Anticonvulsants
Limited data is available for the association of falls and use of anti-epileptics, mainly due to lower usage rates in the older population. However, CNS side effects of these drugs such as sedation, dizziness, ataxia and impaired postural control can increase the risk of falls.1,2
General recommendations3:
- Consider decreasing the dose if appropriate.
- Use the lowest strength possible for seizure protection while monitoring serum concentrations.
- Dizziness and drowsiness can be avoided by starting a low dose and titrating up slowly or splitting the dose throughout the day.
- Reducing the intervals between dosing can minimise fluctuations in serum drug levels which can decrease the impact of side effects.
- Check the availability for extended-release formulations as they are associated with a steady state serum concentration and can minimise side effects.
Older agents:4
- The established anticonvulsants; phenytoin, carbamazepine, sodium valproate and phenobarbital lead to high incidence of sedation in elderly.
- Oxcarbamazepine and topiramate increase imbalance risk at all doses.
Newer Agents:4
- Consider using newer agents like Gabapentin and Levetiracetam as it does not increase imbalance at any dose.
References
Zeimer H. Medications and falls in older people. J. Pharm. Pract. Res. 2008;38(2):148-151.
Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013;75(1):51-61.
Perucca E. Extended‐release formulations of antiepileptic drugs: rationale and comparative value. Epilepsy Curr. 2009;9(6):153-157.
Bulat T, Castle SC, Ruthledge M, Quigley P. Clinical practice algorithms: medication management to reduce fall risk in the elderly—part 3, benzodiazepines, cardiovascular agents, and antidepressants. J Am Acad Nurse Pract. 2008; 20(2):55-62.