This guideline does not apply to those with other sleep disorders or untreated anxiety , depression , or other physical or mental health conditions that might be causing or aggravating insomnia .
Benzodiazepine receptor agonists are associated with harms , and therapeutic effects might be short term .
Tapering BZRAs improves cessation rates compared with usual care without serious harms .
Patients might be more amenable to deprescribing conversations if they underst and the rationale ( potential for harm ) , are involved in developing the tapering plan , and are offered behavioural advice .
OBJECTIVE To develop an evidence -based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists ( BZRAs ) ; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development , review , and endorsement processes .
Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach.
BACKGROUND Benzodiazepines are the most frequently used drug for the treatment of insomnia . Prolonged use of benzodiazepine therapy is not recommended . However , many patients , particularly older patients , have difficulties discontinuing therapy . Melatonin , a hormone that is produced at night by the pineal gl and , promotes normal sleep in humans and augments sleep induction by benzodiazepine therapy . OBJECTIVE To assess whether the administration of melatonin could facilitate the discontinuation of benzodiazepine therapy in patients with insomnia . METHODS Thirty-four subjects receiving benzodiazepine therapy were enrolled in the 2-period study . In period 1 , patients received ( double-blinded ) melatonin ( 2 mg in a controlled-release formulation ) or a placebo nightly for 6 weeks . They were encouraged to reduce their benzodiazepine dosage 50 % during week 2 , 75 % during weeks 3 and 4 , and to discontinue benzodiazepine therapy completely during weeks 5 and 6 . In period 2 , melatonin was administered ( single-blinded ) for 6 weeks to all subjects and attempts to discontinue benzodiazepine therapy were resumed . Benzodiazepine consumption and subjective sleep- quality scores were reported daily by all patients . All subjects were then allowed to continue melatonin therapy and follow-up re assessment s were performed 6 months later . RESULTS By the end of period 1 , 14 of 18 subjects who had received melatonin therapy , but only 4 of 16 in the placebo group , discontinued benzodiazepine therapy ( P = .006 ) . Sleep- quality scores were significantly higher in the melatonin therapy group ( P = .04 ) . Six additional subjects in the placebo group discontinued benzodiazepine therapy when given melatonin in period 2 . The 6-month follow-up assessment s revealed that of the 24 patients who discontinued benzodiazepine and received melatonin therapy , 19 maintained good sleep quality . CONCLUSION Controlled-release melatonin may effectively facilitate discontinuation of benzodiazepine therapy while maintaining good sleep quality
This guideline does not apply to those with other sleep disorders or untreated anxiety , depression , or other physical or mental health conditions that might be causing or aggravating insomnia .
Benzodiazepine receptor agonists are associated with harms , and therapeutic effects might be short term .
Tapering BZRAs improves cessation rates compared with usual care without serious harms .
Patients might be more amenable to deprescribing conversations if they underst and the rationale ( potential for harm ) , are involved in developing the tapering plan , and are offered behavioural advice .
OBJECTIVE To develop an evidence -based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists ( BZRAs ) ; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development , review , and endorsement processes .