A programme for short-term withdrawal from benzodiazepines in geriatric hospital inpatients: success rate and effect on subjective sleep quality

Abstract

Objective We tested the hypothesis that a short‐term programme for withdrawal of benzodiazepines (BZD) is feasible in hospitalized geriatric patients. Methods Fifty‐six geriatric subjects who had been taking BZD for at least 3 months were asked to discontinue these drugs upon admission to the inpatient ward. A withdrawal programme including initial substitution therapy combined with psychological consulting was offered. The usual BZD medication was replaced by either lormetazepam 1 mg or trazodone 50 mg, administered at bedtime. After 1 week of replacement therapy all sedative medication was stopped. The subjective estimations of sleep quality were evaluated four times during a period of 6 weeks. Results Forty‐nine patients agreed to participate. In this group four subjects (8.2%) resumed BZD use while in the hospital and another seven subjects (14.3%) relapsed after discharge. Therefore, the overall success rate was 77.6% in the group of volunteers and 67.9% in the total group of eligible patients. The data of the present study further demonstrate that no major withdrawal symptoms occurred and that the subjective quality of sleep remained virtually unchanged in the course of the programme. The sleep quality was not significantly different in patients on trazodone versus patients on lormetazepam. The success rate was similar in both drug substitution groups. Conclusions Short‐term withdrawal of BZD may be achieved in two‐thirds of elderly hospital inpatients without deterioration of sleep quality or other deleterious side‐effects. Copyright © 1999 John Wiley & Sons, Ltd.

Strategies for discontinuing long-term benzodiazepine use

“…After screening of the abstracts and if necessary the full text, 246 papers were excluded (Fig. 1) and 29 papers met the inclusion criteria (Tyrer et al , 1981; Lader & Olajide, 1987; Ashton et al , 1990; Cantopher et al , 1990; Jones, 1990; Udelman & Udelman, 1990; Garcia-Borreguero et al , 1991; Schweizer et al , 1991; Di Costanzo & Rovea, 1992; Lader et al , 1993; Otto et al , 1993; Bashir et al , 1994; Cormack et al , 1994; Schweizer et al , 1995; Tyrer et al , 1996; Lemoine et al , 1997; Hantouche et al , 1998; Garfinkel et al , 1999; Petrovic et al , 1999; Rickels et al , 1999, 2000; Cialdella et al , 2001; Zitman & Couvée 2001; Gerra et al , 2002; Vorma et al , 2002; Baillargeon et al , 2003; Oude Voshaar et al , 2003 a ; Rynn et al , 2003; Morin et al , 2004).…”

Is There a Rationale for Prescription of Benzodiazepines in the Elderly? Review of the Literature

“…Most geriatric patients who are habituated to a lowdose of BZDs may wean during a short period, if an initial phase with dose reduction and psychological support is included in the withdrawal program. Two-thirds of chronic elderly users can thus successfully be withdrawn from BZDs by a single step of dose reduction, maintained during 1 week (78,79). The authors conclude that a faster taper should be encouraged, as it may fit in a short-term admission to the ward.…”

“…Trazodone, a non-tricyclic sedative antidepressant, is frequently used in low doses as a hypnotic. It has also been proposed as a convenient agent for the substitution of BZDs in withdrawal programmes (78)(79)(80). Trazodone is particularly effective for patients with depression-associated insomnia.…”

“…The size of the stepwise lowering in dosage that should be utilized is arguable as well. Certain investigators use a fixed tapering schedule, while others claim that the reduction rate should be titrated against the patient's withdrawal symptoms (78).…”

“…Recently Petrovic et al showed that a short-term BZD withdrawal program is possible in the hospital setting (78). Most geriatric patients who are habituated to a lowdose of BZDs may wean during a short period, if an initial phase with dose reduction and psychological support is included in the withdrawal program.…”