Greta Mitkutė1, Nida Skamarakaitė1
1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania
Benzodiazepines are used worldwide for numerous indications, including insomnia, anxiety, muscle relaxation and epilepsy. Medications act as positive allosteric modulators at the GABAA binding site, potentiating GABA‘s inhibitory effect and, in this way, exert their effects. Although benzodiazepine use has many therapeutic roles and is highly prevalent in the elderly, over-prescribing has many side effects and can result in morbidity or even mortality. Despite all recommendations to limit benzodiazepines use to 2 – 4 weeks, doctors are still prescribing it for months or years, which leads to addiction to benzodiazepines. There is a concern about the over-prescribing of benzodiazepines and the resultant harm. Falls and fall-related complications are significantly associated with use of benzodiazepines. It also increases risk for hospitalization for femur fractures resulting from an accidental fall. Also, chronic consumption of these drugs are most strongly related with cognitive decline in the elderly. Apart from the mentioned risks, long-term usage of benzodiazepines has a tendency to increase the incidence of dementia, particularly in a group of people aged 65 years and older. It seems that benzodiazepine use is associated with an increased risk of Alzheimer’s disease and deaths among Alzheimer’s disease patients. Moreover, prescribed benzodiazepines and attempted or completed suicide has a direct correlation. It is important to recognize and prevent addiction and harm. It can be done by following guidelines on the consumption of benzodiazepines. It is clear that the residual neuropsychological sequelae must be considered when making treatment decisions for older patients. This review reveals the risk of long-term benzodiazepine use, gives recommendations on the management of drugs and offers some ways in which dependence could be prevented.
Keywords: benzodiazepines, GABA, elderly, risk, falls, dementia, Alzheimer’s disease, suicide.