How do you approach the use of benzodiazepines in patients with chronic medical illnesses that may be susceptible to respiratory compromise (e.g., CHF, COPD, ILD)?

It’s a very good question and answers may vary among different specialty providers. Yes, a slow or gradual weaning of the benzodiazepines would be advisable. When they reach lower doses the taper should be even slower over weeks or longer. There is a risk for not weaning them off benzodiazepines inc...

It is generally accepted that for patients with chronic respiratory conditions, benzodiazepines should be used cautiously due to the risks of respiratory depression, particularly when combined with opioids. In new patients, we consider alternatives like SSRIs or non-pharmacologic approaches first. F...

It depends on what it is you need to control. Anxiety would have SSRIs, SNRIs, bupropion, mirtazapine, buspirone, gabapentin, etc. For depression, as above, for sleep, the orexin antagonists are magnificent.

The answer is relatively self-evident. With great care, only when absolutely necessary, the risk of respiratory depression clearly indicates a necessity to use non-benzodiazepines, and of course, if we use benzodiazepines–the lowest possible strength and duration.

Slight tangent

Patients with sleep apnea and on Ambien or similar for chronic insomnia. This combo makes me nervous, but I have had some patients' Sleep Medicine docs weigh in and say that the Ambien may be continued. Very helpful, since they are better able to gauge what is happening during sleep. ...