Benzodiazepine withdrawal management
The onset and duration of symptoms varies depending on the particular benzodiazepine/s taken as there is a wide variation in half-life and some benzodiazepines have active metabolites.
Symptoms can be considered under three main headings:
Anxiety and related symptoms
- anxiety, panic attacks, hyperventilation, tremor
- sleep disturbance, muscle spasms, anorexia, weight loss
- visual disturbance, sweating
- altered mood.
- hypersensitivity to very loud noises
- abnormal body sensations
- generalised seizures
- precipitation of delirium or psychotic symptoms.
Predictors of benzodiazepine withdrawal
Withdrawal is unlikely if the patient’s use is intermittent only or follows a binge pattern only. More severe withdrawal is associated with:
- abrupt cessation
- short-acting agent (especially alprazolam)
- high dose.
Benzodiazepine withdrawal can be safely managed as an outpatient unless:
- other major medical or psychiatric problems co-exist
- there is polydrug dependence
- the patient takes a high dose (>50mg diazepam equivalent per day) or injects
- the patient requires stabilisation of other medication (for example methadone, buprenorphine).
- If the patient has been using more than 50mg diazepam equivalent then they should be initially managed in an inpatient setting.
- Use the CIWA-B (PDF 75KB) for monitoring benzodiazepine withdrawal
- Convert daily intake into equivalent dose of diazepam - see Conversion Chart (PDF 187KB).
- Commence diazepam at equivalent dose (but no greater than 40mg bd)
- If the patient becomes sedated to the extent that they can not be easily roused, medication should be with-held.
- Reduce the daily dose by 10mg (for example 5mg bd) each day.
- Once the patient’s daily dose is less than 50mg, they can be discharged and their medications continued on a tapering basis as per Outpatient Withdrawal.
- Convert daily intake into equivalent dose of diazepam - see Conversion Chart (PDF 187KB)
- Prescribe diazepam equivalent with gradual reduction of 5 to 10% of the dose each week.
- The patient is required to sign an Authority to release personal Medicare and Pharmaceutical Benefits Scheme Claims information to a third party form regarding medical visits and scripts dispensed through PBS.
- A patient/doctor agreement needs to be completed in writing - see example patient/doctor agreement (PDF 165KB).
- The patient may need to collect Diazepam from the pharmacy daily, depending on their circumstances.
- The patient will require a weekly medical review.
- Benzodiazepines: Information for GPs (PDF 163KB): designed to assist doctors in the management of patients ceasing benzodiazepine use and should be read in conjunction with the patient resource Benzodiazapines: Reasons to stop and stopping use.
- Benzodiazepines: Reasons to stop and stopping use (PDF 231 KB): designed for people who are considering stopping, or who have decided to stop, using benzodiazepines. It contains two parts
- Part 1: Reasons to stop
- Part 2: Stopping use.
Further information and advice
Alcohol and Drug Information Service (ADIS) 1300 13 1340
ADIS is a telephone information, counselling, and referral service.
Drug and Alcohol Clinical Advisory Service (DACAS)
DACAS provides general practitioners and other health professionals direct telephone access to a specialist drug and alcohol medical officer.
Telephone: (08) 7087 1742.