Benzodiazepines

Abstract

Benzodiazepines are used for a variety of indications. Age-related changes in the pharmacokinetics and pharmacodynamics of benzodiazepines place older people at increased risk for side effects. Decreased hepatic blood flow, albumin level, lean body mass, and an increased elimination half-life of active metabolites all play a role. These drugs can result in excessive sedation, cognitive impairment, delirium, agitation, and balance problems leading to falls and fractures. Consistent adverse effects related to benzodiazepine use have been reported in the community, in nursing homes, and in hospitals. Guidelines for rational use of benzodiazepines in older individuals should be followed. If needed, short-term treatment (i.e. less than 4 weeks for insomnia) might be considered using an intermediate-acting benzodiazepine. Patients should be clearly informed of the risk of falls when using these drugs. Long-term prescribing should be avoided. Benzodiazepine withdrawal strategies should be proposed to chronic users with proper psychological support and a drug tapering schedule adjusted to the patient’s individual needs.