Doc: Discuss long-term benzodiazepine use with doctor

Dear Dr. Roach: Recently, there was an article in your column on the fact that you don’t recommend alprazolam as a long-term sleep aid. It has been recommended to me.

What are the consequences of long-term use?

A.T.

Dear A.T.: Alprazolam (Xanax) is a relatively short-acting benzodiazepine drug, in the same class as diazepam (Valium). These are pretty powerful sedatives, and are used extensively in people with anxiety disorders, such as panic disorder, agoraphobia (fear of open spaces) and generalized anxiety disorders.

I very seldom prescribe benzodiazepine drugs for long-term use (I often use them while other therapies, such as cognitive-behavioral therapy or SSRI medications are first administered, until they have a chance to become effective).

The reason is that they all can cause confusion or trouble thinking, and contribute to potential motor vehicle accidents and falls with fractures, which I have seen too often lead to a progressive decline, ending in death.

As an internist, I have respect for the downsides of these medications. They are particularly likely to cause problem in people older than 65.

However, they sometimes still are the best treatment for a given individual. I have patients who have done well with chronic use of these medications, when prescribed and carefully monitored by a psychiatrist.

I think that too many people are probably taking them unnecessarily, but my general advice can in no way be considered to have more applicability to you than that from your own doctor or any other provider, someone who knows your individual medical details.

I do hope that my advice leads to a more productive conversation between my readers and their doctors.

Dear Dr. Roach: Your column contained a letter about side effects from drugs for alleviating the symptoms of benign prostatic hyperplasia. You did not mention the use of daily low-dose (2.5 mg) Cialis.

I could not stand the side effects of Flomax, but find that daily low-dose Cialis has no side effects and cuts my urination frequency in half.

A.M.

Dear A.M.: Tadalafil (Cialis) is best known as a treatment for erectile dysfunction, but a 2012 study showed that it is about as effective as tamsulosin (Flomax) for treatment of prostate enlargement.

While I am glad you have had no side effects, there is no medication that will be free from side effects in everybody.

With tadalafil, some people will notice a significant drop in blood pressure, as can happen with tamsulosin. The combination of the two can produce even greater drops in blood pressure in some men. Tadalafil cannot be used with nitrates. Visual symptoms also are possible, but uncommon.

Daily tadalafil is a reasonable alternative for men who have intolerable side effects to medications like tamsulosin, although it is expensive.

It also treats erectile dysfunction, which is common in older men, the ones who are likely to have BPH.

Email questions to ToYourGoodHealth@med.cornell.edu.