COMMENTARY

A New Guide to Deprescribing Benzos and Z-Drugs

Charles P. Vega, MD

Disclosures

June 11, 2018

Hello. I'm Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

Benzodiazepines and "Z" drugs (including zopiclone, zolpidem, and zaleplon) are widely prescribed as a long-term treatment for insomnia. However, the American Geriatrics Society Beers Criteria say they should be avoided,[1] and use in older adults has been associated with falls, dementia, motor vehicle accidents, and physical addiction.

A new guideline[2] provides an evidence-based algorithm to guide the deprescribing process. Most patients, when told that they can expect improvements in cognition and reduction of other adverse effects, are very willing to try to discontinue use of these drugs. And 60%-80% of patients can be successfully tapered off of these hypnotic drugs.

Clinicians should discuss the need to slowly taper in all patients aged 65 years and older, regardless of treatment duration. Younger adults who have used these drugs for longer than 4 weeks should also slowly taper off. A goal reduction of 25% of the dose every 2 weeks is reasonable. The full text of the guidelines, which includes a downloadable version of the algorithm, is available online.

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