Revisión bibliográfica sobre deprescripción de benzodiacepinas en pacientes con insomnio/ansiedad

Appropriate prescription is an essential part of the rational use of medicines, where the therapeutic benefits should be looked for over the risks. The higher the consumption of medications, the greater the risk of adverse reactions-interactions. Polymedication is a risk factor for numerous problems. The concept of therapeutic overload arises: when a patient consumes medications that he does not need. Medicalization leads to non-medical problems being defined and treated as diseases. Benzodiazepines are among the most consumed medications. Such consumption may cause: sedation, cognitive impairment, falls / fractures, traffic accidents, tolerance-dependence, withdrawal symptoms, respiratory infections and increased mortality, the elderly being more susceptible. The application of deprescription programs would reduce these risks and the consumption of drugs, detecting and avoiding polypharmacy, inadequate and suboptimal prescriptions. The purpose of this study was to select information about benzodiazepines deprescription strategies. A non-systematic evaluation of relevant benzodiazepines information, recommendations / deprescription strategies was carried out in independent pharmacotherapeutic bulletins belonging to ISDB. The results show that treatment duration should not exceed 2-4 weeks for insomnia and 8-12 weeks for anxiety. In both cases it must be based on non-pharmacological strategies. Providing written and adequate information to the user about risks increases the effectiveness of deprescription. The individualized interview with follow-up of the general practitioner proved to be the most successful deprescription strategy. In benzodiazepines with low risk of dependence (low potency-long half-life): reduce total daily dose by 10-25% at intervals of 2-4 weeks. In benzodiazepines with high risk of dependence (high potency-short / intermediate half-life): replace diazepam at equivalent doses and its gradual reduction between 2-2.5 mg every 2-4 weeks.In case of withdrawal symptoms, keep the same dose for a few weeks and continue the dose reduction slowly. The process can take more than a year.Other pharmacological alternatives are not recommended (hypnotics-Z) or do not have sufficient evidence (antihistamines, melatonin, antidepressants, medicinal plants). It can be concluded that given the high prevalence of benzodiazepines consumption and the important consequences of its inappropriate use, it must be a priority for institutions and professionals to adopt the necessary measures for prudent prescription and, if necessary, deprescription