Abstract
Prescribing guidelines do not recommend the long-term use of benzodiazepines since their effectiveness with chronic use is out-weighed by risks including dependence, memory and cognitive impairment, hip fractures and traffic accidents. Despite these guidelines, historical data points to an increasing proportion of inappropriate, repeat prescribing of benzodiazepines in Ireland and elsewhere, with up to 33% of patients who use these drugs doing so long-term. The typical long-term benzodiazepine user is an older, socio-economically disadvantaged patient who has been prescribed these medicines by their general practitioner (GP) and dispensed them by their community pharmacist. Misuse of benzodiazepines in nursing homes and psychiatric institutions is also of concern, with one Irish study indicating that almost half of all admissions to a psychiatric hospital were prescribed these drugs, usually despite a lack of clear clinical need. Discontinuation of benzodiazepines has proven to be of benefit, as it is followed by improvements in cognitive and psychomotor function, particularly in elderly patients. It is obvious that an inter-professional effort, focusing on the primary care setting, is required to address benzodiazepine misuse and to ensure appropriate pharmaceutical care. Pharmacists must be an integral part of this inter-professional effort, not least because they are uniquely positioned as the health professional with most frequent patient contact. There is already some supporting evidence that pharmacists’ involvement in interventions to reduce benzodiazepine use can have positive effects on patient outcomes. Here, this evidence is reviewed and the potential for pharmacists to play an expanded role in ensuring the appropriate use of benzodiazepines is discussed.
Highlights
Benzodiazepine drugs were first introduced into clinical practice circa fifty years ago as anxiolytic and hypnotic agents
Benzodiazepines have a broad range of activities including anxiolytic, hypnotic/sedative, amnesic, anticonvulsant and anti-spasmodic effects, that largely reflects the distribution of different GABAergic receptor subtypes in the brain, as well as the distinct affinity of particular drugs for particular receptor subtypes
Evidence suggests that while they may have long-term efficacy in limited patient groups including those with panic disorder and social phobia [23,24,25], the proportion of benzodiazepine users who fall into these diagnostic categories is very low, suggesting that the vast majority of long-term users do not derive clinical benefit from benzodiazepines [26]
Summary
Benzodiazepine drugs were first introduced into clinical practice circa fifty years ago as anxiolytic and hypnotic agents. Despite the fact that widespread concerns surrounding their use have abounded for three decades, these drugs are still widely prescribed in most industrialized countries and diazepam is reputedly one of the most widely prescribed drugs of all time [1]. These concerns relate to their unfavourable side-effect profile, as well as their propensity for dependence and potential for abuse [2]. The clinical effectiveness of these drugs is a question of much debate and there is growing evidence that their chronic prescription is a matter of grave concern for health professionals, legislators and, most importantly, patients [3,4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
