Benzodiazepines in Cancer Patients: Uses and Indications
Benzodiazepines like temazepam are primarily used in cancer patients to manage anxiety, insomnia, and as adjuncts for symptom control including delirium, anticipatory nausea/vomiting, and as part of comprehensive palliative care. 1, 2
Primary Indications
Sleep Disturbances
- Benzodiazepines are recommended for refractory insomnia in cancer patients, with short-acting options like lorazepam being preferred 1
- Temazepam, which has a medium duration of action (half-life 5-11 hours), is suitable for managing sleep maintenance issues in cancer patients 3
- Sleep disturbances affect approximately 75% of patients with advanced cancer, making this a common indication for benzodiazepine therapy 1
Anxiety Management
- Benzodiazepines are indicated for moderate to severe anxiety in cancer patients, particularly when rapid symptom control is needed 1
- They should be used as part of a comprehensive approach that addresses underlying medical causes of anxiety first 1
- Caution is warranted regarding long-term use as these medications carry increased risk of abuse, dependence, and adverse effects including cognitive impairment 1
Delirium Management
- Benzodiazepines like lorazepam may be added for agitation that is refractory to high doses of neuroleptics in patients with severe delirium 1
- They are not recommended as first-line treatment for delirium in patients not already taking them 1
- Lorazepam can be used at doses of 1 mg subcutaneously or intravenously (up to 2 mg maximum) for severe agitation in delirious cancer patients 1
Secondary Benefits in Cancer Care
- Benzodiazepines help suppress anticipatory nausea and components of post-treatment nausea during chemotherapy 2
- They provide sedation and suppress recall of unpleasant treatment experiences 2
- They counteract restlessness associated with antiemetic medications like metoclopramide 2
- They can provide adjunctive analgesia, particularly in conditions of high anxiety and muscle spasm 2
Dosing Considerations
- For insomnia, short-term use (up to 4 weeks) is recommended with minimal effective dosage 4, 5
- In elderly or frail patients, lower doses should be used due to increased risk of falls, cognitive impairment, and other adverse effects 1
- For anxiety, diazepam is often the drug of choice, given in single doses or very short courses (1-7 days) 4
- Midazolam can be administered at 2.5 mg subcutaneously or intravenously every hour as needed (up to 5 mg maximum) for severe agitation 1
Important Precautions
- Benzodiazepines should be avoided in older patients and those with cognitive impairment due to risk of worsening confusion 1
- Caution is needed when combining benzodiazepines with olanzapine due to risk of oversedation and respiratory depression 1
- Long-term use (beyond 4 weeks) is associated with tolerance, dependence, and withdrawal effects 4, 6
- Benzodiazepines can themselves cause increased patient agitation and delirium in some cases 1
- They should be used with caution in patients with severe pulmonary insufficiency, severe liver disease, or myasthenia gravis 1
Monitoring and Follow-up
- Regular assessment of treatment response and adverse effects is essential 1
- Consider tapering benzodiazepines if symptoms are under control and primary sources of anxiety are no longer present 1
- Longer periods of tapering are often necessary, particularly with potent or rapidly eliminated medications 1
- After 8 weeks of treatment, if symptom reduction is poor despite good compliance, alternative interventions should be considered 1