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Home > Canadian guidelines on benzodiazepine receptor agonist use disorder among older adults.

Canadian Coalition for Seniors’ Mental Health. (2019) Canadian guidelines on benzodiazepine receptor agonist use disorder among older adults. Toronto: Canadian Coalition for Seniors’ Mental Health. 26 p.

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The development of this Clinical Guideline document was led by national working groups comprised of clinical and academic experts from the fields of seniors' mental health, geriatrics, and substance use and addictions. Each working group included a person whose life has been directly impacted by a substance use disorder. The Guidelines all reflect the fact that older adults are much more vulnerable to the potential adverse effects of these substances and that most individuals are also taking a variety of prescribed medications and over-the-counter products which can result in dangerous interactions.

Benzodiazepine Receptor Agonists: Drugs referred to as BZRAs act as allosteric modulators of gammaaminobutyric acid (GABA) activity by binding to inotropic benzodiazepine receptors at the GABA A receptor complex. BZRAs increase GABA binding and chloride ion channel opening, facilitating inhibitory activity. Some of these drugs have a benzodiazepine chemical structure (i.e., alprazolam, bromazepam, chlordiazepoxide, clobazam, clonazepam, clorazepate, diazepam, flurazepam, lorazepam, midazolam, nitrazepam, oxazepam, temazepam, triazolam) while others, referred to as non-benzodiazepine receptor agonists, novel benzodiazepine receptor agonists, or z-drugs (i.e., zolpidem, zopiclone), do not. We use the term BZRAs for both. Our recommendations deal with all BRZAs as they have similar benefits, side effects, and risks. These drugs have regulatory approval for the management of anxiety and panic disorders, short-term treatment of insomnia, seizures, alcohol withdrawal, sedation, and spasticity. They are also often used in an off-label manner (i.e., any use of a drug beyond what Health Canada has reviewed and authorized to be marketed in Canada and as indicated on the product label), for example to treat anxious depression or the behavioural and psychological symptoms of dementia (BPSD), which are also described as responsive behaviours.


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