Benzodiapine: using, side effects and risks

Benzodiazepines : too many patients to risk of adverse effects

In 2013, nearly half of users of benzodiazepines were in a situation increasing the risk of occurrence of adverse effects associated with this class of drug : either they were taking other drugs that don't mix with benzodiazepines, they either had health problems that require precautions or contra-indicating the use of benzodiazepines.

Misuse, abuse and dependence of drugs available without a prescription

Psychotropic drugs, consumption and pharmacodépendances : a collective expertise of Inserm Always too many medications prescribed to children off-label Drug-drug Interactions, breathing problems... : Some situations increase the risk of adverse effects of benzodiazepines, particularly the risk of respiratory disorders and alertness, but also that of falls and fractures. However, a study conducted by an Inserm team* within the framework of the platform of pharmaco-epidemiology DRUGS-SAFE, funded by the national security Agency of medicines and health products (MSNA), has just highlighted that almost half of the users are in (at least) one of these situations. Taking into account the frequency of use of these medicines in France, this observation is interesting.

Benzodiazepines are psychotropic drugs that act at the level of the brain and have particular properties of anxiolytics and hypnotics. These drugs are the subject of increased surveillance because of their long-term use exposes them to a risk of pharmacological tolerance, as well as the mental and physical dependence which can manifest itself by a withdrawal syndrome upon cessation of treatment. In addition, benzodiazepines are not without side effects : they can lead to disorders of vigilance, ranging from simple drowsiness to profound sedation, including an increased risk of falls among the elderly. These medications may also lead to the occurrence of respiratory distress which is manifested by an inability to breathe normally.

Drugs under surveillance

The MSNA is closely following the use of these drugs in order to develop measures to limit the use. In this context, she asked the researchers to produce a report from data care reimbursement of health Insurance. This work has been to look at the profile of users of benzodiazepines, including their risk factors for adverse effects. "We know that taking other drugs, among those acting on the central nervous system with a sedative effect, can increase the risk of sedation, falls and respiratory failure. It's the same with certain comorbidities, such as respiratory problems or mobility. We therefore wanted these different risk factors among the users," says Anne Bénard, one of the authors of this work.

In the first place, their analysis confirms the very high consumption of these drugs in the general population, with 13.8% of patients having undergone at least a refund in 2013. Women are by far the most involved and the frequency of use increases with age. Thus, past 80 years, nearly two women out of five have benefited from at least a refund of a benzodiazepine in the year !

Many counter-indications

But the authors mostly found that nearly half of the users had a risk factor of adverse effect at the time of prescription : drug interactions at risk (40% of the users concerned), particularly with opioid analgesics or antitussives, respiratory problems such as asthma, chronic obstructive pulmonary disease or respiratory failure (11% of the users), or comorbidity increasing the risk of falls and fractures (7%).

For Anne Bénard, "these figures are worrying given the large number of subjects treated with benzodiazepines in France, in particular among elderly subjects in whom the risk of side effects from these medications is increased. Potential drug-drug interactions, the most frequently encountered, are yet in the instructions for use and should therefore be restricted to cases where other alternatives do not exist".

The question then arises as to the justification of all these prescriptions for benzodiazepines : "On this point, our data do not allow to meet, the exact indication of the treatment is not known. But previous work has already highlighted a misuse of these drugs and durations of use inadequate", she says. However, there are therapeutic alternatives : "the antidepressant-like inhibitors of serotonin reuptake inhibitors are currently recommended in first intention in the treatment of anxiety disorders. Benzodiazepines should be reserved for the symptomatic treatment of the manifestations of anxiety. By the way, their place in the treatment of severe disturbances of sleep was questioned, as was recently reminded of the High authority of health," she concludes.