Don’t routinely prescribe benzodiazepines or Z -drugs in elderly patients in case of insomnia as first choice treatment. Physicians should always recommend intermittent use of these drugs.In case of chronic use, evaluate both the indications and the possible occurrence of side effects
Several studies show an increased risk of falls and hip fracture in elderly patients taking benzodiazepines or Z-drugs (zolpidem, zopiclone, zaleplon). This risk also exists for safer protocols (i.e. short-term therapies with low-dose and short half-life drugs). The risk of falls can be increased initially by a reduced state of alertness upon awakening. Later may intervene accumulation with possible motor and cognitive impairments, also favoured by the elderly different pharmacokinetics.
1. Finkle WD et al., Risk of fractures requiring hospitalization after an initial prescription of zolpidem, alprazolam, lorazepam or diazepam in older adults. J Am Geriatr Soc [Internet] 2011 Oct; 59(10): 1883–1890.
2. Allain H et al., Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Drugs Aging [Internet] 2005; 22(9): 749–765.
3. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012 Apr; 60(4): 616-31.
4. Bain KT, Management of chronic insomnia in elderly persons. Am J Geriatr Pharmacother. 2006 Jun; 4(2): 168-92.
5. Dündar Y et al., Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation. Health Technol Assess 2004 Jun;8(24): iii-x, 1-125.
Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.