According to the findings of a study conducted on older people who were benzodiazepine dependent, withdrawal may be accomplished with minimal issues and might result in improvements in sleep and cognitive capacities. After 52 weeks of effective withdrawal, researchers discovered a 22 percent increase in cognitive status, as well as an improvement in social functioning.
In a prospective study of benzodiazepine usage and withdrawal in senior medical inpatients, confusion and disorientation, with or without hallucinations, were the most common symptoms of withdrawal after benzodiazepine use was abruptly discontinued (i.e., halted quickly). The senior individuals who participated in the trial did not experience any other withdrawal symptoms.
Macodynamics rather than pharmacokinetics may be more relevant in understanding the altered response to benzodiazepines observed in older people than is commonly assumed.The greater susceptibility of older persons to benzodiazepines is attributable to age-related changes in the receptors of the central nervous system, according to research.It is likely that the benzodiazepine treatment was successful.
According to the American Geriatrics Society, several major medical and psychiatric organizations advise against the use of benzodiazepines or nonbenzodiazepine hypnotics in older persons, including those with dementia.Despite these cautions, benzodiazepines continue to be supplied in large quantities to a subset of people who are at the greatest risk of experiencing significant side effects from these prescriptions.
When older persons are exposed to a drug education program designed specifically for them, their knowledge, beliefs, and risk perceptions concerning improper benzodiazepine prescriptions in the elderly alter. Patient Education and Counseling, 2013;92:81–7.
It has been shown that the use of benzodiazepines in older persons can impair cognition, mobility, and driving abilities, and can increase the risk of falling. A previous study also discovered a link between benzodiazepine usage in elderly adults and an increased risk of Alzheimer’s disease, according to the researchers.
After as little as one month of continuous use, benzodiazepine withdrawal syndrome can manifest itself. When people who have been using benzos for more than six months suddenly cease taking them, around 40% of them have moderate to severe withdrawal symptoms. The remaining 60% of the population only has minimal symptoms.
Appropriate usage refers to the administration of very low dosages of short-acting benzodiazepines, such as lorazepam, oxazepam, or temazepam on a daily or bi-daily basis (0.5 mg or less).
Age-related renal issues and undesired side effects (e.g., severe sleepiness, dizziness, disorientation, clumsiness, or unsteadiness) are more common in senior patients, and patients receiving diazepam should be treated with caution and at a lower dose than younger patients.
Physical dependence on benzodiazepines is accompanied by withdrawal symptoms that include sleep disturbances, irritability, increased tension and anxiety, panic attacks, hand tremors, sweating, difficulty concentrating, dry wretching and nausea, some weight loss, palpitations, headache, nausea, and vomiting (see Figure 1).
It is recommended that benzodiazepines be avoided in patients who have a history of drug dependence.Alprazolam, clonazepam, diazepam, and lorazepam are some of the most commonly prescribed benzodiazepines for GAD.Mirtazapine (Remeron) and buspirone are also beneficial in the treatment of generalized anxiety disorder (GAD) in individuals who have failed at least two trials of SSRIs or SNRIs.
When using benzodiazepines or going through withdrawal, sleeplessness and exhaustion are relatively frequent side effects to experience. As previously stated, the medicines have an adverse effect on the brain chemicals that aid in sleep, and while they will ultimately resume functioning, it will take time. It’s that old withdrawal adversary adrenaline at work once more.
When someone is suffering from acute benzodiazepine withdrawal, they are more likely to experience psychosis, which can have life-threatening medical consequences. Drugs known as benzodiazepines, sometimes known as ″benzos,″ are powerful sedatives that are among the most commonly prescribed medications in the United States.
According to the studies included in the literature review, citalopram, sertraline, and extended-release venlafaxine are effective in reducing anxiety in older people. Buspirone and bupropion are two other medications to consider. According to Dr. Pacala, cognitive behavioral therapy (CBT) should also be examined as an option.
In contrast, elderly patients are more likely to experience unwanted side effects (such as severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness) and organ dysfunction (such as kidney or liver failure), which may necessitate caution and a dose reduction for patients taking this medication.
Both medicines are included on the Beers’ List of prohibited substances (drugs that may be inappropriate in older adults). When using Ativan or Xanax, older persons have higher sensitivity to benzodiazepines, and there is an increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in older adults.
Age-related renal, liver, and cardiac issues in senior individuals are more common than in younger people, and they may necessitate greater vigilance and dose reductions in order to avoid undesired side effects (such as severe sleepiness or unsteadiness).
Because of the potential for cumulative toxicity, long-acting benzodiazepines are generally not recommended for elderly individuals. High-potency chemicals (e.g., lorazepam, alprazolam) may be more harmful than low-potency compounds when it comes to short-half-life medications (e.g., benzodiazepines) (e.g., oxazepam).
It is possible to experience drowsiness, dizziness, fatigue, blurred vision, or unsteadiness. If any of these symptoms persist or worsen, notify your doctor or pharmacist as soon as possible. Please keep in mind that this medicine has been recommended by your doctor because he or she has determined that the benefit to you outweighs the risk of adverse effects.