Benzodiazepines for anxiety associated with chronic breathlessness in palliative care

The role of benzodiazepines in the management of anxiety associated with breathlessness is limited. There is insufficient evidence to support benzodiazepine monotherapy.

In patients with palliative care needs, benzodiazepines may have a role in the management of anxiety or panic associated with acute exacerbations of chronic breathlessness that do not respond to nonpharmacological therapy and opioidsHui, 2021Navigante, 2006Simon, 2016Zemel, 2021. However, benzodiazepine use is associated with increased drowsiness, confusion, falls, dependency and risk of respiratory depression. Furthermore, management of anxiety by addressing psychosocial factors, using nonpharmacological strategies and, if indicated, an anxiolytic antidepressant, may be more beneficial. If breathlessness responds well to the addition of a benzodiazepine, definitive treatment of anxiety is recommended, rather than continuous use of benzodiazepines beyond 2 to 4 weeks—see Anxiety and associated disorders in palliative care for more information.

For management of breathlessness in the last days of life, see Breathlessness causing distress in the last days of life.