Assessing medications in a frequent faller is something I do on a pretty regular basis.  There are often multifactoral reasons for the falls, but as a pharmacist, our obvious focus is on the medications and how they might complicated our frequent faller’s situation.

An 81 year old female has had an increasing number of falls.  She has had a long history of anxiety, depression, hypertension, hyperlipidemia, GERD, back pain, and Parkinson’s.  Her current medications include:

• Ativan 1 mg three times daily as needed
• Fosinopril 20 mg once daily
• Effexor XR 75 mg once daily
• Pravastatin 20 mg daily
• Levothyroxine 25 mg once daily
• Protonix 40 mg once daily
• Aspirin 81 mg once daily
• Tizanidine 2 mg QID prn
• Sinemet CR 50/200 three times per day
• Ambien 10 mg at bedtime

The first thing I notice here is the Ativan.  I would want to know how much she is taking of this, how she got to this dose, and if it is contributing to the falls.  If she is using the Ativan, I would probably like to see a reduction in this if possible as that is a pretty steep dose for an 81 year old.

This is likely a scenario of multiple factors contributing to the falls and the Parkinson’s disease is also likely contributing to the problem.  It would be very important to assess if the falls are due to the movement disorder.

The Ambien is also of concern and should be looked at.  Also is the Ativan being taken close to the same time as the Ambien as that could lead to a very sedated, unsteady patient at higher risk for falls.  Identifying non-drug interventions or possibly alternative agents would be something to look at here.

Tizanidine could certainly contribute to the falls situation as well.  I wouldn’t strongly suspect it given the other factors, but asking about as needed use certainly needs to be done in this frequent faller.

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