2023-05-08 20:55:00
For some years now, the different clinical practice guidelines have promoted a prudent and time-limited use of these drugs.
By: Mariana Mestizo Hernandez
Las benzodiazepines are a class of drugs commonly used to treat eating disorders anxiety and disorders of dreamas well as to prevent convulsions and relax the muscles. These drugs work by increasing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which causes a decrease in nerve activity, producing a feeling of calm and relaxation.
Due to its depressant effect on the central nervous system (CNS), benzodiazepines They are considered as a type of sedative medication.
Reframe the prescription
According to a study published in General and Family Medicine, 89% of prescriptions for benzodiazepines in patients older than 65 years they may be potentially inappropriate. Therefore, it is essential that the physician pay special attention to the suitability and reassessment of these prescriptions, since these medications should not be prescribed for a period longer than four weeks.
However, for some years the different clinical practice guidelines have promoted a prudent and time-limited use of these drugs. In addition, there are other psychoactive drugs such as antidepressants, antipsychotics or antiparkinsonian drugs whose prescription is considered potentially inappropriate if combined with the benzodiazepines.
Important aspects to prescribe the drug
Dr. Javier Gómez Pavón, head of the Geriatric Service of the Red Cross Hospital in Madrid, and member of the leadership team of the Spanish Society of Geriatrics and Gerontology, commented on important aspects when prescribing a benzodiazepine to an older patient.
“They should not be prescribed for more than four weeks, since there is no indication for longer treatments due to the risk of prolonged sedation, confusion, loss of balance, falls and traffic accidents; all benzodiazepines should be discontinued gradually if the treatment has exceeded four weeks, since there is a risk of withdrawal syndrome when discontinued abruptly,” he explained.
What did the study consist of?
Dr. Cayetana de Miguel, a family doctor at the Ventura Rodríguez health center in Madrid, and one of the authors of the study, pointed out that “the reason that the STOPP/START criteria were not met was the prescription of benzodiazepines with a duration of less than four weeks, since the criteria are defined as the prescription for more than four weeks or two benzodiazepines concurrent”.
According to the National Library of Medicine, the STOPP/START criteria make it possible to detect potentially inappropriate prescribing (PPI) at the individual level. Its application at the population level makes it possible to determine the prevalence of PPI and its relationship with various variables of the patient and the health system.
The research sought to establish a cause-effect relationship for the population over 65 years of age with at least one benzodiazepine prescribed in the indicated period. Likewise, hospitalized and terminally ill patients are excluded.
Only 11% meet the criteria
The study had the initial participation of 226 people, but 18 of them were excluded for not meeting the inclusion criteria, resulting in a total of 208 participants. Nearly 89% of patients older than 65 years were found to have a potentially inappropriate prescription for benzodiazepines according to the 2014 STOPP/START criteria. In addition, it was observed that 72.1% of the patients included in the study were women.
Similarly, half of the subjects belonged to the 65 to 75 age group and the other half (49.5%) to patients older than 75 years, with a mean age of 75.4 years.
On the other hand, the indication of the prescription, 51.9% was for insomnia51.3% for anxiety, 36.1% for depression and 7.2% for agitation; there were 14% due to other reasons not registered or different from the options contemplated.
In addition, 11.5% of the older patients had been prescribed at least two benzodiazepines. In turn, it was observed that more than half of the patients were being treated with other psychoactive drugs (antidepressants: 41.3%; hypnotics: 8.2%; antipsychotics: 4.3%).
must be stopped on time
Dr. Gómez Pavón highlighted that with regard to pharmacological alternatives for older patients, “the benzodiazepines in the elderly they are useful and have their usual indications, but the question is not not to prescribe them, but to withdraw them on time, that is, not to leave them beyond four weeks, facilitating the non-pharmacological treatment of each entity, sharing in common exercise, hygiene dreamprescription of unindicated treatments and of course, psychotherapy”.
alternative treatment
Among the hygienic-dietary measures of the dreamDr. De Miguel affirmed that there are techniques that the patient can use to avoid the consumption of these drugs, such as establishing more or less regular times to get up or go to bed, trying to achieve a quiet environment, without light and noise, being able to implement the use mask or earplugs, avoid naps, especially for more than half an hour.
Likewise, avoid the consumption of stimulating drinks, as well as physical exercise in the six hours before going to sleep, try to maintain a balanced diet; Minimize the use of screens at night and try not to sleep with the television on or similar, preferable to induce dream with relaxing music or reading; relaxation exercises are also beneficial.
On the other hand, the specialist pointed out the alternative treatment of the anxiety“regarding behavioral measures for the treatment of anxietywe refer to them to define the recommendations to implement small or large changes in the habits of daily life and thus reduce the level of stress and nervousness”.
That is, exercising regularly, limiting the consumption of alcohol, stimulants, tobacco or other drugs, seeking pleasurable activities to do daily or on weekends that provide motivation or challenge, spending time outdoors taking walks or practicing a sport, among others.
Analyze side effects
“In this case, it would be interesting to assess the prevalence of side effects of these drugs, evaluating whether patients with a potentially inappropriate prescription of benzodiazepines have suffered falls, have dizziness, instability or agitation, among others, as well as assess whether the symptoms for which the prescription was started improved or disappeared, or conversely, continued or worsened,” he concluded.
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