Fall Risk in Older Adults on Sedating Antihistamines: Prevention Strategies

Every year, nearly one in four older adults falls. For many, the cause isn’t slippery floors or poor lighting-it’s a pill they took for allergies or sleep. First-generation antihistamines like diphenhydramine (Benadryl), chlorpheniramine, and brompheniramine are still widely used by seniors, often without knowing the real danger. These drugs don’t just stop sneezing-they slow down the brain, blur vision, and wreck balance. And in older bodies, the effects last longer, hit harder, and can lead to broken hips, hospital stays, or worse.

Why These Medications Are So Dangerous for Seniors

First-generation antihistamines were designed in the 1940s to block histamine and ease allergy symptoms. But unlike newer versions, they easily slip through the blood-brain barrier. Once inside, they act like sedatives, slowing nerve signals that control movement, balance, and reaction time. In a 70-year-old, the half-life of diphenhydramine stretches from 8.5 hours to over 13 hours. That means if someone takes a 25mg tablet at 8 a.m., they’re still feeling drowsy at 8 p.m.-and maybe even at midnight.

These drugs also have strong anticholinergic effects. On the Anticholinergic Cognitive Burden Scale, diphenhydramine scores a 4-meaning it’s one of the most potent. That’s the same level as some antidepressants and bladder medications linked to dementia. A 2018 meta-analysis in Osteoporosis International found that older adults taking these antihistamines had a 54% higher risk of injurious falls and a 43% higher risk of fractures. The CDC’s STEADI program lists them alongside benzodiazepines and opioids as top fall-risk medications.

It’s not just falls. A 2023 study in Neurology Advisor found that seniors on these meds were 2.3 times more likely to develop delirium in the hospital. Delirium means confusion, hallucinations, and agitation-conditions that make falling even more likely. And yet, these drugs are still sold over the counter with labels that barely warn about dizziness or drowsiness.

The Safer Alternatives That Actually Work

There’s a better way. Second-generation antihistamines like loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) were developed specifically to avoid the brain. They don’t cross the blood-brain barrier easily, so they don’t cause the same level of sedation. Studies show they don’t increase fall risk at all.

Here’s the difference in real numbers:

• Diphenhydramine causes drowsiness in 15-20% of users; fexofenadine causes it in only 6%.
• Chlorpheniramine increases fall risk by 87% compared to no use; loratadine shows no increase.
• Fexofenadine has an anticholinergic score of 0. Diphenhydramine? Score of 4.

Even among second-generation options, there’s variation. Cetirizine still causes drowsiness in about 14% of older adults-twice as many as fexofenadine. So if someone needs an antihistamine, fexofenadine is the safest pick. It’s just as effective for allergies, doesn’t impair thinking, and doesn’t make you wobbly on your feet.

The American Geriatric Society’s Beers Criteria has labeled first-generation antihistamines as “potentially inappropriate” for older adults since 2015-and strengthened that warning in 2025. Yet, a 2019 study found doctors still prescribed them at nearly the same rate for seniors as for younger people. Why? Because many don’t know the risks. Or worse, they assume OTC means safe.

What to Do If You or a Loved One Is Taking These Meds

If someone you care about is taking Benadryl for allergies, sleep, or even an upset stomach, here’s what to do:

1. Don’t stop cold turkey. Sudden withdrawal from diphenhydramine can cause rebound itching, insomnia, or anxiety. Work with a doctor or pharmacist to taper slowly.
2. Switch to fexofenadine. For allergies, it’s just as effective and far safer. The dose is 180mg once daily. No need to split it.
3. Check all meds. Many seniors take multiple OTC products. Diphenhydramine hides in sleep aids, cold medicines, and even some pain relievers. Read every label.
4. Ask for a brown bag review. Take all pills, vitamins, and supplements to a pharmacist. They’ll spot hidden antihistamines and other fall risks. Studies show this reduces falls by 26%.

For sleep issues, don’t reach for Benadryl. It’s not a sleep aid-it’s a sedative with long-term risks. Instead, try sleep hygiene: no screens after 8 p.m., consistent bedtime, keeping the bedroom cool and dark, and avoiding caffeine after noon. If needed, melatonin (3mg) is a safer, non-anticholinergic option.

Non-Medication Ways to Control Allergies

Antihistamines aren’t the only way to manage allergies. In fact, reducing exposure works better-and has zero side effects.

• Nasal saline irrigation. Using a neti pot or squeeze bottle with sterile salt water reduces allergy symptoms by 35-40%, according to JAMA Otolaryngology.
• Allergen-proof bedding. Dust mites trigger most indoor allergies. Special covers for pillows and mattresses reduce exposure by 83%.
• HEPA air filters. A good one removes 99.97% of airborne allergens-pollen, pet dander, mold spores. Place one in the bedroom.
• Shower before bed. Washing off pollen from hair and skin prevents nighttime symptoms.

These steps don’t just reduce the need for meds-they improve overall quality of life. No drowsiness. No confusion. No fear of falling.

Environmental Fixes That Save Lives

Even if you can’t stop the medication right away, making the home safer helps.

• Install grab bars. In the bathroom, near the toilet and shower. Reduces fall risk by 28%.
• Improve lighting. Add nightlights in hallways and bathrooms. Falls drop by 32% with better light.
• Remove rugs and cords. Tripping hazards are the #1 cause of home falls.
• Wear non-slip shoes. Even socks with rubber dots help. Avoid slippers with smooth soles.

These changes cost little but save lives. A single fall can lead to a broken hip, surgery, long-term care, or death. For every dollar spent on home safety, $3.50 is saved in healthcare costs.

What’s Changing in 2026

The tide is turning. Since 2024, Medicare’s Annual Wellness Visit now requires doctors to review all medications for fall risk-including antihistamines. Pharmacies are starting to flag high-risk prescriptions automatically. The FDA now requires stronger warnings on OTC sleep aids containing diphenhydramine.

And new drugs are coming. Two next-generation antihistamines (AGS-2025-01 and FEX-AGE-101) are in Phase II trials. Early results show 89% less drowsiness than diphenhydramine-with no loss of allergy relief. These could be available by 2028.

But we don’t have to wait. The tools we have now-safer meds, home fixes, pharmacist reviews-are enough to prevent thousands of falls. The question isn’t whether we can do better. It’s whether we will.