TY - JOUR
T1 - Therapeutic dilemmas with benzodiazepines and Z-drugs
T2 - insomnia and anxiety disorders versus increased fall risk: a clinical review
AU - Capiau, Andreas
AU - Huys, Liesbeth
AU - van Poelgeest, Eveline
AU - van der Velde, Nathalie
AU - the EuGMS Task, Finish Group on FRIDs
AU - Petrovic, Mirko
AU - Somers, Annemie
N1 - Funding Information: This paper was written on behalf of the EuGMS Task and Finish group on FRIDs. The T&F group consists of the following members: Austria: Heinrich Thaler; Belgium: Mirko Petrovic; Czech Republic: Eva Topinková, Denmark: Jesper Ryg; Finland: Sirpa Hartikainen; France: Hubert Blain, Jean Bousquet; Ireland: Irene O’Byrne-Maguire, Rose Anne Kenny; Italy: Francesco Landi; Netherlands: Tischa van der Cammen, Marielle Emmelot-Vonk, Eveline van Poelgeest, Lotta Seppälä, Nathalie van der Velde; Poland: Katarzyna Szczerbińska; Spain: Leocadio Rodriguez Mañas, Marta Gutiérrez Valencia, Maria Angeles Caballero-Mora; Sweden: Lucie Laflamme, Gösta Bucht, Yngve Gustafsson, Olle Svensson, Patrik Eklund, Ulrika Pettersson-Kymmer; Turkey: Gulistan Bahat, Birkan Ilhat; UK: Tash Masud, Alpana Mair, Tomas Welsh, Yvonne Morrissey. Publisher Copyright: © 2022, The Author(s).
PY - 2023/8
Y1 - 2023/8
N2 - Purpose: The aim of this clinical review was to summarise the existing knowledge on fall risk associated with benzodiazepines (BZDs) and Z-drugs in older people with focus on appropriate prescribing, including deprescribing. Methods: We conducted a literature search in June 2021 in PubMed and Embase with citation and reference checking. Personal reference libraries and international websites were also used. Keywords for the searches included “benzodiazepines”, “Z-drugs”, “falls”, “deprescribing”, “fall-risk-increasing-drugs”, “inappropriate prescribing”, “older people” and matching synonyms. We discuss use of BZDs and Z-drugs, potential fall-related adverse reactions, alternatives for and deprescribing of BZDs and Z-drugs in older persons. Results: BZDs and Z-drugs differ in fall-related adverse effect profile. They contribute to fall risk through orthostatic hypotension, dizziness and/or imbalance, sedation, muscular weakness, ataxia, etc. Fall incidents contribute significantly to mortality and morbidity. Therefore, there is a need for appropriate prescribing and use of BZDs and Z-drugs in older people. In practice, this means pertaining to a strict indication, strongly consider to non-pharmacological alternatives, limit use to the lowest dose and the shortest duration possible. Judicious deprescribing should be considered and encouraged as well. Practical resources, tools and algorithms are available to guide and assist clinicians in deprescribing BZDs and Z-drugs. Conclusions: Prescribing BZDs and Z-drugs should be done in a well-considered way in fall-prone older people. A good overview and insight in the fall-related adverse effects of these drugs, as well as the availability of different strategies to increase the appropriate use, including deprescribing initiatives, can assist clinicians in clinical decision-making.
AB - Purpose: The aim of this clinical review was to summarise the existing knowledge on fall risk associated with benzodiazepines (BZDs) and Z-drugs in older people with focus on appropriate prescribing, including deprescribing. Methods: We conducted a literature search in June 2021 in PubMed and Embase with citation and reference checking. Personal reference libraries and international websites were also used. Keywords for the searches included “benzodiazepines”, “Z-drugs”, “falls”, “deprescribing”, “fall-risk-increasing-drugs”, “inappropriate prescribing”, “older people” and matching synonyms. We discuss use of BZDs and Z-drugs, potential fall-related adverse reactions, alternatives for and deprescribing of BZDs and Z-drugs in older persons. Results: BZDs and Z-drugs differ in fall-related adverse effect profile. They contribute to fall risk through orthostatic hypotension, dizziness and/or imbalance, sedation, muscular weakness, ataxia, etc. Fall incidents contribute significantly to mortality and morbidity. Therefore, there is a need for appropriate prescribing and use of BZDs and Z-drugs in older people. In practice, this means pertaining to a strict indication, strongly consider to non-pharmacological alternatives, limit use to the lowest dose and the shortest duration possible. Judicious deprescribing should be considered and encouraged as well. Practical resources, tools and algorithms are available to guide and assist clinicians in deprescribing BZDs and Z-drugs. Conclusions: Prescribing BZDs and Z-drugs should be done in a well-considered way in fall-prone older people. A good overview and insight in the fall-related adverse effects of these drugs, as well as the availability of different strategies to increase the appropriate use, including deprescribing initiatives, can assist clinicians in clinical decision-making.
KW - Adverse reactions
KW - Benzodiazepines and Z-drugs
KW - Deprescribing
KW - Falls
KW - Older people
KW - Potentially inappropriate medication
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85145181942&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36576689
UR - http://www.scopus.com/inward/record.url?scp=85145181942&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s41999-022-00731-4
DO - https://doi.org/10.1007/s41999-022-00731-4
M3 - Review article
C2 - 36576689
SN - 1878-7649
VL - 14
SP - 697
EP - 708
JO - European Geriatric Medicine
JF - European Geriatric Medicine
IS - 4
ER -