Understanding Benzodiazepines and Their Impact on Older Adults.

Benzodiazepines are a class of medications that act on the central nervous system to produce sedative, anxiolytic, hypnotic, anticonvulsant, and muscle relaxing effects. They are commonly prescribed to treat anxiety disorders, insomnia, seizures, and other nervous system-related issues. However, their prolonged use can lead to dependence and other adverse effects. The most commonly used by older adults are those with a shorter half-life and less tendency to accumulate in the body, such as lorazepam (Ativan), alprazolam (Xanax), and oxazepam (Serax). These are preferred due to their lower potential to cause adverse effects and accumulation in the body. However, their use must be carefully monitored due to the risk of dependence and side effects, particularly in older adults, where they may increase the risk of falls, confusion, excessive drowsiness, and loss of memory and attention, in addition to their prolonged use potentially leading to dependence and tolerance, which complicates withdrawal.

This pharmacological group has interactions due to its metabolism (pharmacokinetics), increasing benzodiazepine concentrations in relation to medications like digoxin, omeprazole, and beta-blockers, which are frequently used by older adults. Additionally, in terms of effect (pharmacodynamics), antidepressants, anticonvulsants, neuroleptics, and antihistamines enhance their depressive effects.

The use of these medications should be evaluated by psychiatrists, and depending on the clinical picture, comorbidities, and the age of the older adult, the prescription of benzodiazepines will proceed or not.

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References

Hirschtritt, M. E., Olfson, M., & Kroenke, K. (2021). Balancing the risks and benefits of benzodiazepines. Jama, 325(4), 347-348.es

Ballokova, A., Peel, N. M., Fialova, D., Scott, I. A., Gray, L. C., & Hubbard, R. E. (2014). Use of benzodiazepines and association with falls in older people admitted to hospital: a prospective cohort study. Drugs & aging, 31, 299-310.