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Benzodiazepine and z-drug withdrawal - Management
How should I manage withdrawal symptoms?
- Review frequently to detect and manage problems early, and to provide encouragement and reassurance during and after drug withdrawal.
- Manage anxiety.
- Explain that anxiety is the most common acute withdrawal symptom.
- Reassure that anxiety is likely to be temporary.
- Consider slowing or suspending withdrawal until symptoms become manageable.
- Consider additional use of non-drug treatments.
- Adjunct drug therapy should not be routinely prescribed but may be considered:
- Propranolol: for severe, physical symptoms of anxiety (such as palpitations, tremor, and sweating) only if other measures fail.
- Antidepressants: only if depression or panic disorder coexist or emerge during drug withdrawal.
- Do not prescribe antipsychotics which may aggravate withdrawal symptoms.
- Seek specialist advice if symptoms are severe or difficult to manage.
- Manage depression.
- If depression emerges or coexists with withdrawal symptoms:
- Consider suspending drug withdrawal until the depression resolves.
- See the CKS topic on Depression for further information on the management of depression.
- Manage insomnia.
- Adverse effects on sleep are not likely to be a problem if drug withdrawal is slow.
- Non-drug treatments have proved to be beneficial in managing long-term insomnia and should be considered for all people with long-term insomnia problems — see the CKS topic on Insomnia.
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