Older Patients, Wiser Care

Dizziness: 5 Things to Do If You're Worried

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A question from a Caring.com community member recently caught my eye:

My mom uses lipitor 40mg, metoprolol 25mg, amitriptyline 50mg, hydrochlorothiazide 25mg, aspirin 81mg, eplerenone 25mg, actos 30mg and cozaar 50mg.

She takes all of the above simultaneously. What side effects can she have? She is complaining of dizziness.

What a savvy caregiver. When concerned about dizziness, checking into medication side effects is just where geriatricians like to start. In fact, there's a saying in geriatrics that goes something like this: "What are the top three causes of problems in an older person? Medications, medications, and medications."

Do the eight drugs listed above sound like a lot of pills? Actually, it's a pretty unexceptional list for someone with heart disease, high blood pressure, and diabetes, a common combination in middle-age and beyond.

Now that you know a complaint of dizziness is so often linked to medications, make sure your loved one's health provider does these five things:

1. Identifies medicines being taken that affect blood pressure.

The caregiver's mother in the example above is on three medications for blood pressure: metoprolol, hydrochlorothiazide, and losartan (brand name Cozaar). All blood pressure drugs can potentially cause dizziness by causing blood pressure to be too low. Eplerone, and other diuretics usually given for heart failure, can also contribute to low blood pressure.

It's not just drugs for hypertension and heart conditions you have to watch. Other pills that often affect blood pressure include a class of prostate medications known as alpha-blockers (terazosin and tamsulosin).

2. Checks blood pressure and pulse, both while the patient is sitting and two minutes after standing up.

Especially if an older person is taking blood pressure medicine (and so many are), it's vital to check the pressure and make sure the drugs aren't working too well. Low blood pressure often makes people feel dizzy. It's also good to check the pressure after the person has been standing for two minutes; if the blood pressure is much lower when standing than it was while sitting, this can be a sign that blood-pressure drugs may need to be cut back a bit.

Although it's best to have this check done at a doctor's office (especially if dizziness is a concern), if you have a home blood pressure cuff you can report the numbers (for seated and standing blood pressure) by phone to your doctor or the office advice line. Be sure to have your home cuff checked by the doctor's office when you go in for appointments to make sure it's reliable.

3. Identifies medicines known to cause dizziness as well as confusion, especially in the elderly.

There's a class of drugs that geriatricians love to hate known as anti-cholinergics, which can cause confusion, dizziness, or falls, especially in the elderly or those who have dementia. One type is amitriptyline, which the mother in the example is taking. (What presents as feeling dizzy to one person may seem like confusion or a tendency to fall in another; the symptoms can also be seen together. Other common side effects in these drugs include dry mouth, constipation, and difficulty urinating.)

Younger people tend to handle anti-cholinergics just fine. Doctors often prescribe amitriptyline for depression or for nerve pain, for example. But in an older person who's feeling dizzy, it's usually possible to switch to a different drug that's not anti-cholinergic. Other often-used anti-cholinergics to look out for are antihistamines like diphenhydramine (Benadryl, which is also the "sleep" drug included in the PM versions of over-the-counter pain relievers), as well as pills for overactive bladder, like oxybutynin (Ditropan).

Interestingly, although strong pain medicines like morphine can make some people feel drowsy, this side-effect usually goes away in people who take pain medicines regularly, and one large research study found that opiate pain medicines were not associated with falls in the elderly.

A word about atorvastatin (Lipitor), which the woman in the example is also taking: Cholesterol medications almost never cause dizziness; Lipitor is the least-likely pill on the list to cause side effects.

4. In people with diabetes, looks for medicines that lower blood sugar.

Dizziness can be caused by low blood sugar, which is always a risk in diabetics who are on insulin or oral drugs that lower blood sugar, such as pioglitazone (Actos). If the person you're caring for is taking any of these medicines, it's a good idea to check blood sugar using a home glucometer, during a dizzy spell or at any other time that a diabetic person feels unwell.

5. Identifies any new medicines or recently changed doses.

Often side effects like dizziness occur after a pill has been added or its dosage increased. It can be very helpful for a caregiver to point out any such changes to the doctor, especially if the medications were changed by a specialist or other doctor. Mention new over-the-counter medication use, too.

These five easy steps should be routine when an older person comes to the doctor complaining of dizziness. (Of course, he or she will also consider causes other than pills.) Unfortunately, with busy doctors' offices being the way they are, sometimes things slip through the cracks "“ which is why it's so useful for you, as a caregiver, to be aware of them.

Has your loved one ever gotten dizzy due to medications? How did you figure out which medicine was the problem?