Diazepam-Associated Hypotension Contributing to Recurrent Syncope in an Older Adult

Syncope in older adults is often multifactorial, with polypharmacy being a common and potentially modifiable factor. Benzodiazepines are prescribed for anxiety and insomnia in this population despite being associated with adverse effects, including falls, cognitive impairment, and hypotension. We present the case of a 68-year-old female patient with multimorbidity and recurrent unexplained syncope despite extensive cardiologic and neurologic evaluations. She was on diazepam therapy for anxiety as part of a complex medication regimen. A temporal relationship was observed between diazepam administration and episodes of hypotension, with systolic blood pressure dropping as low as 70 mmHg approximately three to four hours after dosing. Following stepwise dose reduction of diazepam, the frequency of syncopal episodes decreased over a four-month period, with no alternative single factor fully explaining the improvement. This case highlights the importance of medication review in older adults presenting with syncope. Benzodiazepines may contribute to clinically significant hypotension, particularly in the context of polypharmacy, and dose reduction or deprescribing may lead to clinical improvement.