Don’t routinely continue benzodiazepines initiated during an acute care hospital admission without a careful review and plan of tapering and discontinuing, ideally prior to hospital discharge.

Benzodiazepines, while helpful for short-term relief of anxiety and insomnia, are associated with a variety of side-effects and long-term problems including cognitive and psychomotor impairment as well as abuse and dependence. Benzodiazepines are commonly used in hospital to treat anxiety or insomnia in association with either the presenting condition or the hospital environment. Once the presenting condition is treated, benzodiazepines should be tapered and discontinued. For patients who are still on benzodiazepines at the time of discharge, a plan for tapering and discontinuing them after discharge should be completed and specified in the discharge summary and prescription.

 

Sources:

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Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005 May;18(3):249-55. PMID: 16639148.

Bell CM, et al. Initiation of benzodiazepines in the elderly after hospitalization. J Gen Intern Med. 2007 Jul;22(7):1024-29. PMID: 17453266.

Cunningham CM, et al. Patterns in the use of benzodiazepines in British Columbia: Examining the impact on increasing research and guideline cautions against long-term use. Health Policy. 2010 Oct;97(2-3):122-9. PMID: 20413177.

Grad R, et al. Risk of a new benzodiazepine prescription in relation to recent hospitalization. J Am Geriatr Soc. 1999 Feb;47(2):184-8. PMID: 9988289.

Lader M. Benzodiazepines revisited-will we ever learn? Addiction. 2011 Dec;106(12):2086-109. PMID: 21714826.

Olfson M, et al. Benzodiazepine use in the United States. JAMA Psychiatry. 2015 Feb;72(2):136-42. PMID: 25517224.

Olfson M, et al. The popularity of benzodiazepines, their advantages, and inadequate pharmacological alternatives—Reply. JAMA Psychiatry. 2015 Apr 1. PMID: 25830609.

Swinson R, et al. Clinical practice guidelines: Management of anxiety disorders. Can J Psychiatry. 2006 Jul;51 Suppl 2:1S-93S.

Yokoi Y, et al. Benzodiazepine discontinuation and patient outcome in a chronic geriatric medical/psychiatric unit: a retrospective chart review. Geriatr Gerontol Int. 2014 Apr;14(2):388-94. PMID: 24666628.

 

Related Resources:

Toolkit: Less Sedatives for Your Older Relatives – A toolkit for reducing inappropriate use of benzodiazepines and sedative-hypnotics among older adults in hospitals