discontinuation of chronic benzodiazepine use; benzodiazepine deprescribing
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Management
- direct education with a tapering schedule is useful for stopping inappropriate benzodiazepine use in the elderly[2]
- cross-tapering not necessary[3]
- tapering by 25% every 1-2 weeks reduces risk of withdrawal symptoms[3]
- a shared decision-making approach is suggested[5]
- advice from Medscape readers[6]
- patients with complex persistent benzodiazepine dependence may require special consideration regarding benzodiazepine deprescribing[7]
Clinical trials
Randomized control study:
Design:
- 67 adults, age 55-82 who had used benzodiazepines at bedtime for an average of 10 years
- Median dose was 10 mg of diazepam or equivalent
Groups:
- Supervised dosage taper of 25% every 2 weeks.
- Cognitive therapy, 10 weekly 90 minute group sessions.
- both 1 & 2
Results:
- 59% success rate of discontinuation of benzodiazepine after 12 months in group 3 vs 52% in group 1 vs 33% in group 2
- polysomnography revealed improvement in sleep quality
More general terms
Additional terms
- benzodiazepine
- benzodiazepine toxicity
- benzodiazepine withdrawal
- complex persistent benzodiazepine dependence
References
- ↑ Journal Watch 24(6):49, 2004
Morin CM Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. Am J Psychiatry 161:332, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14754783 - ↑ 2.0 2.1 Tannenbaum C et al Reduction of Inappropriate Benzodiazepine Prescriptions Among Older Adults Through Direct Patient EducationThe EMPOWER Cluster Randomized Trial. JAMA Intern Med. Published online April 14, 2014. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24733354 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1860498
- ↑ 3.0 3.1 3.2 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Soyka M Treatment of Benzodiazepine Dependence. N Engl J Med 2017; 376:1147-1157. March 23, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28328330 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1611832
- ↑ 5.0 5.1 Pottie K, Thompson W, Davies S et al Deprescribing benzodiazepine receptor agonists. Canadian Family Physician May 2018, 64 (5) 339-351 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29760253 PMCID: PMC5951648 Free PMC article <Internet> http://www.cfp.ca/content/64/5/339
- ↑ 6.0 6.1 Vega CP Stop the Benzo: It's Worth the Screaming. Medscape - Oct 27, 2020 https://www.medscape.com/viewarticle/939361
Vega CP Stopping Benzos Is Not Easy: Advice From Medscape Readers. Medscape - Dec 09, 2020. https://www.medscape.com/viewarticle/941993 - ↑ 7.0 7.1 Peng L, Meeks TW, Blazes CK Complex Persistent Benzodiazepine Dependence - When Benzodiazepine Deprescribing Goes Awry. JAMA Psychiatry. Published online May 18, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35583897 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2792518