Benzodiazepine withdrawal in the elderly: A practical approach

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.