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Pharmacists should review benzodiazepine use, says academic

Taking benzodiazepines for three months or more was linked to a 43 to 51 per cent increased risk of developing Alzheimer's, the study found. 

An academic has called for pharmacists to work with GPs and carers to review benzodiazepine use among patients, as it has been found to increase the risk of Alzheimer's disease

An academic has called for community pharmacists to review benzodiazepine use among their patients, following fresh evidence linking the drugs with dementia.


Pharmacists should work with GPs and carers to assess prescriptions for benzodiazepines among Dementia patients, Aston University clinical lecturer Ian Maidment told C+D on Thursday (September 11), after a study found  taking the drugs for three months or more was linked to up to a 51 per cent increased risk of developing Alzheimer's disease.


Mr Maidment stressed that the study by Canadian and French universities, published in the BMJ in September, did not prove benzodiazepines caused dementia. However, it provided an opportunity to check the drugs were being prescribed correctly, as the media coverage may prompt patients to ask pharmacists about the risks, he said. 


Community pharmacists should assess the drugs' suitability as part of a "holistic care model", but they would need training and support to deliver this, added Mr Maidment. 


The study of 1,796 people diagnosed with Alzheimer's and 7,184 control patients in Quebec, found that the strength of the association between the disease and benzodiazepines increased with longer exposure to the drugs or when taking longer-acting benzodiazepines, such as diazepam and nitrazepam.


But it was still unclear whether benzodiazepines were a cause of dementia or were being prescribed to treat a condition that was an "early marker" of the disease, the authors said.


The  authors said unwarranted long-term use of these drugs was a public health concern and it was crucial for physicians to balance the benefits and risks before initiating or renewing treatment of benzodiazepines in elderly patients or younger adults. 


The researchers recommended that the drugs should not be prescribed as an anxiety treatment for more than three months.




Will you be monitoring benzodiazepine prescriptions?

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14 Comments

Meera Sharma, Community pharmacist

Just love this - there is plenty of evidence around already to show that there is a lot pharmacists can do. That's the whole debate going on at the moment! Having said that, how do you propose that this gets fitted into the day & night job and gets funded adeqautely? Or are we just expected to do this for free like every other service that pharmacists are already doing. To the academics and researchers out there, please can you find something practical to research and write up for a change e.g. juggling workloads in your normal community pharmacy, financial squeeze in dispensing and staffing levels! I just find it amazing that this is the white elephant in the room, yet not one person has bothered to look into it. I think I'm turning into an evangelical pharmacist at this stage of my career and saying enough is enough - about time we start saying NO THANKS to any service that is not properly thought through!

David McNaughton, Community pharmacist

wow ..... did this in 1983 in Tranent with Gp Dr Alan Reid .... lovely to see its was up to date then.....
hey ho ... we just did these things then .. should have written up but was just part of job.
David McNaughton ( qualified 1974!)

Uma Patel, Community pharmacist

Any person including ' our leaders' who has not worked in a dispensary in the last 2 years for one whole month dispensing 7000 items is not qualified to tell us what to do.

Brian Austen, Senior Management

The pharmacist was paid very well for providing the service. The Practice also benefited financially. Patients, Pharmacist and GPs were all winners.

N O, Pharmaceutical Adviser

That is the core issue. These articles are published (encouraged by NHS commissioners, may be) in order to show that Pharmacists can do things on their own. It also tries to highlight that despite the opportunity existing the Pharmacists are not pulling their weight. Ultimately someone there is trying to get all these time consuming services done through Pharmacies for nothing. They feel that by showing Pharmacists in poor light will make the sector grab whatever is thrown at them. Pathetic !!!

Brian Austen, Senior Management

You may find this hard to believe but 6 years ago when I was a Practice Manager, I set up a Benzo Reduction Clinic with a Pharmacist, commissioned by a Drug and Alcohol Team in a General Practice. It was a great success. The practice went from being 2nd highest prescriber of Benzo's and Zs to the 2nd lowest. It benefited patients and GPs and the pharmacist collaborated. It worked so well it was a major factor in the Practice becoming a shared care provider of substance misuse service, not only in its own area but also providing outreach services where other GPs couldn't or wouldn't get involved. Pharmacists and GPs can work together for the benefit of patients.

What a wonderful story.

O Y, Locum pharmacist

Some rather narrow minded posts here. As front line pros we are in a great position to audit this. Monitor all patients on long term benzos, and follow them up. Excellent data can be gathered across pharmacies. Community pharmacies that start producing published data will greatly enhance the respect of the profession from the outside

MESUT OZIL,

As front line pros we are in a great position to audit this. Monitor all patients on long term benzos, and follow them up. Excellent data can be gathered across pharmacies. Community pharmacies that start producing published data will greatly enhance the respect of the profession from the outside

It is clear why you are a locum and not a contrctor. We do enough paperwork already without adding ANOTHER audit to the paper mountain that is the NHS

N O, Pharmaceutical Adviser

You must be kidding !!!

""Excellent data can be gathered across pharmacies.""

and do what??

Who is going to pay for all this extra work on top of other nonsense we have been burdened with, if the prescribing pattern is not going to change? The data on Benzodiazepines prescribing is already available with NHSBSA/ NHSE.

""respect of the profession from the outside"" Really ??

If the GPs are not going to listen to you and still continue their prescribing, how on earth are we going to get any respect and from who? You may end-up losing patients for attempting to stop their LA LA pills. Unless the change occurs at the root (GPs) we are helpless, all our efforts are going to be wasted unless the prescribers join hands in this effort.

Gerry Diamond, Primary care pharmacist

Benzodiazepines are highly addictive GAD should be best treated with an SSRI if it is long term, Three months on benzos would unlikely to get off them even after 12 weeks without a detox.

Michael Stewart, Community pharmacist

To quote the BNF...

Important: benzodiazepine indications
1.
Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness.

Good luck getting prescribers to stick to four weeks treatment - one guideline that is routinely overlooked. Might have more luck recommending 3 months maximum but that is still outside of these best practice guidelines.

Kevin Western, Community pharmacist

"But it was still unclear whether benzodiazepines were a cause of dementia or were being prescribed to treat a condition that was an "early marker" of the disease, the authors said"
So we should challenge a GPs prescribing on unclear evidence? I am sure GPs are rubbing their hands with relish at the coming argument which they will win. I am all for helping with prescribing decisions and will challenge if I feel justified but this one is just a bit too uncertain for me.
Also, yet again P'cists should work with GPs - why not the other way round for a change - its the GPs with the key to the door and they are keeping it firmly in their pocket.

[email protected], Pre-reg graduate

One more Academic trying to push more nonsensical work on the Pharmacists, to make some headline news. Can't they do something better, to actually help to reduce the work load of the Pharmacists? Any research in the are of "How to Make a Pharmacists work Stress Free"

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