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A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people

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Abstract

Purpose

Benzodiazepines are effective medicines for insomnia and anxiety but are commonly used beyond recommended treatment time frames, which may lead to adverse drug events. The aim of this systematic review was to critically evaluate the success of interventions used to reduce benzodiazepines and ‘Z-drug’ use, and the impact of these interventions on clinical outcomes in older adults.

Methods

A search was conducted in PubMed, Embase, Informit, International Pharmaceutical Abstracts, Scopus, PsychINFO, Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL. Studies conducted in older adults (≥65 years) and published between January 1995 and July 2015 were included. Two authors independently reviewed all articles for eligibility and extracted the data.

Results

Seven studies of benzodiazepines and Z-drug withdrawal were identified. Benzodiazepine discontinuation rates were 64.3% in one study that employed pharmacological substitution with melatonin and 65.0% in a study that employed general practitioner-targeted intervention. Mixed interventions including patient education and tapering (n = 2), pharmacological substitution with psychological support (n = 1) and tapering with psychological support (n = 1) yielded discontinuation rates between 27.0 and 80.0%. Five studies measured clinical outcomes following benzodiazepine discontinuation. Most (n = 4) observed no difference in prevalence of withdrawal symptoms or sleep quality, while one study reported decline in quality of life in those who continued taking benzodiazepine vs. those who discontinued over 8 months.

Conclusions

Current evidence shows that benzodiazepine withdrawal is feasible in the older population, but withdrawal rates vary according to the type of intervention. As the benefits and sustainability of these interventions are unclear, further studies should be conducted to assess this.

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Author information

Author notes

  1. Emily Reeve and Magdalene Ong contributed equally to the work.

Authors and Affiliations

  1. Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, Australia

    Emily Reeve

  2. Aging and Pharmacology, Royal North Shore Hospital, Level 12 Kolling Building, St Leonards, NSW, Australia

    Emily Reeve

  3. Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, Australia

    Magdalene Ong, Angela Wu & Danijela Gnjidic

  4. Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia

    Jesse Jansen

  5. Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), The University of Sydney, Sydney, NSW, 2006, Australia

    Jesse Jansen

  6. Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Mirko Petrovic

Authors
  1. Emily Reeve
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  2. Magdalene Ong
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  3. Angela Wu
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  4. Jesse Jansen
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  5. Mirko Petrovic
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  6. Danijela Gnjidic
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Contributions

ER was involved in the conception and design of the work, supervised screening and data extraction, conducted quality assessment, was involved in drafting and revising the manuscript for important intellectual content and approved the final version.

MO was involved in the conception and design of the work, conducted screening of abstracts and data extraction, drafted the manuscript and approved the final version.

AW was involved in the conception and design of the work, conducted screening of abstracts and data extraction, reviewed the manuscript and approved the final version.

JJ was involved in the conception and design of the work, reviewed the manuscript critically for important intellectual content and approved the final version.

MP was involved in the conception and design of the work, reviewed the manuscript critically for important intellectual content and approved the final version.

DG was involved in the conception and design of the work, supervised screening and data extraction, was involved in drafting and revising the manuscript for important intellectual content and approved the final version.

Corresponding author

Correspondence to Emily Reeve.

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The authors declare that they have no competing interests.

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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 73, 927–935 (2017). https://doi.org/10.1007/s00228-017-2257-8

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  • DOI: https://doi.org/10.1007/s00228-017-2257-8

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