A longitudinal study published in Stroke found that, although benzodiazepine initiation declined between 2013 and 2021, an excess supply of prescriptions post-stroke discharge remains.

Benzodiazepine usage among older adults in the United States (US) is an ongoing concern due to their association with risk for dementia, falls, and stroke.

Investigators from Harvard Medical School sourced data for this study from the Centers for Medicare & Medicaid Services. In a 20% random sample of Medicare Beneficiaries Claims, patients (N=126,050) aged 65 years or older without a history of benzodiazepine usage who were discharged between 2013 and 2021 after acute ischemic stroke (AIS) were evaluated for benzodiazepine initiation within 90 days of discharge.

The participants had a mean age of 78.48 (SD, 8.35) years, 54.4% were women, 82.3% were White, they had a 6-month Charlson comorbidity score of 1.38 (SD, 1.80), 59.5% had a mild AIS, and the length of stay after AIS was 3.7 (SD, 3.6) days.

Despite an overall downward trend of benzodiazepine initiation among AIS survivors, we noted a concerning possible overuse pattern of benzodiazepine prescriptions dispensed to patients within 90 days of discharge.

A total of 6127 patients initiated benzodiazepines after AIS discharge.

Among benzodiazepine initiators, the most common benzodiazepine prescriptions were lorazepam (40%) and alprazolam (33%). Most patients (76%) were prescribed a supply of more than 7 days and most (55%) were prescribed a 15 to 30 days’ supply. The median total daily dose was 1 mg/day for lorazepam and 0.5 mg/day for alprazolam.

The cumulative incidence of benzodiazepine initiation at 90 days was 4.7%. From 2013 to 2017, the incidence of benzodiazepine initiation was stable, between 5.0% to 5.2%. In 2018, the rate began to decline to 4.8% and, in 2020, to 4.4%. The benzodiazepine initiation rate was lowest in 2021, at 3.5%.

Stratified by patient sociodemographic characteristics, more women initiated benzodiazepines than men, the highest initiation rate was observed among Hispanic individuals and the lowest rate was observed among Black individuals, and the rate of initiation was higher in the Southeast and Southwest and lowest in the Midwest.

A total of 36% of patients were prescribed other psychotropic medications within 90 days of AIS discharge. Stratified by benzodiazepine usage, 61% of benzodiazepine initiators and 35% of noninitiators were prescribed psychotropic medications. The most common psychotropic medication was gabapentin, followed by sertraline, donepezil, escitalopram, and trazodone.

These findings may not be generalizable to other, non-Medicare populations.

The study authors concluded, “Despite an overall downward trend of benzodiazepine initiation among AIS survivors, we noted a concerning possible overuse pattern of benzodiazepine prescriptions dispensed to patients within 90 days of discharge. Those prescriptions consistently covered a 2-week or more extended period.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor