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Drugs & Therapy Perspectives

, Volume 35, Issue 2, pp 72–76 | Cite as

Take a multifaceted stepwise approach when deprescribing benzodiazepines in older patients

  • Adis Medical WritersEmail author
Practical Issues and Updates
  • 22 Downloads

Abstract

Benzodiazepines (BZDs) lose their benefits as anxiolytics and sedatives with longer-term use, due to the development of tolerance, as well as the development of harms (e.g. dependence, impaired cognition and other CNS effects). Older patients are at increased risk of BZD-related harms, including fractures and falls. Deprescribing BZDs in this patient population should be done slowly to avoid withdrawal syndrome, and should use a multifaceted stepwise approach.

Notes

Compliance with ethical standards

Conflict of interest

The article was adapted from Drugs & Aging 2018;35(6): 493–521 [1] by employees of Adis/Springer, who are responsible for the article content and declare no conflicts of interest.

Funding

The preparation of this review was not supported by any external funding.

References

  1. 1.
    Ng BJ, Le Couteur DG, Hilmer SN. Deprescribing benzodiazepines in older patients: impact of interventions targeting physicians, pharmacists, and patients. Drugs Aging. 2018;35(6):493–521.CrossRefGoogle Scholar
  2. 2.
    Vinkers CH, Olivier B. Mechanisms underlying tolerance after long-term benzodiazepine use: a future for subtype-selective GABA(A) receptor modulators? Adv Pharmacol Sci. 2012;2012:416864.Google Scholar
  3. 3.
    Dell’osso B, Lader M. Do benzodiazepines still deserve a major role in the treatment of psychiatric disorders? A critical reappraisal. Eur Psychiatry. 2013;28(1):7–20.CrossRefGoogle Scholar
  4. 4.
    American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.Google Scholar
  5. 5.
    O’Mahony D, O’Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.CrossRefGoogle Scholar
  6. 6.
    Reeve E, Gnjidic D, Long J, et al. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80(6):1254–68.CrossRefGoogle Scholar
  7. 7.
    Markota M, Rummans TA, Bostwick JM, et al. Benzodiazepine use in older adults: dangers, management, and alternative therapies. Mayo Clin Proc. 2016;91(11):1632–9.CrossRefGoogle Scholar
  8. 8.
    Petrovic M, Pevernagie D, Mariman A, et al. Fast withdrawal from benzodiazepines in geriatric inpatients: a randomised double-blind, placebo-controlled trial. Eur J Clin Pharmacol. 2002;57(11):759–64.CrossRefGoogle Scholar
  9. 9.
    Reeve E, Ong M, Wu A, et al. A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people. Eur J Clin Pharmacol. 2017;73(8):927–35.CrossRefGoogle Scholar
  10. 10.
    Gould RL, Coulson MC, Patel N, et al. Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials. Br J Psychiatry. 2014;204(2):98–107.CrossRefGoogle Scholar
  11. 11.
    Paquin AM, Zimmerman K, Rudolph JL. Risk versus risk: a review of benzodiazepine reduction in older adults. Expert Opin Drug Saf. 2014;13(7):919–34.CrossRefGoogle Scholar
  12. 12.
    Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890–8.CrossRefGoogle Scholar
  13. 13.
    Martin P, Tannenbaum C, Tamblyn R, et al. D-prescribe overtakes empower in patient-centered deprescribing of benzodiazepines: preliminary results from a pragmatic cluster-randomized community-based trial in Canada [abstract no. P3]. J Am Geriatr Soc. 2017;65(Suppl 1):S1–2.Google Scholar
  14. 14.
    Mugunthan K, McGuire T, Glasziou P. Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis. Br J Gen Pract. 2011;61(590):e573–8.CrossRefGoogle Scholar
  15. 15.
    Salonoja M, Salminen M, Aarnio P, et al. One-time counselling decreases the use of benzodiazepines and related drugs among community-dwelling older persons. Age Ageing. 2010;39(3):313–9.CrossRefGoogle Scholar
  16. 16.
    Darker CD, Sweeney BP, Barry JM, et al. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane Database Syst Rev. 2015;5:CD009652.Google Scholar
  17. 17.
    Denis C, Fatseas M, Lavie E, et al. Pharmacological interventions for benzodiazepine mono-dependence management in outpatient settings. Cochrane Database Syst Rev. 2006;3:CD005194.Google Scholar
  18. 18.
    Voshaar RC, Couvee JE, van Balkom AJ, et al. Strategies for discontinuing long-term benzodiazepam use: meta-analysis. Br J Psychiartry. 2006;189:213–20.CrossRefGoogle Scholar
  19. 19.
    Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescr. 2015;38(5):152–5.CrossRefGoogle Scholar
  20. 20.
    Westbury J, Jackson S, Gee P, et al. An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project. Int Psychogeriatr. 2010;22(1):26–36.CrossRefGoogle Scholar
  21. 21.
    Westbury J, Tichelaar L, Peterson G, et al. A 12-month follow-up study of “RedUSe”: a trial aimed at reducing antipsychotic and benzodiazepine use in nursing homes. Int Psychogeriatr. 2011;23(8):1260–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.SpringerAucklandNew Zealand

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