An expert weighs in on what you should know before giving benzodiazepine drugs like Xanax to Alzheimer's patients.
Benzodiazepines are a type of drug often used to treat agitation, anxiety and insomnia in Alzheimer’s patients. You know them as Xanax, Klonopin, Ativan and Valium, though there are dozens of approved benzos, as they’re known in medical slang. In a new study, scientists have found that these drugs, meant to calm Alzheimer’s patients and ease their suffering, may contribute to an earlier death.
Using Drugs Like Xanax for Alzheimer’s Patients
The study focused on what effects the use of drugs like Xanax has on those already diagnosed with dementia. Researchers analyzed 31,340 adults with Alzheimer’s disease, about a third of whom started taking benzodiazepines or benzodiazepine-related drugs after their diagnosis. None were prescribed the medication in the year before diagnosis.
The drugs in the study included Valium, Librium, Ativan, Xanax, Restoril, Serax and one other drug not approved in the United States. Within six months of starting the medication, 1,225 people had died. Patients given benzo drugs were 40 percent more likely to have died than those who did not take those drugs. While that number sounds alarming, that translates to 5 more deaths per 100 “person years”—100 people living one year during the study. However, after 120 days of being on the medication, the study found that the risk dropped off, and was no longer significant after 180 days in comparison to those not taking benzos.
Past Studies on Xanax and Alzheimer’s
In the past, the connection between drugs like Xanax and Alzheimer’s was difficult to tease out. A study of 8,930 people published in 2014 found that the use of benzos was associated with an increased risk of Alzheimer’s disease itself—by 43 to 51 percent. But another study published in 2016 of 3,434 subjects found that high doses of benzos did not result in an increased risk of dementia, though moderate and low doses showed a slightly increased risk. Researchers attributed the slight increase to the fact that those suffering from symptoms benzos treat, like insomnia and depression, may be in the very early stages of dementia.
Of course, it’s difficult to say whether taking medication like Xanax is associated with Alzheimer’s, or if those with insomnia and depression may be more inclined to develop Alzheimer’s in the first place. Though the researchers in the first study accounted for risk factors like depression and only included patients who had been taking benzos for five years or more, the correlation doesn’t necessarily mean the medication causes early death.
What Experts Say About Xanax and Alzheimer’s
For patients and caregivers, experts say to keep this study in perspective. “I don’t think this study should change clinical practice. It is a little alarming, but it is one study, and there have been other studies [on benzodiazepines], and they’ve really had mixed results,” said Keith Fargo, Ph.D., Alzheimer’s Association director of scientific programs and outreach. “That being said, I certainly think there are things that patients and caregivers should do when they get a new prescription or a doctor is talking about a new prescription,” said Fargo.
What to Know Before a Person With Alzheimer’s Tries Xanax
The first thing patients and caregivers should ask is if anything else has been tried in place of the medication. Fargo said that many things besides medication can be used to control behavioral and psychiatric symptoms like insomnia or violence. He says it can be as simple as making sure the patient is eating and going to the bathroom regularly, or taking the TV out of the room if they’re having trouble sleeping. “Medication should certainly not be a first resort,” said Fargo.
The Risk of Xanax for Alzheimer’s
Benzodiazepines have been shown to have a stronger effect on older people, and past studies have shown that they are associated with the risk of falls and injury. In 2012, the American Geriatric Society labeled them as “inappropriate” for treating insomnia, delirium and agitation due to the risk of accidental overdose and falls, which often lead to death. Benzos like Xanax are known to have a potential for addiction, especially if they’re used for a long period of time.
This study was not a clinical trial, where patients were all given similar dosages in similar situations. We also don’t know why patients were prescribed the drugs in the first place, points out Fargo. “It’s highly likely that the people who were prescribed benzodiazepines are not in the same clinical situation [as those who were not],” he said. This type of study is meant to raise a red flag in the medical community, said Fargo, not change clinical practice.
This study was conducted by a team at the University of Eastern Finland and published in the International Journal of Geriatric Psychiatry.
