drug adverse effects of benzodiazepines
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Adverse effects
- cognitive impairment in the elderly
- confusion, especially in the elderly
- amnesia, aggression, delirium
- impairment in inferring anger from facial expressions, posture or prosody[14]
- use of benzodiazepines in the elderly is associated with increased risk of dementia[6]; RR-1.7 for >180 days use
- use of benzodiazepines among older adults is associated with a 50% increased risk for developing Alzheimer disease[7]
- benzodiazepine use is not associated with increased risk for dementia or Alzheimer's disease[8][15]
- although both benzodiazepines & anxiety disorders increase risk of dementia in the elderly, benzodiazepine use in elderly with anxiety disorder does not increase risk of dementia[18]
- urinary incontinence
- increased risk falls & of hip fracture[1]
- increased risk of community-acquired pneumonia & pneumonia-related death[4]
- increased risk of pneumonia in Alzheimer's disease[11]
- increased mortality
- use in early pregnancy is associated with increased risk for spontaneous abortion (1.4 vs 0.6%)[13]
- highest risk with diazepam, temazepam, alprazolam[13]
- withdrawal may occur within 24-48 hours after discontinuation*[2][3][16]
- moderate dose
- high-dose
- peripheral manifestations of benzodiazepine withdrawal may be masked by beta-blockers[3]
- benzodiazepine-induced neurological dysfunction (BIND)
- associated adverse life consequences
- may present during benzodiazepine use or tapering
- may continue after benzodiazepine discontinuation
- not all benzodiazepine users experience BIND[17]
* see discontinuation of chronic benzodiazepine use
More general terms
References
- ↑ 1.0 1.1 Wang PS et al Hazardous benzodiazepine regimens in the elderly: effects of half-life, dosage, and duration on risk of hip fracture. Am J Psychiatry 158:892 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11384896
- ↑ 2.0 2.1 The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996 pg 564
- ↑ 3.0 3.1 3.2 3.3 3.4 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 4.0 4.1 Obiora E et al The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort. Thorax. 5 December 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23220867 <Internet> http://thorax.bmj.com/content/early/2012/11/12/thoraxjnl-2012-202374
- ↑ 5.0 5.1 Weich S et al Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ 2014;348:g1996 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24647164 <Internet> http://www.bmj.com/content/348/bmj.g1996
- ↑ 6.0 6.1 Billioti de Gage S, Begaud B, Bazin F, Verdoux H et al Benzodiazepine use and risk of dementia: prospective population based study. BMJ. 2012 Sep 27;345:e6231. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23045258
Billioti de Gage S et al. Benzodiazepine use and risk of Alzheimer's disease: Case- control study. BMJ 2014 Sep 9; 349:g5205 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25208536 - ↑ 7.0 7.1 Young K, Fairchild DG, Di Francesco L Physician's First Watch, Sept 10, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
- ↑ 8.0 8.1 Gray SL, Dublin S, Yu O et al Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study. BMJ 2016;352:i90 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26837813 <Internet> http://www.bmj.com/content/352/bmj.i90
- ↑ Lader M. Benzodiazepine harm: how can it be reduced? Br J Clin Pharmacol. 2014 Feb;77(2):295-301. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22882333 Free PMC Article
- ↑ Paquin AM, Zimmerman K, Rudolph JL. Risk versus risk: a review of benzodiazepine reduction in older adults. Expert Opin Drug Saf. 2014 Jul;13(7):919-34. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24905348
- ↑ 11.0 11.1 Taipale H, Tolppanen AM, Koponen M et al Risk of pneumonia associated with incident benzodiazepine use among community-dwelling adults with Alzheimer disease. CMAJ April 10, 2017 vol. 189 no. 14 E519-E529 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28396328 <Internet> http://www.cmaj.ca/content/189/14/E519
Rochon PA, Vozoris N, Gill SS. The harms of benzodiazepines for patients with dementia. CMAJ April 10, 2017 189:E517-E518 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28396327 <Internet> http://www.cmaj.ca/content/189/14/E517 - ↑ 12.0 12.1 Orciari Herman A, Sofair A, Chavey WE Link Between Benzodiazepines and Mortality Called into Question Physician's First Watch, July 2017 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Patorno E et al Benzodiazepines and risk of all cause mortality in adults: cohort study. BMJ 2017;358:j2941 http://www.bmj.com/content/358/bmj.j2941 - ↑ 13.0 13.1 13.2 Sheehy O, Zhao JP, Berard A et al Association Between Incident Exposure to Benzodiazepines in Early Pregnancy and Risk of Spontaneous Abortion JAMA Psychiatry. Published online May 15, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31090881 https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2733517
- ↑ 14.0 14.1 Garcez H, Fernandes C, Barbosa F et al. Effects of benzodiazepines administration on identification of facial expressions of emotion: A meta-analysis. Psychopharmacology (Berl) 2019 Nov 18 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31740993
- ↑ 15.0 15.1 Osler M, Jorgensen MB. Associations of benzodiazepines, Z-drugs, and other anxiolytics with subsequent dementia in patients with affective disorders: A nationwide cohort and nested case-control study. Am J Psychiatry 2020 Apr 7; PMID: https://www.ncbi.nlm.nih.gov/pubmed/32252539 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.1903031
- ↑ 16.0 16.1 Jobert A, Laforgue E, Grall-Bronnec M et al. Benzodiazepine withdrawal in older people: what is the prevalence, what are the signs, and which patients? Eur J Clin Pharmacol. 2021;77(2):171-177 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33006626 https://link.springer.com/article/10.1007/s00228-020-03007-7
- ↑ 17.0 17.1 Rivito AD, Foster DE, Huff C et al Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLOS One, 2023. Jun 29;18(6):e0285584. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37384788 PMCID: PMC10309976 Free PMC article
- ↑ 18.0 18.1 Brieler JA, Salas J, Amick ME et al Anxiety disorders, benzodiazepine prescription, and incident dementia. J Am Geriatr Soc. 2023. Nov 71(11):3376-3389 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37503956 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18515