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Benzodiazepine-related falls and sedation — SCE Geriatric Medicine MCQ

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HardPolypharmacyBenzodiazepine-related falls and sedationSCE Geriatric Medicine

An 83-year-old man with mild cognitive impairment is admitted after a fall. He is taking diazepam 5 mg at night, zopiclone, oxycodone modified release, amlodipine, furosemide and tamsulosin. He is drowsy, respiratory rate is 10/min, oxygen saturation is 91% on air and creatinine is unchanged. Which medication should be reviewed/stopped most urgently?

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Correct answer: E — Diazepam

Benzodiazepines are strongly associated with sedation, falls, delirium and respiratory depression in older people, particularly when combined with opioids and Z-drugs. Diazepam is long-acting and therefore especially problematic in frailty. Antihypertensives and tamsulosin may contribute to falls, but the immediate drowsiness and low respiratory rate make sedative load the priority. Deprescribing should be planned safely, with tapering if dependence is likely.

Reference: STOPP/START v3; BNF; NICE NG56