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Sedative-hypnotic deprescribing — CCFP MCQ

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HardMental healthSedative-hypnotic deprescribingCCFP

An 80-year-old has taken zopiclone nightly for eight months and now has falls and daytime cognitive slowing. She is willing to stop but fears rebound insomnia. What is the best approach?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Taper zopiclone gradually with behavioural insomnia treatment and follow-up

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

D is correct. Long-term hypnotic harms outweigh benefit in many older adults; a negotiated gradual taper plus behavioural treatment improves success and limits withdrawal and rebound insomnia. E combines abrupt cessation with another anticholinergic fall-risk drug. A mistakes dependence for benefit. B perpetuates benzodiazepine-related harm. C adds off-label antipsychotic toxicity. The taper is individualized and can pause if symptoms become difficult.

Reference: Canadian Family Physician: Deprescribing benzodiazepine receptor agonists: https://www.cfp.ca/content/63/9/691