Researchers at the University of North Carolina at Chapel Hill  Eshelman School of 
Pharmacy have created a list of prescription drugs that increase the risk of falling 
for patients aged 65 and older who take four or more medications on a regular 
basis. The medications on the list cover a wide range of common prescription 
antidepressants, seizure medications, painkillers and more. The common 
denominator among them is that they all work to depress the central nervous 
system, which can make patients less alert and slower to react.  

To download a list of the prescription medications that increase the risk of falls for 
patients 65 and older, see http
://uncnews.unc.edu/images/stories/news/health/2008/drugslist.pdf

“Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and 
older, and research suggests that those taking four or more medications are at an 
even greater risk than those who don’t – perhaps two to three times greater,” said 
Susan Blalock, Ph.D., associate professor.  Dr. Blalock is the principal investigator 
of an ongoing study of a falls-prevention program she and fellow researchers 
developed for pharmacists to implement.  Both the list of prescription drugs and 
some of the study’s finding were published in the June (2008) issue of the 
American Journal of Geriatric Pharmacotherapy.

Stefanie Ferreri, Pharm.D., lead author of the paper and a clinical assistant 
professor in the pharmacy school, warns that patients need to be wary of more 
than just prescription medications, as many over-the-counter medications can also 
contribute to falls.  “Some allergy medications, sleep aids and some cold and cough 
remedies can have the same effects as prescription drugs,” Ferreri said. “Always 
let your doctor know what over-the-counter medications you are taking and be 
sure to read the labels. Anything that can cause drowsiness can put you at 
increased risk of falling.”  The researchers offered the following advice to patients:


1) If patients see a drug they are taking on the list, they should not stop taking it. 

2) The next time they see their doctor, talk about the risk of falling and possible 
alternative medications.

  The Food and Drug Administration (FDA) has notified manufacturers of 
fluoroquinolone antimicrobial drugs that a Boxed Warning in the product labeling 
concerning the increased risk of tendinitis and tendon rupture is necessary.  The 
agency also: 1) determined that it is necessary for manufacturers of the drugs to 
provide a Medication Guide to patients about possible side effects, and 2) issued 
Information for Health Care Professionals today to alert health care professionals to 
the increased risk of tendinitis and tendon rupture in patients taking these drugs 
and to highlight new information concerning who may be at higher risk for this side 
effect.  Fluoroquinolones are drugs approved for the treatment or prevention of 
certain bacterial infections. Like other antibacterial drugs, fluoroquinolones do not 
treat viral infections such as colds or flu.  


  The risk of developing fluoroquinolone-associated tendinitis and tendon rupture is 
further increased in people older than 60, in those taking corticosteroid drugs, and 
in kidney, heart, and lung transplant recipients. Patients experiencing pain, 
swelling, inflammation of a tendon or tendon rupture should be advised to stop 
taking their fluoroquinolone medication and to contact their health care 
professional promptly about changing their antimicrobial therapy. Patients should 
also avoid exercise and using the affected area at the first sign of tendon pain, 
swelling, or inflammation.  The medications involved in this action are: Cipro and 
generic ciprofloxacin, Cipro XR and Proquin XR (ciprofloxacin extended release), 
Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin 
(norfloxacin), and Floxin and generic ofloxacin.

AHRQ released a new pair of plain-language guides to compare medications for the 
treatment of osteoporosis, including clinical benefits, risks, and cost estimates.  
Osteoporosis Treatments That Help Prevent Broken Bones, A Guide for Women 
After Menopause, and Fracture Prevention Treatments for Postmenopausal Women 
with Osteoporosis, a guide for clinicians. The consumer and clinician guides include 
basic facts about osteoporosis (also known as low bone density) and the 
medications commonly used in treatment.  Among the medications analyzed are six 
bisphosphonates – Fosamax, Didronel, Boniva, Aredia, Actonel and Zometa – plus 
alternative treatments such as estrogen, calcitonin (a man made hormone), 
calcium, vitamin D, testosterone, parathyroid hormone, and selective estrogen 
receptors modules.  Both guides include estimated monthly costs for the 
medications.  

 

The guides are the latest in a series of AHRQ publications that help clinicians and 
patients make the best possible treatment choices. Others guides produced by 
AHRQ compare treatments for diabetes, depression, gastroesophageal reflux 
disease, high blood pressure, narrowed kidney arteries and osteoarthritis. All guides 
will be available in Spanish.  Copies of the guides are available by sending an e-mail 
to ahrqpubs@ahrq.gov

The Arizona Center for Education and Research on Therapeutics, a national center 
for improving medication safety,* has new medication record forms available in 
English and Spanish. These forms can be printed and filled in by hand, or completed 
online and downloaded as a PDF to store on personal computers.  

Consumers are urged to use medication record forms to keep an up-to-date record 
of all the medicines and dietary supplements they take and show it to their doctor 
or pharmacist at each visit. This record is an important tool in routine health care, 
and provides vital information in emergencies. The AZ CERT has also produced a 30-
second public service ad featuring Dr. Richard Carmona, 17th US Surgeon General, 
encouraging people to keep track of their medicines using personal medication 
forms.   (* Funded by the US HHS Agency for Healthcare Research and Quality) 

Many Search Online for Prescription Info (53%), Visit Pharm Co. Web Site (50%) 

According to the 11th annual national survey, “Consumer Reaction to DTC 
Advertising of Prescription Medicines,” doctors' endorsement of drugs in 
pharmaceutical ads has little impact on consumer perception of those drugs.  
Seventy-five percent of consumers say a doctor's appearance in an ad does not 
make an advertised medicine seem more effective, and 72% say it doesn't make it 
seem safer.   The survey, conducted by Prevention, Men's Health and Women's 
Health magazines, with technical assistance from the U.S. Food and Drug 
Administration's Division of Drug Marketing, Advertising, and Communication (FDA-
DDMAC), is one of the primary consumer studies informing the FDA's stance on 
Direct-to-Consumer (DTC) issues.  Mirroring overall trends in information seeking, 
the study found a significant increase in consumers using the web for medical 
queries: 

 
More than half (53%) of all consumers go online to look for prescription drug 
information, vs. 41% in 2007, and 10% have clicked on a DTC banner ad, compared 
to 5% in 2006. 

 
Many have visited the Web site of a pharmaceutical company (50%) or 
advertised brand of medicine (40%). 

"Consumers are firmly rooted in the era of online health management as more 
and 
more patients embrace tools and trackers such as Google, Yahoo and Revolution 
Health," said Cary Silvers, Director of Consumer Insights at Rodale, who 
spearheaded this year's survey. "Along with the doctor and pharmacist, the online 
component has become the third leg of the stool as consumers learn about drugs. 
The more consumers know, the more likely they are to take action." 

Other key findings from the 11th annual survey on Consumer Reaction to DTC 
Advertising of Prescription Medicine: 

 
Doctors' offices are valuable distributors of health information: 63% of 
consumers notice informational materials (posters, brochures, videos) featured 
there. 

 
The majority of consumers say that magazine DTC ads are "somewhat/very 
useful" in conveying a drug's benefits (75%) and risks (76%). Consumers feel 
similarly about TV DTC ads in conveying a drug's benefits (69%) and risks (78%). 
Fifty-six percent say that ads are "done responsibly." 

 
58% of consumers are currently taking a prescription drug, compared to 47% 
ten years ago. Of those taking prescription medicines, 55% saw an advertisement 
for the medicine they were taking. 

 
Over a 5-year average, among every one who saw a DTC ad, 73% of the 
consumers talked to their doctor about a medicine while 25% asked the doctor to 
prescribe it. Of those who just talked about the drug, 25% received the 
prescription for the advertised medicine. Of those who specifically asked, 77% 
received the prescription.