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Benzodiazepine Withdrawal in the Elderly: A Practical Approach

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Medication-Related Falls in Older People

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Abstract

Benzodiazepines are widely prescribed in older patients. Studies have shown that these medications can increase the risk of falls, hip fractures, cognitive impairment, delirium, dementia, traffic accidents, drug dependence and mortality. Guidelines and expert consensus statements addressing the adverse effects of chronic benzodiazepine use have not been effective in changing prescribing practices. Different interventions have been published to decrease or stop benzodiazepines. In the elderly, benzodiazepine withdrawal under medical supervision coupled with psychotherapy has been shown to work. For pragmatic reasons (access to psychotherapy not always available), medication review coupled with patient education should be tried. There is no evidence to support a substitution of a short/intermediate half-life benzodiazepine for a long half-life benzodiazepine. Tapering a benzodiazepine should be initiated with the benzodiazepine the patient is currently taking. Using different formulations of a particular drug should also be considered to facilitate reductions in dosage. The optimal duration of withdrawal varies with each patient, and a flexible tapering schedule is suggested at a reduction rate that is acceptable for that individual. An illustration of a sample schedule to discontinue for oxazepam is presented.

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Abbreviations

BZD:

Benzodiazepine

CI:

Confidence interval

CYP:

Cytochrome P450

OR:

Odds ratio

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Author information

Authors and Affiliations

  1. Faculty of Pharmacy, University of Montréal, Montréal, QC, Canada

    Louise Mallet BScPharm, PharmD, CGP, FESCP

  2. Department of Pharmacy, McGill University Health Center, Glen Site, Montréal, QC, Canada

    Louise Mallet BScPharm, PharmD, CGP, FESCP

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  1. Louise Mallet BScPharm, PharmD, CGP, FESCP
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Correspondence to Louise Mallet BScPharm, PharmD, CGP, FESCP .

Editor information

Editors and Affiliations

  1. University of Ottawa and The Ottawa Hospital, Head, Division of Geriatric Medicine University of Ottawa and The Ottawa Hosp, Montréal, Québec, Canada

    Allen R. Huang

  2. Head, Faculty of Pharmacy Université de Montréal, Université de Montréal, Montréal, Québec, Canada

    Louise Mallet

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Mallet, L. (2016). Benzodiazepine Withdrawal in the Elderly: A Practical Approach. In: Huang, A., Mallet, L. (eds) Medication-Related Falls in Older People. Adis, Cham. https://doi.org/10.1007/978-3-319-32304-6_18

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  • DOI: https://doi.org/10.1007/978-3-319-32304-6_18

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  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-32302-2

  • Online ISBN: 978-3-319-32304-6

  • eBook Packages: MedicineMedicine (R0)

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