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.

Conditions: Anxiety, Insomnia, Sleep Disorder, Sleeplessness

Treatments: Benzodiazepines (BZD)

Sources

• Alessi-Severini S, Bolton JM, Enns MW, Dahl M, Collins DM, Chateau D, et al. Use of benzodiazepines and related drugs in Manitoba: A population-based study. CMAJ Open. 2014 Oct;2(4):E208-16. (PubMed)
• Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005 May;18(3):249-55. (PubMed)
• Bell CM, Fischer HD, Gill SS, Zagorski B, Sykora K, Wodchis WP, et al. Initiation of benzodiazepines in the elderly after hospitalization. J Gen Intern Med. 2007 Jul;22(7):1024-29. (PubMed)
• Cunningham CM, Hanley GM, Morgan S. 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. (PubMed)
• Grad R, Tamblyn R, Holbrook AM, Hurley J, Feightner J, Gayton D. Risk of a new benzodiazepine prescription in relation to recent hospitalization. J Am Geriatr Soc. 1999 Feb;47(2):184-8. (PubMed)
• Lader M. Benzodiazepines revisited-will we ever learn? Addiction. 2011 Dec;106(12):2086-109. (PubMed)
• Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiatry. 2015 Feb;72(2):136-42. (PubMed)
• Olfson M, King M, Schoenbaum M. The popularity of benzodiazepines, their advantages, and inadequate pharmacological alternatives—Reply. JAMA Psychiatry. 2015 Apr 1. (PubMed)
• Swinson R, Antony M, Katzman MA, Bleay P, Chokka P, Craven M, et al. Clinical practice guidelines: Management of anxiety disorders. Can J Psychiatry. 2006 Jul;51 Suppl 2:1S-93S. (PubMed)
• Yokoi Y, Misal M, Oh E, Bellantoni M, Rosenberg PB. 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. (PubMed)