Handgrip strength and balance in older adults following withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotics

BMC Geriatrics

Sirkka-Liisa Kivelä⁴  Pertti J Neuvonen⁵  Ismo Räihä³  Markku Partinen⁶  Alan Lyles⁴  Tero Vahlberg¹  Ritva Lähteenmäki⁷  Juha Puustinen²  Janne Nurminen³ 

[1] Department of Biostatistics, University of Turku, Turku, Finland;Satakunta Central Hospital, Pori, Finland;Department of Family Medicine, University of Turku, Lemminkäisenkatu 1, FI-20014 Turku, Finland;Division of Social Pharmacy, University of Helsinki, Helsinki, Finland;Department of Clinical Pharmacology, University of Helsinki, Helsinki University Central Hospital, HUSLAB, Helsinki, Finland;Department of Neurology, Vitalmed Research Center, Helsinki Sleep Clinic, University of Helsinki, Helsinki, Finland;Medical Teaching and Research Health Centre, University Consortium of Pori, Pori, Finland

关键词: Older adults;    Improvement;    Balance;    Handgrip strength;    Withdrawal;    Zolpidem;    Zopiclone;    Temazepam;    Benzodiazepines;   

Others  :  1089854
DOI  :  10.1186/1471-2318-14-121

 received in 2014-04-23, accepted in 2014-10-29,  发布年份 2014

【 摘 要 】

Background

Benzodiazepines and related drugs affect physical functioning negatively and increase fall and fracture risk. As impaired muscle strength and balance are risk factors for falls, we examined the effects of hypnotic withdrawal on handgrip strength and balance in older adult outpatients during and after long-term use of temazepam, zopiclone and zolpidem (here collectively referred to as “benzodiazepines”).

Methods

Eighty-nine chronic users (59 women, 30 men) of temazepam, zopiclone or zolpidem aged ≥55 years participated in a benzodiazepine withdrawal study. Individual physician-directed withdrawal was performed gradually over a one-month period and participants were followed up to six months. Handgrip strength was assessed using a handheld dynamometer, and balance using the Short Berg’s Balance Scale during the period of benzodiazepine use (baseline), and at 1, 2, 3 weeks, and 1, 2 and 6 months after initiating withdrawal. Withdrawal outcome and persistence were determined by plasma benzodiazepine-determinations at baseline and at four weeks (“short-term withdrawers”, n = 69; “short-term non-withdrawers”, n = 20), and by interviews at six months (“long-term withdrawers”, n = 34; “long-term non-withdrawers”, n = 55). Also most of the non-withdrawers markedly reduced their benzodiazepine use.

Results

Within three weeks after initiating withdrawal, handgrip strength improved significantly (P ≤ 0.005) compared to baseline values. Among women, long-term withdrawers improved their handgrip strength both when compared to their baseline values (P = 0.001) or to non-withdrawers (P =0.004). In men, improvement of handgrip strength from baseline was not significantly better in withdrawers than in non-withdrawers. However, men did improve their handgrip strength values compared to baseline (P = 0.002). Compared to balance test results at baseline, withdrawers improved starting from the first week after withdrawal initiation. There was, however, only a borderline difference (P = 0.054) in balance improvement between the long-term withdrawers and long-term non-withdrawers. Of note, the non-withdrawers tended to improve their handgrip strength and balance compared to baseline values, in parallel with their reduced benzodiazepine use.

Conclusions

Withdrawal from long-term use of benzodiazepines can rapidly improve muscle strength and balance. Our results encourage discontinuing benzodiazepine hypnotics, particularly in older women who are at a high risk of falling and sustaining fractures.

Trial registration

EU Clinical Trials Register: EudraCT2008000679530. Registered 31 October 2008

【 授权许可】

   
2014 Nurminen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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