Family Docs Issue Guidelines on Deprescribing Benzodiazepines

A new evidence-based clinical practice guideline published in Canadian Family Physician is designed to help doctors safely deprescribe benzodiazepine receptor agonists (BZRAs), including benzodiazepines, zopiclone, and zolpidem, in adults, reports Medscape . BZRAs continue to be widely prescribed as a long-term treatment for insomnia in adults, but although their short-term use can slightly improve sleep onset latency, prolonged use may lead to physical and psychological dependence. BZRA use in seniors has been associated with falls, dementia, motor vehicle accidents, and physical addiction. "This guideline outlines these harms and, through a systematic review, demonstrates the efficacy of deprescribing using tapering regimens in people who were willing to enter deprescribing trials," the researchers say. They rate Choosing Wisely Canada's recommendation to taper the dose of BZRA in seniors as "strong," and the recommendation to deprescribe BZRAs in younger adults as "weak" due to the reduced risk for adverse effects associated with prolonged use of these drugs in this population. The guideline states clinicians should discuss the need to slowly taper BZRAs in all seniors irrespective of treatment duration, as well as in those aged 18 to 64 years who have used BZRAs for more than four weeks. The authors note this guideline does not apply to people with other sleeping disorders, unmanaged anxiety or depression, or other physical or mental health problems that might induce or worsen insomnia.