Benzodiazepines (BZD) and other related medicines are powerful anxiolytics and sedatives. In the elderly, these treatments expose them to fall, cognitive deteriorations and risks of accidents in public spaces.
In addition, the brutal stop of the treatment can involve a withdrawal syndrome. It is thus necessary to define with the patient a strategy of ceasing and this as from the setting of the treatment.
In October 2007, the Haute Autorité de Santé
established professional recommendations concerning the methods of ceasing benzodiazepines and the connected drugs in elderly patients.
Here are the recommendations.
Treatment by BZD and similar drugs
The HAS recommends to explain well to the patient, at the beginning of the treatment, the methods of progressive stop, because of the risks associated with taking these drugs.
The doctor must imperatively wonder about the implementation of a strategy of quitting in the event of a request for renewal of the treatment. If the older patient (more than 65) has been treated daily for more than 30 days and the treatment is not valid any more, it is then necessary to offer him a strategy to quit its consumption.
When to quit, the HAS advises "to evaluate the expectations of the patient, his degree "of attachment" to BZD, to lead to a shared decision and to evaluate the prognostic factors. And, in addition, to distinguish the situations requiring a particular strategy".
Strategy of the attending physician
When there is no need to treat a patient with BZD anymore and that the decision to quit was made commonly by the patient and the doctor, the latter will have to evaluate the difficulty of this cease for his patient.
Indeed, in certain cases, special precautions must be taken. These cases are:
- Chronic insomnia;
- Characterised anxious disorder ( panics, obsessive-compulsive disorder);
- Cognitive disorder, dementia ;
- Former failures of cease;
- Regular overconsumption of alcohol.
The following cases require a joint specialist dealing:
- Very high doses of BZD;
- Rebel insomnia;
- Addiction to alcohol;
- Another addiction;
- Associations with other psychotropic medication;
- Severe psychiatric disorders.
The HAS insists on the fact that quitting must be progressive and adapted. Generally it is spread out over 4 to 10 weeks. After the discontinuation of treatment, the patient will be followed for 6 months.
A certain number of tools exist to determine the degree of attachment of the patient to BZD, to evaluate sleep quality or to follow the cease.
Find here the sleeping-wake up calender.
Download the cognitive scale of attachment to benzodiazepines (ECAB).
Lastly, download the calendar of cease follow-up.
Find the professional recommendations of the HAS in their entirety: Steps to stop benzodiazépines and other related drugs in the elderly patient
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