Benzodiazepine dependence: strategies for prevention and withdrawal

In Australia the use of benzodiazepines has fallen. Benzodiazepine dependence and withdrawal symptoms can occur as early as 2 weeks after starting the drug, even at the recommended doses. It is estimated that one in three patients will become dependent after taking benzodiazepines daily, for 3-4 months. It is difficult to predict which patients will become dependent, so all patients must be considered at risk. GPs should review patients' diagnosis and therapy if they have been taking benzodiazepines for 2 months or more. Benzodiazepines should be reduced or ceased over a minimum of 6-8 weeks. Conversion to a long half-life benzodiazepide such as diazepam can be helpful, especially when short half-life drugs have been used during the day. The rate of reduction should be titrated to the patient's symptoms. The patient needs regular reassurance and support as necessary. Where the dosage has been high, or if multiple drugs are being used, referral for patient detoxification may be necessary. (author abstract)