Benzodiazepines

In general, benzodiazepines are frequently associated with increasing confusion, falls and memory impairment in elderly patients. In people with FTD, benzodiazepines have been associated with an increase in behavioral problems and impair both memory and psychomotor skills. Repeated use of large doses or, in some cases, daily use of therapeutic doses of benzodiazepines is associated with amnesia, hostility, irritability and vivid or disturbing dreams, as well as tolerance and physical dependence. Use can result in reduced inhibition and impaired judgment. Benzodiazepines have also been associated with anticholingeric-like effects, such as urinary retention and dry mouth. Anxiolytics recognized as benzodiazepines should be avoided.

Carefully evaluate alternatives for these medications, and if they cannot be avoided, consider using them for only a short time. When used for anxiety, consider nonpharmacological supportive strategies. If co-existing with depression, consider use of paroxitene (Paxil®), citalopram (Celexa®) or buspirone (Buspar®). When used for sleep:

• Consider good sleep hygiene
• Encourage adequate physical activity during the day
• Try melatonin
• Try trazodone (Desyrel®)

Examples

• Short-acting benzodiazepines: triazolam (Halcion®) and Midazolam (Versed®)
• Intermediate-acting benzodiazepines: lorzepam (Ativan®), temazepam (Restoril®), alprazolam (Xanax®), oxazepam (Serax®), estazolam (ProSom®)
• Longer-acting benzodiazepines: diazepam (Valium®), chlordiazepoxide (librium®), clorazepate (Tranxene®), halazepam (Paxipam®), prazepam (Centrax®), quazepam (Doral®) and clonazepam (Klonopin®), flurazepam (Dalmane®)