First-generation antihistamines linked with falls in the elderly

These older drugs have significant anticholinergic effects

Older patients taking first-generation antihistamines are at increased risk of a fall or fracture, a meta-analysis suggests.

A pooled analysis of the two studies, including more than 30,000 elderly people (almost all male), showed a significant association between hospitalisation for an injurious fall or fracture and taking antihistamines.

First-generation drugs include cyproheptadine, dexchlorpheniramine, pheniramine, promethazine and trimeprazine. All can make patients drowsy. 

Unlike second- and third-generation antihistamines, these drugs have significant anticholinergic effects and this may put people taking them at a greater risk of falls, the authors suggested.

An increased risk of falls had been found with other anticholinergic medications such as tricyclic antidepressants, PPIs and antiparkinsonian drugs, but to their knowledge, this was the first meta-analysis to look at the effect of

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