The mechanism of action of benzodiazepines is through the modulation of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that suppresses the central nervous system (CNS); the drugs have efficacy for short-term use (less than 1 month), but patients can develop a tolerance and dependence with long-term use.2 The benefits of benzodiazepines decrease over time and there are increased associated risks such as cognitive decline, accidental injuries, falls, and increased rates of hospital admissions and ED visits.2 Patients can also have paradoxical anxiety while on benzodiazepines.3 Studies have shown that long-term use of benzodiazepines increases the risk of dementia.4,5 Recent clinical practice guidelines recommend deprescribing benzodiazepines for older adults (age 65 years or older) for use in insomnia, and the American Geriatric Society (AGS) BEERs Criteria recommend avoidance of benzodiazepines in older adults because of the increased risk of adverse reactions such as falls and fractures.1,6 The AGS does say that benzodiazepines may be appropriate for use in older adults in certain circumstances such as ethanol withdrawal, and periprocedural anesthesia.6 The FDA has cautioned providers about prescribing benzodiazepines in patients using opioids but does not recommend withholding medications used for opioid use disorder in patients taking benzodiazepines.7,8 NPs can be instrumental in adequately treating anxiety and insomnia disorders with nonpharmacologic interventions (such as yoga and sleep hygiene) as well as with other medication classes that are not benzodiazepines. 5 key findings →
Evidence: low
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