Resource Recommended by Dr. Brianna McQuade: Deprescribing Benzodiazepine Receptor Agonists

Benzodiazepine receptor agonists (BZRAs) are commonly prescribed for insomnia and anxiety, but their long-term use is associated with significant harms. This article presents evidence-based recommendations and clinical considerations for safely tapering and discontinuing BZRAs, with a focus on improving patient outcomes and minimizing adverse effects. An expert team comprising clinicians from various disciplines, along with a methodologist, utilized a systematic process, including the GRADE approach, to develop evidence-based guidelines for BZRA deprescribing. The team conducted a systematic review of deprescribing trials for insomnia and reviewed existing evidence on the harms of continued BZRA use. 

The guideline recommends deprescribing BZRAs for elderly adults (≥65 years) regardless of duration of use and suggests deprescribing for adults aged 18 to 64 who have used BZRAs for more than 4 weeks. These recommendations apply to patients using BZRAs for primary or comorbid insomnia where underlying conditions are effectively managed. However, they do not apply to patients with other sleep disorders or untreated mental health conditions contributing to insomnia. BZRAs pose significant risks, and their therapeutic benefits may be short-lived. Tapering BZRAs has been shown to improve cessation rates without causing serious harm. Patient involvement in the deprescribing process, along with clear communication about the rationale and behavioral advice, can enhance the success of deprescribing efforts. This guideline provides clinicians with evidence-based recommendations to guide decision-making regarding BZRA deprescribing, emphasizing the importance of patient-centered care.

https://www.cfp.ca/content/cfp/64/5/339.full.pdf