Benzodiazepines and Z-drugs raise the risk of falls, fractures, confusion and road accidents in older people, and many long-term users would like to stop. Abrupt withdrawal causes rebound insomnia, anxiety and occasionally seizures. Agree a plan with the patient, reduce the dose by about a quarter every two weeks or more slowly, and slow down further at the lowest doses. Offer cognitive behavioural therapy for insomnia alongside. Written information about the risks and the taper improves success.
- Discuss the falls and confusion risk of long-term hypnotics with every older user.
- Taper gradually — about a quarter of the dose every two weeks, slower near the end.
- Offer cognitive behavioural therapy for insomnia during and after the taper.
- Do not stop abruptly in long-term users.
Why it matters
Removing a sedative-hypnotic is one of the simplest ways to cut falls risk in an older patient.
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