‘Benzo’ side-effects harmful to elderly

Those with respiratory issues seeing problems worsen after taking drugs, study finds

Seniors with serious respiratory problems should think twice about taking benzodiazepines, a group of drugs that treats insomnia and anxiety, a massive new study by Toronto researchers suggests.

The drug class, which is also prescribed to treat breathing issues, was found to actually worsen pulmonary problems in older adults with emphysema, the European Respiratory Journal reported Thursday.

Last year, the drug class was subject to a federal safety review by Health Canada, the results of which have not been released in a public report, as highlighted in a recent Star investigation. It’s unknown what triggered the review or what government officials found.

Benzodiazepines, which include brand name pills like Ativan and Xanax, were among the 10 most-prescribed classes of medication in Canada last year. The Canadian Rx Atlas, an online compendium that analyses drug use and spending data for more than 10,000 medications, noted that prescriptions for seniors (age 66 and older) accounted for half of all sales in the class, which topped $330 million. A third of Canadian seniors with emphysema take benzodiazepines, often called “benzos.”

“Physicians, when prescribing these pills, need to be careful, use caution and monitor the patients for respiratory side effects.”

DR. NICHOLAS VOZORIS

ST. MICHAEL’S HOSPITAL

While long-term use has been associated with increased risk of addiction, dizziness and falls, the sevenyear, population-based study carried out by Dr. Nicholas Vozoris of St. Michael’s Hospital in Toronto, paints an even more alarming picture.

Until now, no study on the respiratory side effects of benzodiazepines has measured “real-world, important clinical outcomes and realworld dosing with this breadth of people,” said Vozoris, a respirologist.

The study tracked nearly 100,000 seniors across Ontario age 66 and older. Half of them were new users of benzodiazepines who suffered from chronic obstructive pulmonary disease (COPD or emphysema) between 2003 and 2009. The other half included seniors in the same health group who had not taken benzodiazepines in the past year.

Vozoris found that patients in the first category faced a 45 per cent higher risk of having a side effect that forced them to seek outpatient care for respiratory-related problems. This group was also 92 per cent likelier to visit an emergency department because their respiratory condition had deteriorated or they had developed pneumonia.

While previous studies examined respiratory risk based on a single, often low dose of the drug with limited follow-up, the Toronto group monitored patients for 30 days after taking the drug. In many cases, troubling symptoms appeared within the first week. Adverse events included increased shortness of breath, more coughing than usual, and thicker or darker phlegm. Excessive fatigue was “a more significant and concerning symptom,” Vozoris said. “That may happen if someone let their breathlessness go on too long.”

There are three prime reasons why benzodiazepines are prescribed in people with emphysema. It can treat shortness of breath that can’t be controlled with other medications. It can help with insomnia, which is very common in this group. And it can help manage anxiety, which goes hand-in-hand with not being able to breathe normally, Vozoris explained.

Bottom line: “Physicians, when prescribing these pills, need to be careful, use caution and monitor the patients for respiratory side effects,” Vozoris said. “Patients should also be diligent about monitoring themselves if they’re worsening from a respiratory perspective and seek medical attention so the medications can be reassessed.”