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Benzodiazepine and z-drug withdrawal - Management
How do I manage someone who wants to stop benzodiazepines or z-drugs?
- Decide if the person can stop their current benzodiazepine or z-drug without changing to diazepam.
- Switching to diazepam is recommended for:
- People using the short-acting potent benzodiazepines (that is, alprazolam and lorazepam).
- People using preparations that do not easily allow for small reductions in dose (that is alprazolam, flurazepam, loprazolam and lormetazepam).
- People taking temazepam or nitrazepam who choose to withdraw from diazepam after discussing the advantages and disadvantages.
- People experiencing difficulty or who are likely to experience difficulty withdrawing directly from temazepam, nitrazepam, or z-drugs, due to a high degree of dependency (associated with long duration of treatment, high doses, and a history of anxiety problems).
- Seek specialist advice (preferably from a hepatic specialist) before switching to diazepam in people with hepatic dysfunction as diazepam may accumulate to a toxic level in these individuals. An alternative benzodiazepine without active metabolites (such as oxazepam) may be preferred.
- For information on converting to diazepam, see Switching to diazepam.
- Negotiate a gradual drug withdrawal schedule (dose tapering) that is flexible. Be guided by the person in making adjustments so that they remain comfortable with the withdrawal.
- Titrate the drug withdrawal according to the severity of withdrawal symptoms.
- Drug withdrawal may take 3 months to a year or longer. Some people may be able to withdraw in less time.
- For information on withdrawing and advice to give people, see Withdrawing a benzodiazepine or z-drug and Advice.
- Review frequently, to detect and manage problems early and to provide advice and encouragement during and after the drug withdrawal.
- If they did not succeed on their first attempt, encourage the person to try again.
- Remind the person that reducing benzodiazepine dosage, even if this falls short of complete drug withdrawal, can still be beneficial.
- If another attempt is considered, reassess the person first, and treat any underlying problems (such as depression) before trying again.
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