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Benzodiazepine withdrawal management

Withdrawal syndrome

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.

Perceptual distortions

  • hypersensitivity to very loud noises
  • abnormal body sensations
  • depersonalisation/derealisation.

Major events

  • 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).

Medication regimes

Inpatient withdrawal

  • 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.

Outpatient withdrawal

Resources

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.

 

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