Antihistamines and Your Risk of Falling

Antihistamines are a common over-the-counter (OTC) drug used to fight allergies, coughs, and colds. They can also be found in sleep aids and pain relievers.

Though these medications are helpful, some can increase your risk of falls and fractures as you get older.

Falling is a big concern for older adults
More than one in four older adults fall each year, according to the Centers for Disease Control and Prevention.

Falls can lead to injuries, hospitalization, and even death. Even if you are not injured, falling can reduce your independence by making you afraid of falling again. This can lead you to withdraw from everyday activities.

Tell your health care provider if you’re concerned about falling. Your doctor can review the side effects of your medications and help you implement strategies to reduce your risk of falling.

Why certain antihistamines increase your fall risk
Because of the way they work, first-generation H1 antihistamines can cause drowsiness and other side effects that can lead to falls and fractures.

• H1 antihistamines block the H1 histamine receptors. When triggered by an allergen, these receptors are what produce allergy and anaphylaxis symptoms.
• First-generation antihistamines are a category of H1 antihistamines. Compared to second-generation antihistamines, they can more easily cross the blood-brain barrier into your central nervous system, causing drowsiness.

Medications that contain these antihistamines
First-generation H1 antihistamine medications include:

• Brompheniramine (BroveX CT)
• Chlorpheniramine (Ahist, Aller-Chlor, and Chlor-Trimeton)
• Clemastine (Dayhist and Tavist Allergy)
• Cyproheptadine (Periactin)
• Dimenhydrinate (Dramamine)
• Diphenhydramine (Alka-Seltzer Plus Allergy, Benadryl, Nytol, Sominex, and Vicks ZzzQuil Nighttime Sleep-Aid)
• Doxylamine (Unisom, Vicks NyQuil, and Tylenol Cold and Cough Nighttime)
• Hydroxyzine (Atarax, Rezine, and Vistaril)

Other side effects
According to the American Academy of Allergy, Asthma & Immunology, additional side effects of first-generation H1 antihistamines in older adults include:

• Anxiety
• Confusion
• Sedation
• Blurred vision
• Reduced mental alertness
• Reduced urinary retention
• Constipation

Talk to your doctor about alternatives 
Second-generation H1 antihistamines have fewer side effects than first-generation H1s, and your doctor may recommend that you switch to one of these non-drowsy allergy medications: 

• Azelastine (Optivar, Astelin, and Astepro) 
• Cetirizine (Zyrtec) 
• Desloratadine (Clarinex) 
• Fexofenadine (Allegra) 
• Loratadine (Claritin) 

Keep in mind that all medications have side effects, and you should talk to your doctor before starting a new medication.

What to do if you fall 
If you fall:

• Get immediate medical attention. Even if you do not have an obvious injury, seek immediate medical attention if you have any loss of consciousness or any sign of confusion after falling. 
• Notify your primary care physician (PCP) or health care provider. Even if you have no injury, make an appointment with your PCP or health care provider. Your fall could be related to a medical problem, and a falls evaluation will be needed to find the cause and help prevent another fall.