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Canadian Clinicians Release New Practice Guideline on Prescribing Benzodiazepines

May 18, 2018
Tapering benzodiazepine receptor agonists (BZRAs) shown effective

A PPM Brief

While prescribing benzodiazepine receptor agonists (BZRAs) for insomnia is common for long-term care, their efficacy is only for the short-term. The use of BZRAs is associated with an increased risk of falls, car accidents, memory problems, and sleepiness; risks that are increased among the elderly population. Thus, Choosing Wisely Canada, a national campaign of clinicians and patients to stop unnecessary treatments and make effective care choices, have demonstrated positive outcomes for the slow tapering of benzodiazepines, and recommends that BZRAs should be avoided as a first-line treatment of insomnia in older patients (at least 65 years), in a new practitioner guideline.1

A team of eight clinicians and one methodologist developed the guideline using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Evidence was generated through a review of BZRA deprescribing trials for insomnia, as well as performing a review of the harms of continued BZRA use, patient preferences and resource implications. The team recommended that deprescribing BZRAs be offered to elderly adults (at least 65 years) who take BZRAs, regardless of duration of use, and suggest that deprescribing be offered to adults aged 18 to 64 who have used BZRAs for more than 4 weeks. These recommendations apply to patients who use BZRAs to treat insomnia on its own or as a comorbid symptom.1

The tapering of BZRAs has been shown to improve cessation rates compared with usual care, without serious harms. A systematic review of BZRA deprescribing in patients demonstrated successful outcomes. The most common withdrawal symptoms were mild, short-term insomnia, anxiety, and restlessness, and there were no evidence of severe withdrawal symptoms.1

The researchers suggest that patients might be open to deprescribing conversations if they understand the rationale, are involved in developing the tapering plan, and are offered behavioral advice. The guideline also provides recommendations for making decisions about when and how to reduce and stop BZRAs. Researchers conclude that this guideline does not apply to those with other sleep disorders or untreated anxiety, depression, or other physical or mental health conditions that might be causing or aggravating insomnia.1

Last updated on: May 21, 2018
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