When can you use benzos appropriately?

I’ve seen a fair number of elderly patients on benzos at bedtime. The patients claim that it calms their nerves and helps them sleep better.

To which I say, yeah, I’d like to have that, too.

Too often, benzos are used to treat symptoms, and do not address the underlying cause. For instance, I saw one 85 year old patient on TID Ativan, which is VERY IRRESPONSIBLE because it’s like throwing nitro patches on someone with new angina and not doing a stress test.

Benzos are appropriate for people with:

  • short-term treatment of anxiety disorders
  • insomnia for short bouts (2-4 weeks, dosed intermittently) although patients can get rebound insomnia
  • maintenance benzos can be used in people who are refractory to other treatments or who have already become dependent and would have a difficult time withdrawing

Here are some guidelines when prescribing benzos:

  • If it’s the first time someone is taking benzos, don’t prescribe for more than 1 month at a time
  • Always use the lowest effective dose
  • If someone is on maintenance¬†benzos, use a long-acting one and do not exceed the equivalent of 15 mg of diazepam daily
  • In elderly patients, avoid long-acting benzos (these can cause cognitive and gait abnormalities and sedation). Make sure you are not treating depression with benzos, because this will only make it worse.

If a person on high-dose, daily benzos comes into the hospitals, do not stop their benzos as this can precipitate withdrawal. But see if they’d be willing to start on a taper, or reduce their benzos.

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