What Is the Best Way to Discontinue Benzodiazepines?

The use of benzodiazepines is very common among patients with a variety of conditions, but clinician guidance on their use is lacking. What do you prescribe these medications for, and what is your approach to deprescribing them? Let us know in the comments section.

This is the Medscape Psychiatry Minute. I’m Dr Peter Yellowlees. Approximately 4% of the population use benzodiazepines, and prolonged treatment is common despite clinical recommendations for short-term use. Discontinuing benzodiazepines is difficult for many patients and it is unclear which pharmacologic interventions are best to facilitate tapering.

To examine this question, a team of investigators from Glostrup, Denmark, conducted a systematic review using standard Cochrane methods.^[1] Data from 2295 patients were extracted from 35 trials. Of 18 comparison interventions, no single intervention was assessed in more than four trials. Furthermore, the authors found that, partly because of the very low quality of evidence for the reported outcomes, it was not possible to draw firm conclusions regarding pharmacologic interventions for facilitating benzodiazepine discontinuation in chronic benzodiazepine users.

So where does this leave us? In short, we have a huge clinical problem. All we know is that weaning patients from benzodiazepines is best done very slowly and is often painful for our patients. In my own practice, I often manage very slow tapers that last between 6 months and a year. It seems that most patients can manage this, but I have no evidence beyond my clinical impression to back up my opinion.

Given the millions of people worldwide who take benzodiazepines long-term, we are desperately short of data and high-quality randomized trials aimed at developing evidence-based withdrawal protocols. These need to occur.

Comments:

Elizabeth Metzgar-Ruggiero|  Other Healthcare Provider

As someone who was prescribed clonazepam for sleep problems on a long-term basis (more than 5 years) I can say it is hell getting off, and almost four years after I tapered and quit, I still have problems associated with the use of the drug.

Mary Offutt|  Registered Nurse (RN)

Curious if the author is familiar with Dr. Heather Ashton and her withdrawal manual. https://www.benzo.org.uk/manual/

I’m a nurse who got physically dependent on 0.25 xanax at bed time for a few months. When I realized I was hooked, I couldn’t wait to get unhooked. But I found I was largely on my own.

So I know from experience how important this research would be.

R C|  Health Business/Administration

@Mary Offutt Ashton’s method makes some key assumptions. Convert short acting benzos such as Xanax to longer acting acting ones such as diazepam (the conversion is included in the tapering schedule). The patient must WANT to taper. Taper SLOWLY on a schedule tailored to each individual. Do not punish failure, if a patient misses a scheduled taper target, revise the schedule or just pick up where they left off. She notes in her comments that doctors in the US inexplicitly seem to want to taper more aggressively.

https://wb.md/2Lrjnh7