Doctors believe they have uncovered reliable evidence to confirm the belief that taking benzodiazepines such as Valium and Ativan intermittently rather than continuously is safer and associated with fewer side effects and reduced falls, hospitalizations, and deaths.

The research was presented at the ECNP Congress in Barcelona, after recent publication in the Journal of Psychopharmacology.

Benzodiazepines such as Ativan, Librium, and Valium were first used to treat anxiety and insomnia in the early 1960s. By 1977, these were the most prescribed medicines globally; they are still regarded as reasonably safe and effective (although some patients developed tolerance and became dependent on the drugs, while the risk of falls and fractures remains a concern in older people). They are still very widely used, but modern antidepressants (such as SSRIs) are more commonly prescribed.

Most studies on benzodiazepines only followed health outcomes for up to six to eight weeks, meaning that there has been little information on the results of long-term use over months and years. This has led to conflicting views amongst doctors with some clinicians saying that benzo use should be limited to a few weeks to avoid the risks of tolerance and dependence, or even that they should not be given to people over 65 at all, whereas other doctors advocate long-term use as being acceptable.

“Using a large, dataset from Ontario, Canada, we were able to examine how people over the age of 65 with anxiety or insomnia actually took benzodiazepines after starting them. We were also able to link this with other health outcomes. So this meant considering 57,000 people who took benzos regularly on most days over a period of six months (chronic users) and 113,000 matched people who took the medicines over a similar period, but with breaks where they didn’t take benzodiazepines (intermittent users). We then followed both groups for a further year. The results were striking,” says lead researcher Simon Davies, DM, of the Centre for Addiction and Mental Health, Toronto, Canada, in a release. 

Results showed that changing the way people take benzos from chronic to intermittent could lead, over one year, to 20% fewer hip fractures (33% fewer in men), 7.5% fewer falls requiring hospitalization or emergency visits, and a 24% reduction in the chance of needing to go into long-term care. 

Falls are the leading cause of death for people over 65 in the US and Canada. More than one in five elderly people who sustain hip fractures die within a year.

“This work shows that, where possible, patients over the age of 65 with anxiety or insomnia who are taking Ativan, Valium, or another benzo long-term would better not to stay on the drugs continuously,” Davies continues in the release. “In practical terms, there will be some who can’t change or do not want to change. These results allow you to understand the excess risks of falls, fractures, emergency visits, long-term care home admission, and death that you are accepting using benzodiazepines chronically rather than intermittently. Of course, these are still prescription drugs, so they need to be taken under the guidance of your clinician.”

Photo caption: Valium in an Italian pharmacy

Photo credit: Tom Parkhill