This week, Mad in America examines four new studies around harms linked to benzodiazepine use. The first finds that benzodiazepines are linked to increased risk of heart failure and heart failure related hospitalization. The second reports that long-term benzodiazepine use (60 days or longer) is associated with worse cognitive function in people diagnosed with schizophrenia. The third finds that taking these drugs during pregnancy is linked to an increased risk of miscarriage. The fourth links benzodiazepines to increased risk of falls and fractures in older adults.
Benzodiazepines Linked to Increased Risk of Heart Failure
A new study published in Cardiovascular Toxicology finds that benzodiazepine use is linked to higher risk of heart failure and heart failure related hospitalization in people prescribed these drugs to treat insomnia. This research, led by Yi-Sin Huang from Taipei Medical University in Taiwan, also suggests that benzodiazepines are associated with a higher risk of heart failure hospitalization than other drugs used to treat insomnia.
The goal of this study was to examine the link between heart failure and benzodiapepine use in people with insomnia. The authors also wanted to compare heart failure outcomes between benzodiapepines and other drugs prescribed for insomnia. They conducted a systematic review and meta-analysis of previous research on this topic. In total, they used data from 11 studies.
Benzodiazepine use was linked to a 41% increased risk of heart failure and a 29% increased risk of heart failure related hospitalization compared to non-use. The risk of heart failure related hospitalizations in people taking these drugs to treat insomnia was also elevated compared to other drugs, including Z-drugs, suvorexant,and antipsychotics. These increased risks were particularly elevated in people that had a history of heart failure and those at high-risk.
This research had three main limitations. Most of the included studies were observational, meaning the findings can speak to a link between bezodiazepines and heart failure, but cannot definitively say that these drugs cause heart failure. Only 11 studies were included in the current work. The included studies varied significantly in follow-up range, methods, and patient populations.
Benzodiazepines Linked to Worse Cognitive Functioning
A new study published in BMC Psychiatry finds that long-term benzodiazepine use is linked to worse cognitive functioning in people diagnosed with schizophrenia. This research, led by Caiping Liu from the Shanghai Jiao Tong University School of Medicine in China, also reports that there was no significant difference in terms of cognition between low- and high-dose users. This means that while any long-term benzodiazepine use was associated with poorer cognition, the current work did not find that higher doses were linked to poorer cognitive function.
The authors used data from the SALT-C study in China, a research project around atypical antipsychotic use in people diagnosed with schizophrenia. They used data collected from 114 SALT-C participants recruited at the Shanghai Mental Health Center between 2016 and 2019. For the purposes of analysis the authors divided participants into two groups, people that had never taken benzodiazepines before and those that had taken a stable dose for at least 60 consecutive days. Each of these groups included 57 participants. The groups were similar in terms of sex, age, duration of illness, and types of atypical antipsychochotics prescribed. There were also no significant differences in overall psychiatric symptoms severity, “illness” severity, or psychological functioning.
Long-term benzodiazepine users had an average score of 16.02 on the Montreal Cognitive Assessment compared to 19.33 for non-users. This indicated significantly poorer cognitive performance for participants taking benzodiazepines for at least 60 consecutive days. This deficit was observed mostly in the visuospatial and executive cognitive domain, meaning benzodiazepine users had greater difficulty understanding visual/spatial information and planning, organizing, and solving problems. The authors note that there was no clear dose-response relationship between benzodiazepine use and cognitive impairment. This means similar cognitive impairment was observed in both low- and high-dose users.
This research had four main limitations. Cognitive ability was assessed at one point in time and the authors were not able to track cognitive changes before and after exposure to benzodiazepines. As a result, the findings cannot establish that benzodiazepine use caused poorer cognition, only that these factors are linked. Unmeasured factors may have affected the outcomes. All participants came from a single treatment facility in China, limiting generalizability. The relatively low number of participants further limits generalizability.
Benzodiazepines Use During Pregnancy Linked to Miscarriage
A new study published in BMC Pregnancy and Childbirth links benzodiazepine use during pregnancy to miscarriage. This research, led by Cyndie Picot from the Hospices Civils de Lyon in France, also presents some evidence that miscarriage risk increases with dose.
The aim of this study was to investigate the link between benzodiazepine use during pregnancy and miscarriage. The authors also wanted to examine whether miscarriage risk varied between individual benzodiazepines. They conducted a systematic review and meta-analysis of previous research around benzodiazepines and miscarriage. To be included in the current work, studies had to compare miscarriage risk between a group that used benzodiazepines during pregnancy and one that did not. The researchers used data from 10 studies.
Overall, benzodiazepine use during pregnancy was linked to a 68% increased risk of miscarriage. All seven individual benzodiazepines with at least 100 exposed pregnancies were linked to greater risk of miscarriage:
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Clonazepam – 82% increased risk
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Diazepam – 70%
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Lorazepam – 48%
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Alprazolam – 48%
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Oxazepam – 48%
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Bromazepam – 55%
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Chlordiazepoxide – 42%
While the meta-analysis found increased risk for each of these individual benzodiazepines, the results did not reach statistical significance for bromazepam and chlordiazepoxide.
Three included studies examined the dose-response relationship between benzodiazepine use and miscarriage, with all three reporting that larger doses translated to higher risk. For example, one study reported an 84% increased risk of miscarriage for low dose clonazepam compared to a more than quadrupled risk (4.5 times higher odds) for high doses. The authors note that they were unable to combine results from the these three studies into a single does-response estimate due to significant differences in definitions and methods.
This research had four main limitations. Five of ten included studies had a high risk of bias due to the possibility of unmeasured factors affecting the findings. Included studies were mostly observational, meaning these results cannot definitively say that bezodiazepines caused miscarriage. Studies differed in their definition of miscarriage. Early miscarriages are likely under-reported, which could have affected the results.
Benzodiazepines Linked to Increased Risk of Falls and Fractures in Older Adults
A new literature review published in Medical Science reports that benzodiazepine use is linked to greater risk of falls and fractures in older patients. This review, led by Szymon Barczak from Mazovian Brodnowski Hospital in Poland, also reports that these risks may be greatest in the 24 hours after starting benzodiazepines.
The goal of this review was to examine the link between benzodiazepine use and fall/fracture risk in older adults. The authors reviewed 21 previously published studies on fall/fracture risk and benzodiazepine use in geriatric patients. Included studies had to be peer-reviewed and published in English.
Most included studies found a link between benzodiazepine use, falls, and fractures in older adults. Included studies found between a 40% to a more than tripled (3.128 times higher odds) increased risk of falls, and between 20% to nearly quadrupled (3.73) increased risk of fractures linked to benzodiazepine use. One study presented evidence that the risk of falls was nearly quadrupled (3.79 times higher odds) in the first 24 hours following the start of benzodiazepine use. Some included studies also reported that higher doses, longer duration of use, and polypharmacy were all linked to increased fall and fracture risk. The authors note that not all included studies linked benzodiazepine use to greater fall risk. Studies conducted with hospitalized participants were less likely to find a link between benzodiazepine use, falls, and fractures.
This study had 3 main limitations. Only English language studies were included, limiting generalizability. Included studies varied significantly in design, definitions of falls and fractures, and exposure periods. Most included studies were observational, meaning these results cannot say for certain that benzodiazepine use causes falls and fractures.
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Barczak, S., Hertz, Z., & Barczak, J. (2026). The risk of falls and fractures in geriatric benzodiazepine users: A review. Medical Science, 30(167), 1–11. (Link)
Huang, Y.-S., Prawesti, G. N., Chiang, Y.-C., Chen, Y.-C., & Chen, H.-Y. (2026). Effects of benzodiazepines on heart failure outcomes and adverse events: A systematic review and meta-analysis. Cardiovascular Toxicology, 26(10). (Link)
Liu, C., Zhang, L., Pan, Q., Shi, Y., Yu, W., Li, G., & Li, H. (2026). Long-term benzodiazepine use is associated with poorer cognitive function in schizophrenia: Findings from the Salt-C Cohort. BMC Psychiatry, 26(1). (Link)
Picot, C., Piroux, Y., Pleau, J., Bérard, A., Cucherat, M., & Cottin, J. (2026). Risk of miscarriage after benzodiazepine use during pregnancy: Updated systematic review and meta-analysis. BMC Pregnancy and Childbirth, 26(1). (Link)
