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discontinuation of chronic benzodiazepine use; benzodiazepine deprescribing

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: 1) Supervised dosage taper of 25% every 2 weeks. 2) Cognitive therapy, 10 weekly 90 minute group sessions. 3) both 1 & 2 Results: 1) 59% success rate of discontinuation of benzodiazepine after 12 months in group 3 vs 52% in group 1 vs 33% in group 2 2) polysomnography revealed improvement in sleep quality

Related

benzodiazepine benzodiazepine toxicity benzodiazepine withdrawal complex persistent benzodiazepine dependence

General

medication deprescribing

References

  1. 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: 14754783
  2. 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. PMID: 24733354 http://archinte.jamanetwork.com/article.aspx?articleid=1860498
  3. 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
  4. Soyka M Treatment of Benzodiazepine Dependence. N Engl J Med 2017; 376:1147-1157. March 23, 2017 PMID: 28328330 http://www.nejm.org/doi/full/10.1056/NEJMra1611832
  5. Pottie K, Thompson W, Davies S et al Deprescribing benzodiazepine receptor agonists. Canadian Family Physician May 2018, 64 (5) 339-351 PMID: 29760253 PMCID: PMC5951648 Free PMC article http://www.cfp.ca/content/64/5/339
  6. 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. Peng L, Meeks TW, Blazes CK Complex Persistent Benzodiazepine Dependence - When Benzodiazepine Deprescribing Goes Awry. JAMA Psychiatry. Published online May 18, 2022. PMID: 35583897 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2792518