How to Check Benzodiazepine Patients for CNS Depressant Overlap
How should clinicians assess adults receiving benzodiazepines for potentially risky overlap with other CNS-depressant medications?
Adults prescribed benzodiazepines commonly receive other sedating medications that can increase risk of adverse drug-drug effects. This guide applies when initiating or continuing a benzodiazepine and helps clinicians identify which patients warrant especially close follow-up based on the prescribing patterns reported in the study.
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Review the full current medication list
Before initiating or continuing a benzodiazepine, check whether the patient has also received other CNS-depressant medications. In this study, the relevant medication groups were prescribed opioids, nonbenzodiazepine hypnotics, gabapentinoids, muscle relaxants, and antipsychotic medications.
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Flag any same-year exposure to another CNS depressant
Treat receipt of at least 1 benzodiazepine prescription plus at least 1 prescription for another CNS depressant in the same year as an important safety signal. Overall, 41.6% of benzodiazepine-treated adults had this pattern, and 93% of those with both medication types in the same year received both prescriptions in the same survey round.
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Use age to estimate likelihood of overlap
Expect same-year exposure to other CNS depressants to be more common in benzodiazepine-treated adults aged 36 to 55 years and 56 years and older than in those aged 18 to 35 years. The percentages were 44.6% for ages 36 to 55 years, 42.9% for ages 56 years and older, and 30.0% for ages 18 to 35 years.
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Check psychological distress and general health status
Pay especially close attention to benzodiazepine-treated adults with serious or moderate psychological distress and to those in worse general health, because these groups were more likely to also receive other CNS depressants. Among benzodiazepine-treated adults, 62.9% of those with serious distress and 72.0% of those in fair or poor general health also received other CNS depressants.
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Increase vigilance in additional higher-risk groups
Same-year use of other CNS depressants was also higher among females than males and among Hispanic than White non-Hispanic benzodiazepine-treated adults in age- and sex-adjusted analyses. Use these characteristics to heighten medication reconciliation and follow-up attention, while recognizing they are risk markers from observational data rather than stand-alone prescribing rules.
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Provide close clinical follow-up for patients with overlap
When a patient is receiving a benzodiazepine together with another CNS depressant, follow the patient closely and carefully assess for drug-drug adverse effects. The article emphasizes this need because concurrent use of benzodiazepines and other CNS depressants has been associated with falls and overdoses.
Clinical Considerations
- Same-year prescribing of benzodiazepines and other CNS depressants does not necessarily mean the medications were used concurrently.
- The MEPS data capture prescription fills rather than how medications were actually taken, so prescribed use and nonprescribed use cannot be distinguished.
- Medication use and reasons for use were household-reported, which may have led to underestimation of benzodiazepine use or misattribution of indications.
- Some subgroup estimates had limited statistical power and wide confidence intervals, and the analyses did not adjust for multiple comparisons.
Bottom Line
For any adult receiving a benzodiazepine, the key safety step is to check for opioids, hypnotics, gabapentinoids, muscle relaxants, or antipsychotics and monitor especially closely if the patient is older, psychologically distressed, or in poor health.
