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Review
. 2023 Aug;14(4):697-708.
doi: 10.1007/s41999-022-00731-4. Epub 2022 Dec 28.

Therapeutic dilemmas with benzodiazepines and Z-drugs: insomnia and anxiety disorders versus increased fall risk: a clinical review

Andreas Capiau #  1   2 , Liesbeth Huys #  1 , Eveline van Poelgeest  3 , Nathalie van der Velde  3 , Mirko Petrovic #  4   5 , Annemie Somers #  1   2 ; EuGMS Task, Finish Group on FRIDs
Affiliations
Review

Therapeutic dilemmas with benzodiazepines and Z-drugs: insomnia and anxiety disorders versus increased fall risk: a clinical review

Andreas Capiau et al. Eur Geriatr Med. 2023 Aug.

Abstract

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.

Keywords: Adverse reactions; Benzodiazepines and Z-drugs; Deprescribing; Falls; Older people; Potentially inappropriate medication.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Factors associated with fall risk
Fig. 2
Fig. 2
Decision tree for benzodiazepine (BZD) withdrawal in patients who have fallen [8]
See this image and copyright information in PMC

References

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