Les benzodiazépines sont largement utilisées chez le sujet âgé pour traiter l’anxiété et les troubles du sommeil. L’intérêt de ces prescriptions est étudié dans cet article. La discussion est basée sur les propriétés pharmacologiques et les effets secondaires des benzodiazépines chez les patients âgés. Les conclusions sont que les benzodiazépines devraient être rarement prescrites chez les sujets âgés ; beaucoup de patients traités par les benzodiazépines devraient être sevrés et d’autres stratégies, et d’autres thérapeutiques que les benzodiazépines devraient être utilisées pour traiter l’anxiété et les troubles du sommeil chez les patients âgés.

Benzodiazepines (BZD) are widely used to treat anxiety and insomnia in elderly patients. The interest of this prescription is discussed in this article. The discussion is based on the pharmacological properties and adverse effects of BZDs in the elderly. The conclusions are that BZDs should be rarely prescribed in this population; many patients treated by BZDs should be withdrawn and therapeutic strategies, other than BZDs, should be considered to treat anxiety and insomnia in these patients. Problems posed by BZD in the aged patient are both of a pharmacodynamic and pharmacokinetic order. In comparison to young adult users, BZD users among the aged are essentially women; the latter take these medications during important periods in their lives and often have a strong comorbidity, such as cardiovascular or rhumatological problems or even psychiatric problems, such as depression or panic disorders. Aged patients who take BZD at high doses can also consume other drugs, such as alcohol, and often have a psychiatric history. Some important side effects are associated with the use of BZD; essentially concerning falls, and it has been noticed for some years that problems posed by aged car drivers can be enhanced by BZD. It is difficult to know if continual users of BZD really have an advantage over other users. However, instruments, such as an indicator in the form of an algorithm, have been developed to identify the appropriateness of prescribing BZD to elderly patients. It is obvious that it is essential, whenever possible, to have a recourse strategy for cessation, and as much as possible to use BZD with a short half-life that are not oxidised, i.e. essentially BZD that are not metabolised in the strictest sense of the term, such as lorazepam or temazepam. Daily doses must be extremely limited and duration of use should not exceed two or three months in young patients.