Orthostatic Hypotension from Medications: Why You Feel Dizzy When You Stand Up

Standing up too fast and feeling like the room is spinning? That dizzy spell isn’t just bad luck-it could be your medications. Orthostatic hypotension, or orthostatic hypotension, is when your blood pressure drops suddenly as you rise from sitting or lying down. This causes reduced blood flow to your brain, leading to lightheadedness, blurred vision, or even fainting. It’s not rare. In people over 70, up to 30% experience it. And in many cases, it’s not aging alone-it’s the drugs they’re taking.

What Exactly Happens When You Stand Up?

When you stand, gravity pulls blood down into your legs. Normally, your body reacts instantly: your heart beats faster, your blood vessels tighten, and your blood pressure stays steady so your brain keeps getting oxygen. But if that system is messed up, your pressure plummets. The medical definition is clear: a drop of more than 20 mm Hg in systolic pressure or 10 mm Hg in diastolic pressure within three minutes of standing. And if you feel dizzy, lightheaded, or faint at the same time? That’s orthostatic hypotension.

It’s not just about getting up too fast. It’s about what’s happening inside your body-and often, that’s linked to the pills you’ve been prescribed.

Which Medications Cause This?

Some drugs are notorious for triggering this drop in blood pressure. The most common culprits fall into a few key groups:

• Antihypertensives-drugs meant to lower blood pressure can lower it too much. Diuretics like hydrochlorothiazide, ACE inhibitors like lisinopril, and calcium channel blockers are frequent offenders. They reduce fluid volume or relax blood vessels, making it harder to maintain pressure when standing.
• Antidepressants-especially tricyclics like amitriptyline. These block norepinephrine, a chemical your body needs to tighten blood vessels. Studies show they increase OH risk by over 3 times.
• Alpha-blockers-used for prostate issues or high blood pressure. Drugs like doxazosin and terazosin directly prevent blood vessels from constricting. Their OH risk is nearly 3 times higher than other BP meds.
• Antipsychotics-clozapine, quetiapine, and chlorpromazine are big ones. They affect brain signals that control blood pressure. Up to 40% of people on high doses report dizziness on standing.
• Opioids-morphine, oxycodone, and hydrocodone can depress the nervous system. About 1 in 5 elderly patients on opioids get OH. The risk jumps even higher if they’re also taking benzodiazepines or drinking alcohol.
• Levodopa-used for Parkinson’s, this drug can cause OH in up to half of users. The body struggles to adjust blood pressure as movement changes.

It’s not just the drug itself-it’s the combo. Someone on five medications has nearly 6 times the risk of someone on one or two. Polypharmacy isn’t just a buzzword-it’s a real danger.

Why Older Adults Are More at Risk

Age isn’t just a number here. As you get older, your body’s ability to regulate blood pressure slows down. Baroreceptors-your body’s pressure sensors-become less sensitive. Blood vessels stiffen. The heart doesn’t respond as quickly. All of this makes you more vulnerable.

But add medications to that? The risk skyrockets. People over 70 are 3.2 times more likely to develop orthostatic hypotension than younger adults. And if you’re taking four or more medications? Your risk jumps to 5.7 times higher. That’s not a small increase-it’s a major red flag.

Many older adults don’t realize their dizziness isn’t normal. They think it’s just getting older. But this isn’t just annoying-it’s dangerous. About 15% to 30% of people with OH fall at least once a year. Falls lead to fractures, hospital stays, and even death. Studies show a 24% to 32% higher risk of dying over 10 years if you have untreated orthostatic hypotension.

How Doctors Diagnose It

It’s not a guess. Diagnosis is based on numbers. Your doctor should measure your blood pressure while you’re lying down for at least five minutes, then again after you stand up-at one, two, and three minutes. The drop has to meet the >20/>10 mm Hg threshold. Symptoms must match the timing too.

But here’s the problem: many patients don’t report dizziness. Up to 40% of people with orthostatic hypotension have no symptoms. They’re just more likely to fall. That’s why screening is critical, especially for those on high-risk meds.

Since 2022, the American Geriatrics Society’s Beers Criteria has listed 12 medications that should be avoided or used with extreme caution in older adults because of OH risk. Many U.S. clinics now screen patients over 65 during routine visits. If you’re on any of those meds and feel dizzy when standing, ask for a BP check.

What You Can Do About It

The good news? Medication-induced orthostatic hypotension is often reversible. In 65% to 80% of cases, symptoms improve once the cause is addressed.

Here’s what works:

1. Review your meds-Don’t assume all your prescriptions are necessary. Ask your doctor: "Which of these could be causing my dizziness?" Sometimes, switching to a different drug in the same class helps. For example, ziprasidone causes far less OH than clozapine. Or replacing hydrochlorothiazide with a different diuretic might make a difference.
2. Stand up slowly-Wait a few seconds after sitting up before standing. Sit on the edge of the bed for 30 seconds. Use your arms to push up. Don’t rush.
3. Stay hydrated-Drink 2 to 2.5 liters of water a day. Fluids help maintain blood volume. Dehydration makes OH worse.
4. Wear compression stockings-These help push blood back up from your legs. They’re simple, cheap, and effective. Studies show they reduce symptoms in over half of users.
5. Avoid heat and alcohol-Hot showers, saunas, and alcohol all dilate blood vessels. That’s the last thing you need if you’re already prone to low pressure.
6. Elevate the head of your bed-Sleeping with your head slightly raised (6 to 9 inches) helps reduce overnight fluid shifts and improves morning blood pressure.

If those steps don’t help, your doctor might consider medication like midodrine, which tightens blood vessels. It’s not first-line, but it’s effective for those who still struggle after lifestyle changes.

Real Stories, Real Impact

One patient on Reddit, "AnxiousSenior89," started quetiapine for anxiety and fainted twice within three weeks. Her blood pressure dropped from 128/82 to 92/61 in under two minutes. After switching meds, the dizziness vanished.

Another case from Cleveland Clinic’s forums: a 78-year-old on six medications had repeated falls. Removing hydrochlorothiazide alone resolved the OH in just 72 hours.

But too often, it takes months for doctors to connect the dots. A Mayo Clinic study found 55% of patients had symptoms for over two months before anyone realized it was medication-related. That delay is dangerous.

What’s Changing in 2025

The healthcare system is catching up. Since 2020, the FDA requires all new drugs with a 5% or higher OH incidence to include warnings in their labeling. In 2023, the American Heart Association updated its guidelines to recommend midodrine as a first-line treatment when non-drug options fail.

Research is also moving toward personalized medicine. Clinical trials are testing genetic markers to predict who’s more likely to develop OH from certain drugs. Soon, doctors might be able to avoid high-risk meds before they’re even prescribed.

For now, the best defense is awareness. If you’re over 65, on multiple medications, and feel dizzy when you stand up-don’t ignore it. Don’t assume it’s just part of aging. Ask your doctor to check your blood pressure standing up. Bring your full med list. And if you’re not getting answers, ask again. This is preventable. And it’s life-changing.

What to Do Next

If you or someone you care about is feeling dizzy when standing:

• Write down every medication, supplement, and over-the-counter pill you take.
• Track when dizziness happens-after standing? After meals? After taking a pill?
• Ask your doctor to check your blood pressure lying down and standing up during your next visit.
• Ask: "Could any of these meds be causing my dizziness? Is there a safer alternative?"
• Start drinking more water and avoid sudden movements.

This isn’t something to brush off. It’s a warning sign your body is under stress. But with the right steps, it’s also something you can fix-without giving up the treatments you need.