Commence initial dose at ½ determined initial dose, to assess tolerance. [eg if estimated to be 80mg per day = 20mg QID then initial dose would be 10mg]. This could be repeated in 2 hours if no sedation evident, then continue with previously determined QID regimen.
If the patient becomes sedated to the extent that they can not stay awake [sedation score 2 or more] 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 as long as restricted dispensing from the community pharmacy is arranged. [see below].
If the patient is also taking/being administered other CNS depressants such as opioids, gabapentinoids, antipsychotics or tricyclic antidepressants then consider halving the doses above, and increasing observations to 2 hourly, at least initially. Seek advice from the Drug and Alcohol Clinical Advisory Service 08 7087 1742.
If the patient has been using less than 50mg diazepam equivalent then they can be managed in an outpatient setting.
If the patient is also taking/being administered other CNS depressants such as opioids, gabapentinoids, antipsychotics or tricyclic antidepressants then seek advice from the Drug and Alcohol Clinical Advisory Service 08 7087 1742.
Test first dose to determine tolerance. Review patient 1-2 hours after first dose. Preferably keep patient in surgery. If tolerated then continue with regimen as estimated.
Prescribe diazepam equivalent with gradual reduction of 5 to 10% of the dose each week.
Review the patient’s medication history in my Health Record but be aware
that this is sometimes incomplete. In future, ScriptCheckSA will be a reliable
source of all S8 and targeted S4 medications prescribed and dispensed
The patient will require at least 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.
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