A Comprehensive Systematic Review of The Relationship between Benzodiazepine Use and Psychomotor Impairment
Keywords:
Benzodiazepines, Psychomotor Performance, Accidental Falls, Hip Fractures, Automobile Driving, Reaction TimeAbstract
Introduction: Benzodiazepines (BZDs) are widely prescribed for anxiety and insomnia, but their impact on psychomotor function is a significant safety concern. This review synthesizes evidence from 41 studies on the association between BZD use and psychomotor impairment.
Methods: A comprehensive review of 41 sources was conducted. Data were extracted on BZD details (type, dose, duration), psychomotor outcomes (reaction time, motor function, driving, falls), and relationship findings.
Results: The evidence consistently demonstrates BZD-associated psychomotor impairment. Meta-analyses show a 60% increased risk of motor vehicle collisions (OR=1.60) and a 34% increased risk of hip fractures (RR=1.34) among users (1,2). An experimental study confirmed acute impairment in reaction time and tracking accuracy lasting up to 14.5 hours (3). Dose-response relationships were observed, with high-dose users (>1 DDD) showing significantly prolonged reaction times (4) and a fourfold increased fall risk (8). Chronic use was linked to neurocognitive impairment in vulnerable populations like people living with HIV (OR=2.13) (5) and executive function deficits (6). Elderly populations were identified as most at risk for falls and functional decline (2,7,10-12).
Discussion: The findings converge on a pattern of impairment across multiple psychomotor domains. While most studies show significant effects, one study in psychogeriatric patients found no cognitive decrements, likely due to confounding by indication where the comparison group was already compromised (9). The synthesis reveals that effects are more pronounced with higher doses, current use, longer-acting agents, and in elderly populations.
Conclusion: Benzodiazepine use is significantly associated with impaired psychomotor function, including prolonged reaction time, impaired driving, and increased risk of falls and fractures. These risks are dose-dependent and more severe in vulnerable populations, particularly the elderly. Clinicians should carefully weigh these risks, prescribe at the lowest effective dose for the shortest duration, and exercise special caution in high-risk groups. Further research should focus on standardized outcome measures and long-term prospective studies in diverse populations.
References
M. Rapoport, K. Lanctôt, D. Streiner, et al (2009) Benzodiazepine use and driving: a meta-analysis. Journal of Clinical Psychiatry. https://doi.org/10.4088/JCP.08m04325
T. N. Poly, M. Islam, Hsuan-Chia Yang, Y. Li (2019) Association between Benzodiazepines Use and Risk of Hip Fracture in the Elderly People: A Meta-analysis of Observational Studies. Joint, bone, spine : revue du rhumatisme. https://doi.org/10.1016/j.jbspin.2019.11.003
J. Dawson, J. Boyle, N. Stanley, et al (2008) Benzodiazepine‐induced reduction in activity mirrors decrements in cognitive and psychomotor performance. Human psychopharmacology. https://doi.org/10.1002/hup.961
L. Manthey, Fawzia van Loenen-Frösch, E. Giltay, et al (2014) High dose benzodiazepines prolong reaction times in chronic users who have major depressive and/or anxiety disorders. British Journal of Clinical Pharmacology. https://doi.org/10.1111/bcp.12224
R. Saloner, D. Grelotti, G. Tyree, et al (2019) Benzodiazepine Use Is Associated With an Increased Risk of Neurocognitive Impairment in People Living With HIV. Journal of Acquired Immune Deficiency Syndromes. https://doi.org/10.1097/QAI.0000000000002183
Y. Bang, H. Jeon, I. Yoon (2022) Effect of Long-Term Benzodiazepines for Chronic Insomnia on Cognitive Function and Waking Electroencephalography: A Case-Control Study. Psychiatry Investigation. https://doi.org/10.30773/pi.2021.0316
L. Marron, R. Segurado, P. Claffey, et al (2019) 342 The Association Between Benzodiazepine Use and Falls, and the Impact of Sleep Quality on this Association: Data from TILDA. Age and Ageing. https://doi.org/10.1093/ageing/afz103.224
Lily Annisa, I. Pramantara, Arianti Arianti, Fita Rahmawati (2019) Hubungan Penggunaan Obat Psikoaktif dengan Risiko Jatuh pada Pasien Geriatri di Klinik Penyakit Dalam Rumah Sakit di Madiun. Indonesian Journal of Clinical Pharmacy. https://doi.org/10.15416/ijcp.2019.8.3.217
G. Høiseth, L. Tanum, M. Tveito, et al (2013) A Clinical Study of the Cognitive Effects of Benzodiazepines in Psychogeriatric Patients. Pharmacopsychiatry. https://doi.org/10.1055/s-0033-1349131
M. Petrov, P. Sawyer, R. Kennedy, et al (2014) Benzodiazepine (BZD) use in community-dwelling older adults: Longitudinal associations with mobility, functioning, and pain. Archives of gerontology and geriatrics (Print). https://doi.org/10.1016/j.archger.2014.04.017
Bermudez-Villalpando Vi, Arvizu-Luviano Kn, Segarra-Linares Sl, Verdin-Bravo C (2025) Use of Benzodiazepines and Fall Risk Assessment in Older Adult Patients. Journal of Family Medicine. https://doi.org/10.26420/jfammed.2025.1377
Ã. Danza, Marcos Rodríguez Branco, Maynés López Pampín, et al (2015) Benzodiazepinas y fractura de cadera: estudio de casos y controles
E. Bierman, H. Comijs, C. Gundy, et al (2007) The effect of chronic benzodiazepine use on cognitive functioning in older persons: good, bad or indifferent? International Journal of Geriatric Psychiatry. https://doi.org/10.1002/gps.1811
M. Asbridge, Kathleen MacNabb, H. Chan, et al (2020) Prescription medication use as a risk factor for motor vehicle collisions: a responsibility study. Injury Prevention. https://doi.org/10.1136/injuryprev-2020-043840
Abbassyyah Abbassyyah, Nurmainah Nurmainah, Hadi Kurniawan (2025) Evaluasi Penggunaan Terapi Benzodiazepin Sebagai Faktor Risiko Jatuh Pada Pasien Geriatri Rawat Inap di Rsud Dr. Soedarso Kalimantan Barat. Multidisciplinary Journal. https://doi.org/10.57096/blantika.v3i10.419
Nevi Sulvita Karsa, Sonny T. Lisal (2024) Effectiveness Of Olanzapine And Diazepam Therapy In Schizophrenic Patients With Agitating States. Journal of Health Science and Prevention. https://doi.org/10.29080/jhsp.v8i1.1052
L. Santos, Amanda Martins Viel, J. T. Ribeiro-Paes, T. Stessuk (2015) Interações medicamentosas potenciais com benzodiazepínicos em prescrições médicas de pacientes hospitalizados
J. Määttä, A. Martikainen, T. Ikäheimo, et al (2020) Benzodiazepine Use Is Associated With Poorer Spinal Cord Stimulation Outcome in 373 Neuropathic Pain Patients. Neuromodulation (Malden, Mass). https://doi.org/10.1111/ner.13045
Riska Yuli Nurvianthi, Tanwir Djafar, Tonsisius Jehanam, et al (2024) Analisis penggunaan obat resep dokter pasien Generalized Anxiety Disorder (GAD) di RSUD Andi Djemma Masamba. Pharmaceutical Journal of Islamic Pharmacy. https://doi.org/10.21111/pharmasipha.v8i2.11860
Zea Maulida Ayati (2017) PENGARUH OBAT ANTI ANSIETAS TERHADAP PERUBAHAN DENYUT NADI DAN LAJU RESPIRASI PADA PASIEN DENGAN KECEMASAN DENTAL PRA PENCABUTAN GIGI
Fabiana Maria Rodrigues Lopes de Oliveira, Thércio Rosas Ferreira, João Euclides Fernandes Braga, et al (2014) Caracterização do uso de benzodiazepínicos por pessoas idosas atendidas no centro de atenção psicossocial. https://doi.org/10.5205/1981-8963-V8I11A13614P3905-3911-2014
Fabiana Maria Rodrigues Lopes de Oliveira, Thércio Rosas Ferreira, João Euclides Fernandes Braga, et al (2014) Characterization of the use of benzodiazepines by elders met in the center of psychosocial care. https://doi.org/10.5205/1981-8963-V8I11A13614P3905-3911-2014
Nevi Sulvita Karsa (2023) Efektivitas Risperidone dan Diazepam pada Pasien Skizofrenia dengan Keadaan Agitas. Wal'afiat Hospital Journal. https://doi.org/10.33096/whj.v4i2.116
Meilanie Dwi Anggraeni, Risna Agustina, Niken Indriyanti (2019) Pola Penggunaan Obat Antikonvulsan pada Pasien Gangguan Kejiwaan di Rumah Sakit Jiwa Daerah Atma Husada Mahakam Samarinda. Proceeding of Mulawarman Pharmaceuticals Conferences. https://doi.org/10.25026/mpc.v10i1.345
Muhammad Hanif Faruq, Okti Nur Purwanti, A. Purnama (2020) EFEK RELAKSASI BENSON DALAM MENURUNKAN KECEMASAN PASIEN YANG MENJALANI HEMODIALISA. Jurnal Ilmiah Keperawatan Sai Betik. https://doi.org/10.26630/JKEP.V16I1.1895
Juscilene Rodrigues Almeida, Neuza Biguinati de Barros, C. A. B. Lugtenburg (2022) As interações medicamentos a de benzodiazepínicos em idosos: revisão integrativa de literatura / Use of benzodiazepinics in the elderly: integrative literature review. Brazilian Journal of Development. https://doi.org/10.34117/bjdv8n4-440
M. Ong, Haiyong Xu, Lily Zhang, et al (2012) Effect of Medicare Part D Benzodiazepine Exclusion on Psychotropic Use in Benzodiazepine Users. Journal of The American Geriatrics Society. https://doi.org/10.1111/j.1532-5415.2012.04031.x
I. Papoutsis, P. Nikolaou, C. Spiliopoulou, S. Athanaselis (2016) Different aspects of driving under the influence of benzodiazepines. Medicine, Science and the Law. https://doi.org/10.1177/0025802415594832
Irene J. Zaal, John W. Devlin, Marijn Hazelbag (2016) Kontinuierliche Benzodiazepingabe erhöht Inzidenz von Delir. Journal Club AINS. https://doi.org/10.1055/S-0042-104002
Anisa Desty Fitriana, Hardian Hardian, Intan Rahmania Eka Dini (2024) Evaluasi Rasionalitas Penggunaan Obat Antipsikotik Pada Pasien Skizofrenia Remaja Di Rawat Inap RSJD Dr Amino Gondohutomo Provinsi Jawa Tengah. Generics: Journal of Research in Pharmacy. https://doi.org/10.14710/genres.v4i2.20423
P. Rumagit, Randy Tampa’i, Douglas N. Pareta, Joke L. Tombuku (2021) Potensi Interaksi Obat Antipsikotik Pada Pasien Skizofrenia Paranoid di Rumah Sakit Jiwa Prof. Dr.V.L Ratumbuysang. Biofarmasetikal Tropis. https://doi.org/10.55724/j.biofar.trop.v4i1.314
I. Ilham, Syuhada Syuhada, Benazir Evita Rukaya (2022) Gambaran penggunaan obat dengan aktivitas psikotik pada pasien di praktik dokter “X” kota Tarakan periode Oktober-Desember 2021. Journal Borneo. https://doi.org/10.57174/jborn.v2i2.44
Yasmim Cristine Figueiredo Cruz Horta Fonseca, Ana Beatriz Amorim Sales, K.C.T. Souza, et al (2024) Benzodiazepínicos e risco de demência/Alzheimer: fisiopatologia e fatores associados. Brazilian Journal of Health Review. https://doi.org/10.34119/bjhrv7n10-131
M. B. K. K. Dendiana, Bintang Tatius Nasrullah, Maya Dian Rakhmawatie (2024) Evaluasi Peresepan Obat Pasien Skizofrenia Lanjut Usia Di Unit Rawat Inap RSUD dr. R. Soedjati Soemodiardjo Purwodadi Indonesia. Jurnal Medika Malahayati. https://doi.org/10.33024/jmm.v8i3.14531
Gabriel Vale Vasconcelos, Poliana Zaine de Souza, Fernando Alencar, et al (2025) INVESTIGAÇÃO SOBRE A UTILIZAÇÃO DE BENZODIAZEPÍNICOS PELA POPULAÇÃO GERIÁTRICA NO BRASIL: UMA REVISÃO SISTEMÁTICA. Asclepius International Journal of Scientific Health Science. https://doi.org/10.70779/aijshs.v4i7.202
Ane del Palacio Totoricagüena, Joseba Pineda Ortiz, Aitziber Mendiguren Ordorica (2021) Antsiolitiko eta hipnotiko sedagarrien kontsumoa: generoaren araberako analisia nazioartean eta Euskal Autonomia Erkidegoan. Osagaiz osasun-zientzien aldizkaria. https://doi.org/10.26876/OSAGAIZ.1.2021.359
Ashwinderjeet Singh, Bintang Arroyantri Prananjaya, Ziske Maritska (2019) GAMBARAN PENGGUNAAN BENZODIAZEPIN PADA PASIEN DEMENSIA DI RSUP MUHAMMAD HOESIN PALEMBANG PERIODE JANUARI 2014–JULI 2019
S. Leung, N. Lintzeris, M. Lenné, et al (2013) The benzodiazepine hangover: next-day residual effects on driving performance
N. Amaliya (2018) EVALUASI PERESEPAN OBAT DENGAN DIAGNOSIS GANGGUAN SARAF PADA PASIEN GERIATRI RAWAT INAP DI RUMAH SAKIT UMUM DAERAH PANEMBAHAN SENOPATI BANTUL PERIODE TAHUN 2016 BERDASARKAN BEERS CRITERIA 2015
Debora Liudi Mulyo (2015) STUDI PENGGUNAAN OBAT ANTICEMAS PADA PASIEN GANGGUAN CEMAS MENYELURUH (Penelitian dilakukan di Poli Jiwa RSUD Dr. Soetomo Surabaya)
S. Rahayu (2015) STUDI PENGGUNAAN HALOPERIDOL PADA PASIEN SKIZOFRENIA (Penelitian Dilakukan di Instalasi Rawat Inap (IRNA) RSJ Dr. Radjiman Wediodiningrat Lawang)
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