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McIntosh B, Clark M, Spry C. Benzodiazepines in Older Adults: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2011 Jan.

1CONTEXT AND POLICY ISSUES

Benzodiazepines are compounds that enhance the activity of gamma-aminobutyric acid (GABA)-A receptors by increasing the affinity of the receptors for GABA.1 Benzodiazepines are typically grouped, based on their pharmacokinetic properties, into three categories: short-acting, intermediate-acting, and long-acting (Table 1).2 The basis for these groups is the differences in the half-life of parent compounds and active metabolites, which can range from one to four hours for short-acting to 100 hours for long-acting.2 These differences are a key consideration when health care professionals select a benzodiazepine for use by patients. For example, short-acting agents are preferable for the treatment of insomnia, and intermediate-acting or long-acting agents are preferable for the treatment of anxiety disorders.2 Overall, the labelled indications include, the treatment of anxiety disorders, panic disorder, insomnia, seizure disorders, skeletal muscle spasticity, and alcohol withdrawal.2

Table 1. Pharmacokinetic Classification of Benzodiazepines Available in Canada.

Table 1

Pharmacokinetic Classification of Benzodiazepines Available in Canada.

Benzodiazepines have been associated with several adverse effects, including ataxia, dizziness, over-sedation, anterograde amnesia, and dependence.2 The severity of adverse effects, particularly those associated with the central nervous system, may be greater in older adults. Therefore, close monitoring is typically recommended when benzodiazepines are used by older adults.2 In addition, several reviews and guidelines recommend that long-acting benzodiazepines be avoided by older adults.35

In 2005, Mamdani et al. estimated that in Ontario, the prevalence of benzodiazepine use by adults older than 65 years was 15%.6 Despite a downward trend in use, benzodiazepines remained the most highly prescribed mental-health related drug in this population from 1996 to 2002.6 Based on the high use of the drug and the documented safety concerns for older adults, a review of the evidence is warranted.

Copyright © CADTH (January 2011)

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Industry: The following manufacturers were provided with an opportunity to comment on an earlier version of this report: Sepracor Pharmaceuticals Inc., Hoffmann-La Roche Ltd., and Pfizer Canada Inc. All comments that were received were considered when preparing the final report.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Cover of Benzodiazepines in Older Adults: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines
Benzodiazepines in Older Adults: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet].
McIntosh B, Clark M, Spry C.

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