An 82-year-old female with osteoarthritis, anxiety, and insomnia is taking Tylenol® Arthritis (acetaminophen 650 mg extended release) two tablets every 8 hours, zolpidem 5 mg at bedtime, and lorazepam 1 mg at bedtime. She presents to the pharmacy complaining of increased confusion and difficulty walking, which started about a week ago. What is the most appropriate initial recommendation for this patient regarding her medications?

Question: An 82-year-old female with osteoarthritis, anxiety, and insomnia is taking Tylenol® Arthritis (acetaminophen 650 mg extended release) two tablets every 8 hours, zolpidem 5 mg at bedtime, and lorazepam 1 mg at bedtime. She presents to the pharmacy complaining of increased confusion and difficulty walking, which started about a week ago. What is the most appropriate initial recommendation for this patient regarding her medications?

Answer options:

• Suggest switching zolpidem to melatonin for sleep.
• Recommend reducing her acetaminophen dose due to potential liver toxicity. ✅ Advise discontinuation of lorazepam and reassessment of sleep/anxiety needs.
• Suggest increasing her daily physical activity to improve mobility.

Correct answer: Advise discontinuation of lorazepam and reassessment of sleep/anxiety needs.

Explanation: The concomitant use of zolpidem and lorazepam, both central nervous system depressants, significantly increases the risk of falls, confusion, and cognitive impairment in the elderly. Deprescribing one or both benzodiazepine receptor agonists is a priority in this polypharmacy case.