Falls Risk Assessment

Back to Review

Antiarrhythmic drugs

Atrial fibrillation

Antiarrhythmic have been associated with an increased risk of falls, especially in high fall risk patients such as the elderly.1 This could be due to their side effects of hypotension, bradycardia and torsade de pointes.2 

  • Avoid the use of class 1A-anti-arrhythmic (Quinidine, Procainamide, Disopyramide) or digitalis glycosides in high fall risk patients when possible.1
  • Disopyramide has strong anticholinergic effects; consider an alternative anti arrhythmic agent.3
  • Digoxin; consider dose reduction with monitoring. The recommended serum digoxin concentration is 0.5-0.9ng/ml (0.65 – 1.17nmol/L) to improve patient outcomes without adverse effects. Doses > 0.125 mg/d tend to be associated with more risks than benefits. Recommend another agent or reduce the dose if possible.3

References

  1. Ham A, Swart K, Enneman A, Dijk S, Araghi S, Wijngaarden J, Zwaluw N, Brouwer-Brolsma E, Dhonukshe-Rutten R, Schoor N, Cammen T. Medication-related fall incidents in an older, ambulant population: the B-PROOF study. Drugs aging. 2014;31(12):917-27.

  2. Lee H, Huang K, Shen W. Use of antiarrhythmic drugs in elderly patients. Rev J Geriatr Cardiol. 2011;8(3):184−194. 

  3. Ferreri S, Roth MT, Casteel C, Demby KB, Blalock SJ. Methodology of an ongoing, randomized controlled trial to prevent falls through enhanced pharmaceutical care. Am J Geriatr Pharmacother. 2008;6(2):61-81.

Back to Review