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Benzodiazepine and z-drug withdrawal - Evidence
Evidence on gradual dose reduction for benzodiazepine withdrawal
For people withdrawing from benzodiazepines, there is very limited evidence from several small studies that gradual withdrawal is more preferable than abrupt withdrawal in terms of reducing symptoms and improving cessation rate.
- In a Cochrane review (search date: up to October 2004) which evaluated pharmacological interventions for managing benzodiazepine dependence [Denis et al, 2006], three small randomized controlled studies (RCTs) were identified which examined the effectiveness of gradual drug withdrawal. Pooling of data for a meta-analysis was not possible because of the non-compatibility of the interventions and outcomes.
- One RCT (n = 68) supported the use of gradual withdrawal, where the dosage was reduced in 25% quantities every 4 weeks until no further benzodiazepines were taken. There were few differences in withdrawal symptoms between the groups taking a short- or long-acting benzodiazepine.
- In another RCT (n = 154) which compared different withdrawal rates (with or without hydroxyzine), progressive withdrawal appeared preferable compared with abrupt withdrawal since the number of drop outs (after the end of the withdrawal process) was less important, and the procedure was judged more favourably by the people undergoing slow withdrawal.
- In the third RCT (n = 31), participants were randomly assigned to either abrupt withdrawal under propranolol cover or slow withdrawal only. More people in the slow withdrawal group (69%) successfully withdrew from their drugs, compared to the abrupt withdrawal group (27%). In addition, the slow withdrawal group had only mild withdrawal symptoms, while the other group suffered more severe symptoms (which lasted around 4 weeks).
- A recent meta-analysis (search date: up to 2007, month unspecified) evaluating treatment approaches for benzodiazepine discontinuation identified only one small study (n = 107) which found that engagement in a programme of gradual dose reduction was more effective than routine care (odds ratio 5.96, 95% CI 2.08 to 17.11) [Parr et al, 2009].
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