This fall, benzodiazepines will be incorporated as Type 2 medications in the Triplicate Prescription program (TPP) and the College will begin monitoring benzodiazepine prescribing by Alberta physicians.
Canadians are the second highest users of benzodiazepines in the world according to the International Narcotic Control Board. While commonly prescribed to treat insomnia and anxiety conditions, benzodiazepine medications can lead to dependency in some patients and cause other adverse effects, particularly if misused.
Here are some guidelines for safe benzodiazepine prescribing in your practice:
Contraindications for benzodiazepines
- NOT appropriate for treating short term mild anxiety or insomnia; non-pharmacological treatments should be offered first when treating these conditions
- NOT appropriate for patients with known substance abuse issues
- NOT recommended for the elderly – delirium, falls, hip fractures and cognitive impairment have all been associated with use in this population
- NOT recommended for children or adolescents
Safe benzodiazepine prescribing
- Prescribe the lowest dose necessary to control symptoms
- Limit prescription to two to four weeks
- Assess efficacy early and review regularly
- Assess the need for more than one benzodiazepine ( including the use of Z-drugs, such as Zopiclone) rigorously and often
- Be alert to the development of dependence. Tolerance to the effects of benzodiazepines develops quickly (within weeks) and more of the drug is needed to achieve the same effect. Dependence can develop after only three to six weeks at prescribed doses.
- Slow taper: Withdrawal symptoms can occur after a few months of using therapeutic doses on a daily basis. Gradual withdrawal is recommended to minimize symptoms and may take months to complete.
- TOP ( Towards Optimized Practice) – Guideline for Adult Insomnia
- Canadian Guidelines to Safe and Effective Use of Opioids in Chronic Pain, Appendix B-6: Benzodiazepine Tapering
- Benzodiazepines, When to Prescribe – South Australia Health (website)
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