Dangers of long-term, daily, Temazepam use in the elderly?

[manicmama]

Hi,

So I'm not sure if I'm just worrying over nothing or right to be concerned.
My Nana's 73, back in February (3/4 months ago) she had severe trouble sleeping (which she's had for years) but she kind of snapped and had enough, she was feeling suicidal.
Her doctor prescribed her 30mg temazepam at bedtime each night - her script was 3 months! I thought 1st scripts for benzos should be 2-4 weeks max then a re-evaluation of the patient? I also thought extra caution had to taken with elderly patients - but I'm not sure why? Anyway, the doctor has given her another 3 month script - though my Nana's admitted to me though it still helps it's not as effective as at first, is she building tolerance? I also found out that prior to the temazepam, she had been on 7.5mg zopiclone a night for 9 years, she had no w/d symptoms, but the temazepam was started in its place.
If anyone can help, I'd like to know if she is taken off it, is she likely to get w/d's? They'll have to taper her right? I mean they put her on it, she didn't score it for herself.
Secondly, if they leave her on it long term even though it's become ineffective like they did with the zopiclone, will it cause her damage?
Is even 6 months likely to harm her?
I only know a bit about drugs that I take/have taken. And the benzo I'm on is a different kettle of fish. I've tried an internet search and not found much, I thought I'd ask you guys and if you don't know I'll ask my pysch 'theoretically' next time I go.
Thanks guys.

 

[NeighborhoodThreat]

Lots of doctors prescribe benzos for longer than 2-4 weeks. That doesn't mean this practice is safe. I know that benzos generally have more side effects in the elderly...

Zopiclone is just as addictive and dangerous as temazepam is.

 

[manicmama]

I know and they left her on that for 9 years, which is why I'm worried they'll either leave her on temazepam - at what risk I don't know, or aged 73 she'll be going through w/d.
I'm feeling very angry at her doctor.

 

[gaktattack]

If you think about the body of knowledge doctors are expected to learn, some of it they will not learn as well or will forget, I am sure there are lot of people on here that know quite a bit more about pharmaceuticals than the average family doc.

 

[Tripman]

Why are you angry at her doctor for helping her to get the sleep she wants?

The only harm I see is if she ever chooses to withdraw from the substance - but I dont see a need to? If she was already on Zopiclone for 9 years then I don't see her coming off these.

 

[gaktattack]

Why are you angry at her doctor for helping her to get the sleep she wants?

The only harm I see is if she ever chooses to withdraw from the substance - but I dont see a need to? If she was already on Zopiclone for 9 years then I don't see her coming off these.

Who were you referring to?

 

[Tripman]

I was referring to the OP.

 

[manicmama]

The zopiclone stopped helping her sleep a long time ago. So I don't see why she was left on a drug that wasn't doing what it was supposed to. I've heard horror stories of temazepam, and I want to know what dangers occur with both w/d and long term use so I can look out for her. I understand not all doctors can be expected to know every single action of every single drug, but the computer symstems they have nowadays should give no excuse for giving guidelines and cautions a quick check if it's a drug they're not familiar with. Not everyone can be perfect all the time, but I can't help being angry it's my Nana - wouldn't you be if it were yours?

Anyway, basically, you are saying as long as she always takes this she will have no ill effects? Because that's pretty much what I want to know - am I worrying over nothing or not. You hear horror stories, esp with temazepam cos abuse was rife few yrs back, so you never know what's bull and what's not - I also wanted to know why extra caution with elderly? Cos I'm pretty sure 73 classed as elderly.

 

[gaktattack]

Mine wouldn't have taken those drugs. My 84 yo GP was sent to the hospital for a followup of a car accident where he was ejected from the car and shaved the top part of his brain off, and had to learn to walk. They tried to shove him on antidepressants and he told them to fuck off. Yesterday a guy on reddit kept telling me that everyone on ADs has a scientifically verifiable brain chemistry imbalance and that ADs are proven to correct it.

The unfortunate reality is that these people's livelihoods depend on consumers taking the drugs, and that they cant be trusted for their opinions when they are in a position to be biased. According to depression and other psych condition rates, it is a wonder we ever survived as a species considering how universally "broken" we are.

I encourage you to watch Orgasm, Inc, Frontline: the medicated child, Generation Rx. All three are available on netflix instant.

 

[kokaino]

Long term temazepam usage:

Abrupt withdrawal after long term use from therapeutic doses of temazepam may result in a very severe benzodiazepine withdrawal syndrome. There are reports in the medical literature of at least six psychotic states developing after abrupt withdrawal from temazepam including delirium after abrupt withdrawal of only 30 mg of temazepam and in another case, auditory hallucinations and visual cognitive disorder developed after abrupt withdrawal from 10 mg of temazepam, 5 mg of nitrazepam and 0.5 mg of triazolam. Gradual and careful reduction of the dosage, preferably with a milder long-acting benzodiazepine such as clonazepam or diazepam, or even a milder short to intermediate acting benzodiazepine such as oxazepam or alprazolam, was recommended to prevent severe withdrawal syndromes from developing. Other strong hypnotic benzodiazepines, whether short, intermediate or long-acting are not recommended. Antipsychotics increase the severity of benzodiazepine withdrawal effects with an increase in the intensity and severity of convulsions. Depersonalisation has also been reported as a benzodiazepine withdrawal effect from temazepam.

Abrupt withdrawal from very high doses is even more likely to cause severe withdrawal effects. Withdrawal from very high doses of temazepam will cause severe hypoperfusion of the whole brain with diffuse slow activity on EEG. After withdrawal, abnormalities in hypofrontal brain wave patterns may persist beyond the withdrawal syndrome suggesting that organic brain damage may occur from chronic high dose abuse of temazepam. Temazepam withdrawal has been well known to cause a sudden and often violent death.

Lots of doctors prescribe benzos for longer than 2-4 weeks. That doesn't mean this practice is safe. I know that benzos generally have more side effects in the elderly...

Zopiclone is just as addictive and dangerous as temazepam is.

I don't think zopiclone is as addictive or as dangerous as benzos are. There are numerous studies that compare zopiclone to benzos and zopiclone comes out with fewer side effects, less memory impairment and less overall behavioral side effects.

 

[effie]

There is an increased risk of falls amongst elderly patients who take benzos, but there is also an increased risk amongst sleep-deprived patients. Elderly patients are often also sensitive to medications and require a lower dose than is the norm. 30mg is a fairly high starting dose for someone elderly, but if you have concerns about this I would discuss it with her and her doctor (if she gives you permission to accompany her). If she feels the doctor is not addressing her concerns or has misprescribed something then she is entitled to seek a second opinion.

Temazepam is a fairly short-acting benzo so once-daily dosing doesn't carry the same risk of physical dependence as taking diazepam once a day, for example, although over time it is possible to build up a residual background level, in which case tapering would be needed rather than abruptly stopping.

The main concern would be psychological dependence and rebound insomnia if she was to stop. There is also the possibility of it becoming less effective over time, yes - but equally some people can take a steady benzo dose for years for sleep; mileage can vary. Sleeping has a large psychological component and this can effect the efficacy of sleeping tablets. Does your nan have good sleep hygiene? This means going to bed at a set time, using bed only for sleeping in, doing relaxing activities before bed (not involving a screen), no caffeine after midday, no nicotine right before bed, getting up after 30-60 mins of not sleeping and doing something else for 10 mins, not lying in no matter how bad the night's sleep was.. it can take a while to get into good habits but they can really help.

I'll see if I can find some papers on temazepam use in the elderly later, or try a google scholar search.

 

[Pagey]

I think the main issue with long-term benzo use is mostly that you become a bit of a vegetable, but that's after years and years...otherwise yeah just addiction and w/d and stuff.

 

[manicmama]

Hi,
My minds somewhat at ease now, I was worried there could be increased risk of heart attacks, stroke, breathing problems, dementia etc. A fall would be bad as she has osteoporosis, but it would appear there's little to no hangover effect and she should be sleeping whilst the temazepams active so hopefully that won't happen.
She has very good sleep hygiene, 10.30 everynight, 2 pages of her book then lamp off. She used to get up if she couldn't sleep - but her GP told her to stop doing that.
The only concern I have, is that the Zopiclone stopped working, she coped for years still taking it as the GP never took her off until sleep deprivation left her suicidal and he switched her to temazepam. I presume - could be wrong, correct me if I am - that the temazepam prevented any w/d's from the zopi. If the temazepam stops working (it's already not as effective) and they take her off it, she could have bad w/d's, though I presume they would taper or just leave her on it as they did the zopi.
Her insomnia's caused by physical pain, which is managed as well as can be unless she went on morphine, which she refuses as she's been on it before and couldn't tolerate it.
Thanks all for your input, I'm a lot less worried about her for the time being

 

[kokaino]

Temazepam is such a horrible pill to give to the elderly. For sleep doctors should really script z-drugs to the elderly and if it has to be a benzo then it should be something like oxazepam, diazepam, or lorazepam. Not temazepam.

 

[manicmama]

She was on Zopiclone 7.5mg for 9 years, it stopped helping her sleep years ago, earlier this year she had enough of lack of sleep - her words were ' I'd happily walk under a bus, my only regret would be if I woke up and not died ' She's mentally strong and I and my Grandad knew she must be feeling terrible to think like this. She saw the doctor, he prescribed the temazepam, I don't know much about drugs, I've only started researching my own recently. Temazepam has a bad rep in the uk as it was a drug of abuse on a huge scale - I know all benzos are abusable but this had a massive rep for it - however, upon researching myself I found the large scale abuse dwindled after changing it to pills instead of gel capsules filled with liquid. And the abuse was largely among recreational drug users, though it is still abused in the manner of other benzos - off prescription use, taking more than prescribed etc.
My concern was that every bit of information I found urged caution in use in elderly patients, but I couldn't find why or what extra risk there is with use in the elderly.
From what people have said on here the risks are falls and w/d. It's also a short acting benzo - as it's used for sleep she will be sleeping for the duration it's active so falling isn't an issue - I am concerned it will stop working to help her sleep and if she gets up to use bathroom or something the drug could increase her risk of falling but at the moment she says its still working, though not as effective as at 1st so not overly concerned yet. The other worry is it stops working and she has to w/d but I'm hoping if that happened they'd taper her gently - and she does do what the doctor tells her never abuses medication. As temazepam has short half life does this not make it less likely to be a contributing factor to a fall, or make her feel a bit stoned the next day? And I know from personal experience that diazepam is crap for sleep, and wouldn't its long half life have more chance of affecting her during the day when she's up and about?
If I've got this wrong please let me know because I can make my Grandad aware of what to look out for and I or my mam, aunt or uncle can accompany her to the doctors.
From what I can gather, the biggest concern is tolerance and addiction. Tolerance means she's back to square 1 - taking something for sleep that doesn't work. As for addiction, I figure she is already after 9 years of taking Zopiclone every night and as temazepam is cross tolerant it's just taken over from that?
If there's something I'm missing please inform me as I'd hate for something to happen to my Nana that was preventable.