Deprescribing benzodiazepines

Topic: Risk, prevention and care in population studies

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. Studies show that providing education on the long-term use of medications and information regarding possible withdrawal symptoms during the process along with a plan to mitigate them can assist the patient in making an informed decision about embarking on the process of gradual reduction.11 Simple tools such as the Eliminating Medications through Patient Ownership of End Results (EMPOWER) brochure, targeted toward the older adult population and available in the public domain, can be a valuable educational instrument.12,13 NPs can then explain how the deprescribing process works and discuss a plan specific to that patient.14 A clear plan designed collaboratively by the prescriber and the patient, with the patient in control of the tapering schedule, is more likely to facilitate patient engagement in the tapering process.1 Concerns and questions from the patient, the family, a

Key findings

• 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
• Studies show that providing education on the long-term use of medications and information regarding possible withdrawal symptoms during the process along with a plan to mitigate them can assist the patient in making an informed decision about embarking on the process of gradual reduction.11 Simple tools such as the Eliminating Medications through Patient Ownership of End Results (EMPOWER) brochure, targeted toward the older adult population and available in the public domain, can be a valuable educational instrument.12,13 NPs can then explain how the deprescribing process works and discuss a plan specific to that patient.14 A clear plan designed collaboratively by the prescriber and the patient, with the patient in control of the tapering schedule, is more likely to facilitate patient engagement in the tapering process.1 Concerns and questions from the patient, the family, and/or caregivers must also be addressed.
• NPs also need to assess for a history of seizure disorders, history of weaning from benzodiazepines, history of substance use, a specific pattern of use, length of use, and type of medication used (short- versus long-acting).
• In patients who have depression or anxiety disorders, start, continue, or increase the dose of a selective serotonin reuptake inhibitor (SSRI) or selective norepinephrine reuptake inhibitor (SNRI) until significant improvement in symptoms (less anxiety and depressed mood, improved appetite and sleep, no suicidal ideation, and so forth) is seen, which may take 8 to 12 weeks before weaning benzodiazepines.
• Withdrawal effects vary among patients and can include anxiety, physical symptoms (for example, perspiration, tachycardia, hot and cold flushes, or tremors), and perceptual symptoms (for example, increased sensitivity to light, taste and smell disturbances, or increased sensitivity to touch).20 These symptoms tend to occur faster with shorter-acting agents (within 2 to 3 days) than longer-acting agents (within 5 to 10 days).21 Tapering may need to be slower if patients have significant withdrawal problems or are long-term users of benzodiazepines (more than 1 year).

Why it matters

This article discusses deprescribing benzodiazepines in older adults, noting that long-term use increases the risk of dementia and that guidelines recommend avoidance in older adults. It suggests that reducing benzodiazepine use may lower a risk factor associated with dementia, but does not test a treatment or cure.

Study details

• Effect sizeincreased by 67%
• Evidence strengthLow

Read the original

• DOI: 10.1097/01.npr.0000550253.04526.30
• PubMed: 30672861
• Original source →

May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.

@article{scrandis2019-30672861,
  author  = {Scrandis, Debra A. and Duarte, Ana Catarina},
  title   = {{Deprescribing benzodiazepines}},
  journal = {The Nurse Practitioner},
  year    = {2019},
  doi     = {10.1097/01.npr.0000550253.04526.30},
  pmid    = {30672861},
  url     = {https://doi.org/10.1097/01.npr.0000550253.04526.30}
}

Related studies in Health systems and care delivery

• Benzodiazepines of long and short elimination half-life and the risk of hip fracture JAMA · 1989-12-01 · usefulness score 55/100
• Disparities in High-Risk Medication Use—Implications for Health Equity and Deprescribing Practices JAMA Network Open · 2025-04-14 · usefulness score 36/100
• Family physicians' attitudes toward people with dementia and their association with empathy Research Square · 2026-10-14 · usefulness score 16/100
• Performance of Claims-based Alzheimer’s Disease and Related Dementias Algorithms in Medicare Advantage and Fee-for-Service Populations The Journals of Gerontology Series A · 2026-09-17 · usefulness score 52/100
• Structural brain imaging for newly diagnosed cognitive impairment by Medicare coverage type Journal of the American College of Radiology : JACR · 2026-09-15 · usefulness score 43/100
• Comparison of Expert Reads Versus Local Clinical Reads of Amyloid PET Scans in the IDEAS Study Journal of nuclear medicine : official publication, Society of Nuclear Medicine · 2026-09-10 · usefulness score 37/100

Similar studies

• Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research 2017 · Clinical safety
• Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management 2016 · Clinical safety
• Using antipsychotic agents in older patients 2004 · Clinical safety
• Deprescribing for People with Dementia: A Roadmap 2025 · Caregiving
• Recomendaciones de uso de donanemab 2026 · Treatments
• Development of Cognitive Instruments for Use in Clinical Trials of Antidementia Drugs 1997 · Cognitive tests and assessment

More on Health systems and care delivery

• Newest in this subject Expert opinion on Alzheimer's disease diagnostics and management in Central Eastern European countries representing 88 million population Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026-09-09 · Peer-reviewed · usefulness score 44/100
• Newest in this subject Association between Internet Use for Health Information and Self-reported Alzheimer’s Disease Diagnosis among Older Adults in the United States: Racial and Gender Disparities Research Square · 2026-08-27 · Preprint — not yet peer-reviewed · usefulness score 16/100

See all studies in Health systems and care delivery →