Frequency of fall risk increasing drugs in a large sample of people with Parkinson’s disease

Introduction: Prescription medication can increase fall risk in older adults with Parkinson’s disease (PD). Polypharmacy and medications that have a sedative effect are associated with fall risk in the general older population [PMID:24484618]. In addition, PD medications (higher levodopa dose, dopamine agonists, anticholinergics) are associated with fall risk [PMID:24484618]. Levodopa provides symptomatic treatment; however high levodopa doses (>400mg/day) are associated with motor complications and falls [PMID:23630119].

This study aimed to explore the frequency of prescription medications known to increase fall risk in PD and its association with fall history and injuries. 

Methods: 601 people with PD who participated in the Mobilise-D Clinical Validation Study (www.mobilise-d.eu) were stratified into non-fallers and fallers (≥1 fall in 12 months), and injurious falls were recorded. FRIDs were classified as antihypertensives, anticholinergics, antihistamines, sedatives, antipsychotics, antidepressants, opioids, nonsteroidal anti-inflammatory drugs (NSAID) and anti-parkinsonian medications (APD). A high levodopa dose (>400mg/day) and polypharmacy (≥5 medications) were identified. Statistical group differences were evaluated (Chi square and Mann-Whitney U tests, as appropriate). 

Results: 65% (n=388) of participants were non-fallers and 35% (n=213) were fallers. Of the fallers 46% (n=99) were injurious fallers. Fallers were significantly older, were more commonly female, and had worse disease severity (MDS-UPDRS Parts II and III). The frequency of PD treated with FRIDS was 95% for non-fallers and 98% for fallers. Use of antihypertensives, anticholinergics, antihistamines, opioids and NSAIDs were similar in fallers and non-fallers. There was a greater frequency of sedatives (9.4% vs. 3.9%), antipsychotics (6.1% vs. 1.0%), antidepressants (26.8% vs. 14.7%), APD (96.7% vs. 92.5%), high doses of levodopa (73.7% vs. 59.8%) and polypharmacy (66.7% vs. 45.4%) in fallers compared to non-fallers (all p<0.05). There was a greater frequency of sedatives (6.1% vs. 1.0%) and high doses of levodopa (6.1% vs. 1.0%) in individuals who reported injurious falls (p<0.05).

Conclusions: FRIDs, high doses of levodopa and polypharmacy are frequently prescribed in PD, irrespective of fall history. Greater care prescribing sedatives may be particularly impactful in people with PD to prevent injurious falls.