รายการยาที่เสี่ยงต่อการหกล้ม

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รายชื่อ ยาที่เสี่ยงต่อการหกล้มในผู้สูงอายุ แบ่งเป็น 3 กลุ่มหลักที่สำคัญ

เรียบเรียงโดย เภสัชกรหญิง กรองทอง พุฒิโภคิน
  1. กลุ่มที่มีผลต่อระบบประสาท ได้แก่ antidepressants, antipsychotics, Benzodiazepines, non-benzodiazepine, hypnotics, antihistamine, anticonvulsants, muscle relaxants, narcotics, analgesics
  2. กลุ่มที่มีผลต่อหัวใจและหลอดเลือด ได้แก่ antihypertensive, antiarrhythmic, digoxin, nitrates, diuretics
  3. กลุ่มอื่นๆ ได้แก่ oral hypoglycemic, H2 blocker, proton pump inhibitors (PPI), NSAIDs, corticosteroid
ประเภทยา ชื่อยา ผลข้างเคียง
Central nervous system    
1. Antidepressants  melitracen, clomipramine, doxepin, imipramine, amitriptyline, nortriptyline, mianserine, mirtazapine, trazodone, escitalopram, sertraline, paroxetine, fluoxetine, vortioxetine, desvenlafaxine, duloxetine, milnacipran, venlafaxine Anticholinergic side effects include confusion, cognitive impairment, delirium, dry mouth, constipation, urinary retention, orthostatic hypotension, sedation, impair balance,  slow reaction Hyponatremia, ataxia, impaired psychomotor function, and syncope
a.Antipsychotics  Risperidone, olanzapine, quetiapine, clozapine, aripiprazole, haloperidol Sedation, dizziness, postural disturbances, altered gait and balance, impaired cognition
b.Benzodiazepines  Alprazolam, chlordiazepoxide, clobazam, clonazepam, dipotassium clorazepate, diazepam, flunitrazepam, lorazepam, midazolam, nitrazepam,  Sedation, dizziness, postural disturbances, altered gait and balance, impaired cognition
c.non-benzodiazepine Zolpidem cognitive impairment, unsteady gait, psychomotor impairment, accidents, delirium, and dependence
e.antihistamine Chlorpheniramine, cyproheptadine, diphenhydramine, hydroxyzine Anticholinergic effects can increase confusion, cognitive impairment, delirium, dry mouth, and constipation and cause urinary retention
f.anticonvulsants Gabapentin, pregabalin, levetiracetam, phenytoin, sodium valproate ataxia, impaired psychomotor function
g.muscle relaxants Orphenadrine, tizanidine, baclofen Anticholinergic effects can increase confusion, cognitive impairment, delirium, dry mouth, and constipation and cause urinary retention
h.narcotics  Morphine, fentanyl, oxycodone  sedation, dizziness, syncope, and central nervous system depression.
i.analgesics  Tramadol sedation, dizziness, syncope, and central nervous system depression
2. Cardiovascular system     
a.Antihypertensive  Doxazosin, prazosin, captopril, enalapril, imidapril, perindopril, quinapril, ramipril, losartan, valsartan, olmesartan, azilsartan, candesartan, irbesartan, telmisartan, amlodipine, felodipine, lercanidipine, manidipine, nifedipine, diltiazem, verapamil, atenolol, bisoprolol, metoprolol, nebivolol, propranolol, clonidine, hydralazine Induced orthostasis, confusion, poor health status
b.antiarrhythmic disopyramide  
c.digoxin     
d.nitrates  Isosorbide dinitrate, isosorbide mononitrate nitrate-induced severe hypotension and bradycardia
e.diuretics  Acetazolamide, furosemide, amiloride,hydrochlorothiazide, spironolactone, indapamide, chlorthalidone orthostatic hypotension, and hypotension risk is increased with dehydration. They also may cause weakness due to potassium loss as well as hyponatremia
3. others    
a.oral hypoglycemic glipizide, glimepiride, gliclazide hypoglycemic
b.H2 blockers famotidine delirium
c.PPIs Omeprazole, esomeprazole, pantoprazole, lansoprazole, rabeprazole, dexlansoprazole increased risk of fracture (hip, spine, or wrist fracture)
d.NSAIDs Ibuprofen, loxoprofen, naproxen, mefenamic acid , diclofenac, indomethacin , sulindac, meloxicam, piroxicam, celecoxib, etoricoxib confusion, lightheadedness
e.corticosteroid Dexamethasone, hydrocortisone, prednisolone confusion, agitationdelirium

 

References

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