Paquin Allison M, Zimmerman Kristin, Rudolph James L
VA Boston Healthcare System (VABHS) , Boston, MA , USA +1 617 794 6401 ;
Expert Opin Drug Saf. 2014 Jul;13(7):919-34. doi: 10.1517/14740338.2014.925444. Epub 2014 Jun 6.
Benzodiazepines (BZD) are potentially inappropriate for older adults, yet their use persists. Patients and providers may hesitate to discontinue BZDs due to concerns for withdrawal or relapse. We reviewed the literature for BZD reduction protocols to examine common elements, safety and efficacy. A framework is proposed for clinicians to address BZD reduction challenges.
Following a systematic literature review, this analysis included 28 studies of older out-patients tapering chronic BZDs. Populations included insomnia, depression and anxiety. Protocols included taper alone (32%), taper plus cognitive behavioral therapy (32%) and taper plus medication substitution (36%). Success rates were favorable for all modalities (mean 60%, median 67%, range 25 - 85%) and independent of dose or duration of use. Common schedules included a 25% dose reduction over 1 - 2 weeks until drug-free. Withdrawal symptoms included mainly mild psychological and somatic concerns. No serious safety events were reported.
BZD reduction protocols among older adults are feasible and successful. Given unique cognitive and functional abilities and comorbidities of older adults, a patient-centered approach to reduction is needed. Our framework guides clinicians in planning and persisting with BZD reduction, while our checklist addresses tailored tapers. Monitoring and support is emphasized, and taper modifications are proposed for struggling patients.
苯二氮䓬类药物（BZD）对老年人可能存在潜在的不适用性，但其使用仍在持续。由于担心戒断反应或复发，患者和医疗服务提供者可能会犹豫是否停用BZD。我们查阅了有关BZD减量方案的文献，以研究其共同要素、安全性和有效性。本文为临床医生应对BZD减量挑战提出了一个框架。
在进行系统的文献综述后，该分析纳入了28项关于老年门诊患者逐渐减少慢性BZD使用的研究。研究人群包括失眠、抑郁和焦虑患者。方案包括单纯减量（32%）、减量加认知行为疗法（32%）和减量加药物替代（36%）。所有方式的成功率都较好（平均60%，中位数67%，范围25%-85%），且与使用剂量或持续时间无关。常见的方案包括在1-2周内将剂量降低25%，直至停药。戒断症状主要包括轻度的心理和躯体问题。未报告严重的安全事件。
老年人的BZD减量方案是可行且成功的。鉴于老年人独特的认知和功能能力以及合并症，需要采取以患者为中心的减量方法。我们的框架指导临床医生规划并坚持进行BZD减量，而我们的清单则涉及量身定制的减量方案。强调了监测和支持，并为减量困难的患者提出了调整方案。
