Hypnotics and anxiolytics

Benzodiazepines are inappropriate to use in patients aged 65 years and older:

for ≥ 4 weeks (no indication for longer treatment; risk of prolonged sedation, confusion, impaired balance, falls, road traffic accidents; all benzodiazepines should be withdrawn gradually if taken for more than 4 weeks as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped abruptly)

with acute or chronic respiratory failure i.e. pO2 < 8.0 kPa ± pCO2 > 6.5 kPa (risk of exacerbation of respiratory failure).

if they have a history of falls (sedative, may cause reduced sensorium, impair balance).

For people with learning difficulties initiate treatment with low doses and titrate cautiously with frequent monitoring for side effects

Information resources

British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders 2019

NICE evidence summary on withdrawal of benzodiazepines and z-drugs

NICE TA77 Guidance on the use of z-drugs for the short-term treatment of insomnia

SPS What are the equivalent doses of oral benzodiazepines?

Formulary medications