keeps falling.

What the evidence does NOT support

• That stopping “fall-risk” drugs will, by itself, prevent falls. Trials don’t back that up. Removing a drug is worth considering for many reasons but expecting it alone to stop falls sets up false hope.
• That all blood-pressure medications are fall culprits. The evidence for cardiovascular drugs is genuinely mixed, and these drugs prevent strokes and heart attacks. This is a discussion for the prescriber, not a reason for alarm.
• That a longer medication list is automatically the problem. More drugs can raise risk, but the goal is the right medications at the right doses not the fewest pills possible.
• That families should manage this themselves. The safe, effective version of this always runs through a clinician. Self-directed deprescribing can do real harm.

When to get help

Talk to a doctor or pharmacist promptly if an older person has fallen, feels dizzy or unsteady, is unusually drowsy, or is taking two or more sedating medications. Ask directly for a medication review focused on fall risk, and mention any recent hospital stay, since medication lists often change during one. If falls are recurring, ask about a referral to a geriatrician or a falls clinic, where a full assessment can weigh medications alongside vision, balance, and other causes together.

Key takeaways

• The medications most linked to falls act on the brain: sleep and anxiety drugs, some antidepressants and antipsychotics, and opioids plus commonly overlooked OTC sleep and allergy aids containing diphenhydramine.
• Blood-pressure drugs have a weaker, more mixed link and shouldn’t be treated with the same certainty.
• These drugs are strongly associated with falls, but trials show that simply stopping them doesn’t reliably prevent falls on its own.
• The safe, effective move is a professional medication review never a solo clean-out. Several of these drugs are dangerous to stop abruptly.
• Medication review works best paired with balance and strength exercise and home safety changes, the interventions with the strongest evidence.

FAQ

What is the number one medication that causes falls in the elderly?

There’s no single culprit, but benzodiazepines and related “Z-drug” sleep medications are the most consistently linked to falls, which is why guidelines like the AGS Beers Criteria recommend avoiding them in adults over 65. That said, the risk rises most when several sedating drugs are combined, so the full list matters more than any one pill.

Can over-the-counter medications cause falls?

Yes. Common OTC sleep aids and older allergy pills often contain diphenhydramine, a strong anticholinergic that causes drowsiness, confusion, and blurred vision in older adults — the classic recipe for a fall. Because they’re bought without a prescription, they’re easy to miss, so include them in any medication review.

Should my parent stop taking a medication that increases fall risk?

Not on their own. Some of these drugs are dangerous to stop abruptly, and the research shows that simply stopping them doesn’t reliably prevent falls anyway. The right step is a medication review with the prescriber or a pharmacist, who can plan any safe changes.

Do blood pressure medications cause falls?

The evidence is mixed. Some blood-pressure drugs can cause dizziness when standing, which can lead to falls, but studies overall are less consistent than for sedatives, and these drugs prevent strokes and heart attacks. It’s worth raising with the prescriber, not a reason to stop them.

How do I get a medication review for fall risk?

Gather every medication and supplement in the house, then ask the prescriber or a pharmacist for a review focused on fall risk. Pharmacists do this routinely, it’s often free, and clinical tools like the Beers Criteria and STOPPFall help them spot the drugs most worth a second look.

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HomeAgingGuide.com provides evidence-based information, not medical advice. Simon Peter Lokomo holds an MPH in public health and is not a licensed physician. Never start, stop, or change a medication without talking to a qualified prescriber or pharmacist.