Pharmacist-Led Medication Review Identifies and Mitigates Fall-Risk-Increasing Drugs and Multi-Drug Interactions

Purpose: Falls, a common cause of injuries and hospitalizations, are observed more commonly as age increases. Several factors may potentiate a fall including vision impairment, muscle weakness, and medications. Among those, medication use is a modifiable risk factor that pharmacists can address to lower the risk for falls and falls-related injuries. Fall-risk-increasing drugs are associated with adverse drug events such as sedation, dizziness, impaired coordination, and orthostatic hypotension. The purpose of this case report is to present mitigation strategies a clinical pharmacist provided after a medication review that identified a fall-risk-increasing drug and multi-drug interactions, to which its resultant intervention reduced the risk for falls and improved patient safety. Case: A 63-year-old male who suffered a recent fall in his home received a targeted fall assessment medication review by a clinical pharmacist. Upon review, the clinical pharmacist identified hydroxyzine as a fall-risk-increasing drug and identified drug-drug interactions with simvastatin and fluoxetine that could increase the risk for hydroxyzine-related adverse drug events. Additionally, other fall-risk-increasing drugs (e.g., clonazepam, meclizine, fluoxetine) were present, each involved in one or more drug-drug interactions. As a first step, the clinical pharmacist recommended to discontinue the hydroxyzine to lower his risk for a future fall and fall-related injury. Conclusion: This case demonstrates an example of a clinical pharmacist’s interventions that resulted in a reduction of falls risk, along with the improvement of patient safety.