From the FDA Drug Label
Adults The usual initial dose of Furosemide tablets is 20 to 80 mg given as a single dose. ... Geriatric patients In general, dose selection for the elderly patient should be cautious, usually starting at the low end of the dosing range
2.2 Dosage for Treatment of Major Depressive Disorder in Adults The recommended starting dosage in adults with MDD is 40 mg/day (given as 20 mg twice daily) to 60 mg/day ... 2.3 Dosage for Treatment of Generalized Anxiety Disorder Recommended Dosage in Geriatric Patients In geriatric patients with GAD, initiate duloxetine delayed-release capsules at a dosage of 30 mg once daily for 2 weeks
The medications that should be adjusted or eliminated to reduce falls risk in the elderly are:
- Mirtazapine 15mg po qhs: as there is no direct information in the provided drug labels to support its adjustment or elimination.
- Duloxetine 30mg po od: the dose is within the recommended range for geriatric patients, but careful monitoring is advised.
- Furosemide 20mg Po od: the dose is at the low end of the recommended range, and geriatric patients should be started at the low end of the dosing range.
The most relevant medication to consider adjusting or eliminating to reduce falls risk is mirtazapine due to lack of direct information, however duloxetine and furosemide should be used with caution in the elderly 1, 2.
From the Research
To reduce falls risk in the elderly, mirtazapine (Remeron) 15mg at bedtime and duloxetine (Cymbalta) 30mg daily should be considered for adjustment or elimination. These medications are psychotropic drugs that can cause sedation, dizziness, and orthostatic hypotension, significantly increasing fall risk in older adults 3. Mirtazapine is particularly sedating, which can lead to morning drowsiness and impaired balance. If these medications are clinically necessary, consider reducing the dose of mirtazapine or administering it earlier in the evening to minimize morning sedation. For duloxetine, a slower titration or lower dose might help reduce side effects. Furosemide (Lasix) 20mg daily, while a diuretic that can cause orthostatic hypotension and electrolyte disturbances, is at a relatively low dose and may be necessary for managing conditions like heart failure or hypertension. Allopurinol (Zyloprim) 100mg daily for gout is generally not associated with increased fall risk. Any medication changes should be done gradually under medical supervision, and non-pharmacological fall prevention strategies should be implemented concurrently, including home safety evaluation, vision assessment, and balance exercises.
Some key points to consider:
- Orthostatic hypotension is a significant risk factor for falls in older adults, and medications that contribute to this condition should be carefully evaluated 4.
- Exercise interventions have been shown to be effective in reducing falls in older adults, and should be considered as part of a comprehensive fall prevention strategy 3.
- Multifactorial interventions, including medication management, home safety evaluation, and vision assessment, can also be effective in reducing falls risk 5, 6.
- The American Geriatrics Society and British Geriatrics Society recommend annual screening for falls risk in adults over 65 years old, and the implementation of targeted interventions to reduce falls risk 7, 5.