BZs, Z-Drugs Cost/Benefit and Medical Decision-Making
Medical providers are expected to address medical problems in a stepwise process, which includes: taking a patient history, performing exams, referring to recent relevant studies, then making an assessment (differential and diagnosis), and establishing a plan. The latter should be performed by means of shared decision-making and informed consent with the patient. Clinicians should not only focus on medication but also non-medication options. The risks, benefits, and alternatives for any one option are to be considered with the risk / benefit ratio for each option compared to the others. A multimodal / multidisciplinary approach enhances provider collaboration and tends to maximize clinical outcomes.
- Does it work?
- Does it work without side effects?
- If there are side effects, are these side effects manageable?
Because long-term treatment is important in chronic conditions, approaches need to have durable efficacy as well as limited, manageable adverse outcomes. Neuroactive medications prompt neuro-adaptive changes that tend to counter the intended effect(s) and result in the development of new or worsening problems that may appear long after the initiation of the drug(s). This challenges practitioners and patients trying to determine a causal relationship.
Benzodiazepines have demonstrated utility as first-line agents for a few indications: crisis anxiety, alcohol withdrawal, status epilepticus, and adjunctively in anesthesia (algoanesthesia). They may be safe and useful for episodic anxiety (e.g., flight anxiety). Although helpful for short-term use, benzodiazepines and Z-drugs do not provide safe and effective options over the long term for such conditions as anxiety and insomnia where they are commonly and inappropriately used. The Efficacy page provides details on the efficacious uses of benzodiazepines. See the neuropharmacologic background and how these agents work.
