Can benzodiazepines be used in patients with Parkinson's disease (PD)?

From the Guidelines

Benzodiazepines can be used cautiously in Parkinson's disease patients, specifically for the treatment of secondary REM sleep behavior disorder (RBD), but with careful consideration of the potential risks and benefits, as recommended by the American Academy of Sleep Medicine 1.

Key Considerations

• The use of benzodiazepines, such as clonazepam, should be conditional, taking into account the patient's underlying disease, age, and risk for sedation and imbalance 1.
• Clonazepam has been shown to improve RBD symptoms in patients with Parkinson's disease, but its use is associated with adverse events such as daytime sleepiness, dizziness, and postural instability 1.
• The American Academy of Sleep Medicine suggests using clonazepam for the treatment of secondary RBD due to a medical condition in adults, with consideration of the patient's individual circumstances 1.

Recommendations

• Clonazepam should be used at the lowest effective dose, starting at 0.25 mg, and titrated as needed to minimize adverse effects 1.
• Non-pharmacological approaches for anxiety and sleep issues should be tried first, and if benzodiazepines are prescribed, regular reassessment is necessary to evaluate ongoing need and monitor for adverse effects.
• Alternative treatments, such as melatonin or rivastigmine, may be considered for patients with RBD and cognitive impairment or other neurodegenerative diseases 1.

From the Research

Benzodiazepines in Parkinson's Disease

• Benzodiazepines are commonly used to treat anxiety and sleep disturbances in Parkinson's disease (PD) patients 2.
• A study found that PD patients taking benzodiazepines may experience select changes in cognition and mood, but these changes are isolated and mild 2.
• The study also found that benzodiazepine-taking PD patients performed below the non-benzodiazepine group on short-term memory, but not on delayed recall, and performed better on a measure of visuospatial judgment 2.
• Another study discussed the diagnosis and treatment of Parkinson's disease, but did not specifically address the use of benzodiazepines in PD patients 3.
• Other studies focused on the treatment of depression in PD patients, including the use of selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants, but did not mention benzodiazepines 4, 5, 6.

Motor and Nonmotor Symptoms

• A study found that benzodiazepine-taking PD patients endorsed more symptoms of anxiety and depression, as well as poorer sleep quality, compared to non-benzodiazepine-taking PD patients 2.
• The study also found that there were no significant differences in motor function between benzodiazepine-taking and non-benzodiazepine-taking PD patients 2.
• Another study discussed the treatment of nonmotor symptoms in PD patients, including depression, anxiety, and sleep disturbances, but did not specifically address the use of benzodiazepines 3.

Treatment Considerations

• The use of benzodiazepines in PD patients should be carefully considered, as they may pose an increased risk of falls and cognitive deficits in this population 2.
• Clinicians should weigh the potential benefits of benzodiazepines in treating anxiety and sleep disturbances against the potential risks and consider alternative treatment options 2.
• Further research is needed to fully understand the effects of benzodiazepines on PD patients and to determine the best treatment approaches for this population 2.