As the COVID-19 pandemic continues, anxiety levels across the world have increased. Benzodiazepines, like alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan) prescriptions have risen 34%, with anti-anxiety medications becoming easier to access through telemedicine. Benzodiazepines have played a dangerous role in COVID-19, both through the many risks of prescribing and the increased risk of respiratory complications and delirium.
A 2022 study found that benzodiazepine use increased the risk of hospitalization in covid-positive patients, but did not increase the risk of test positivity, severe outcomes, or mortality.
Benzodiazepines are potentially dangerous for those with pre-existing respiratory illnesses such as asthma and chronic obstructive pulmonary disease (COPD). Long-term benzodiazepine use increases pneumonia risk.
Delirium, a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment, is also a serious concern. The start of delirium is usually rapid, within a few hours or days.A significant percentage of individuals who are hospitalized for management of acute illness related to COVID-19 experience delirium and other severe neurologic symptoms. The Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center has started using the mnemonic device of F-COVID to help clinicians think about the causes of delirium during the pandemic and what will put a patient at higher risk of developing delirium in the ICU:
Family (and lack of visitation)
Clotting problems
Oxygenation issues
Virus itself
Immobilization
Drugs (eg, benzodiazepines)
According to E. Wesley Ely, MD, MPH, a professor of medicine and critical care at Vanderbilt University Medical Center in Nashville, Tennessee delirium has increased through COVID-19. In a 2020 Infectious Special Edition interview he shared about a New England Journal of Medicine case series that came out in April. In it, 50 of 58 patients (86%) with COVID-19 received a benzodiazepine (midazolam). Dr. Ely noted that:
We’ve been working for 20 years, and we’ve reduced delirium down from 70% in ventilated patients to around 40%, but COVID-19 has got it back up to 80%. So in three months, we’re erased 20 years of progress.
He went on to share another alarming statistic:
We stopped using benzodiazepines years ago because of how deliriogenic they are. To see 86% of people on a ventilator getting a benzodiazepine is like going back to how we practiced in 1995.