Pharmacist-Led Education Associated With Increased Benzodiazepine Discontinuation

Benzodiazepines and closely related sedative-hypnotics (BSH) are frequently prescribed to treat insomnia. Although intended for short-term use, these medications are often continued inappropriately for extended periods. This is particularly concerning in older adults, as prolonged BSH use is associated with adverse outcomes such as cognitive decline, falls, and dependence.^1,2

Benzodiazepine pills | Image credit: AugmentArt | stock.adobe.com

Clinical guidelines recommend discontinuation due to the risks of long-term use, including patient harm, increased health care burden, and cost. However, deprescribing is challenging. Patients may resist discontinuation due to physiological or psychological dependence, anxiety, or sleep disturbances. Additionally, health care providers may lack knowledge of alternative therapies and effective deprescribing strategies.¹

To address this gap, The BMJ published a systematic review and meta-analysis of randomized controlled trials as part of the BMJ Rapid Recommendations project, prompted by the Benzodiazepine and Sedative Hypnotic Use to Improve Patient Safety and Quality of Care (BE-SAFE) initiative. The review assessed the comparative effectiveness of interventions designed to support BSH discontinuation.¹

The evidence supporting various interventions was of low certainty. However, 3 approaches—patient education, medication review, and pharmacist-led educational interventions—were associated with a modest increase in BSH discontinuation rates compared to usual care. Other strategies, including tapering schedules, physician education, combined patient-physician education, cognitive behavioral therapy, mindfulness, other pharmacist-led interventions, and drug-assisted withdrawal, did not consistently outperform usual care.¹

This review updates and expands upon prior research, but the low-certainty evidence highlights the need for more rigorous, high-quality comparative trials. The studies included limited data on long-term outcomes such as quality of life or symptom recurrence. Notably, most participants were in their 50s, limiting generalizability to older adults who are at greater risk from prolonged BSH use.¹

Despite these limitations, the findings reaffirm the risks of prolonged BSH use, which are well recognized by professional societies and healthcare organizations. Patient education, pharmacist-led interventions, and medication reviews can modestly improve deprescribing outcomes. Combining strategies may further enhance effectiveness but could pose implementation challenges within current healthcare systems.¹

Pharmacists and primary care teams are well positioned to lead deprescribing efforts through counseling, structured medication reviews, and ongoing follow-up. Interventions should be patient-centered and tailored to individual needs. Given the low certainty of the evidence, clinicians and decision-makers should interpret the findings with caution.¹

REFERENCES

1. Zeraatkar D, Nagraj SK, Ling M, et al. Comparative effectiveness of interventions to facilitate deprescription of benzodiazepines and other sedative hypnotics: systematic review and meta-analysis. BMJ. 2025;389:e081336. doi:10.1136/bmj-2024-081336

2. Johnon B, Streltzer J. Risks associated with long-term benzodiazepine use. Am Fam Physician. 2013;88(4):224-225.