Benzodiazepine withdrawal

Background

Clinical Features

Differential Diagnosis

Sedative/hypnotic withdrawal

Seizure

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma

Psychiatric

Evaluation

Management

  • Ensure patient and staff safety, airway protection if acutely agitated or seizing
  • Benzodiazepines
  • After acute symptoms controlled, can prescribe gradual benzodiazepine taper
    • One taper strategy: decrease dose by 25% for first week, 25% second week, then by 12.5% for subsequent weeks[3]
  • Consider neurology consult if patient was using benzos for seizure control (may need further antiepileptic management)

Disposition

  • Admit if:
    • Multiple seizures
    • Uncontrolled autonomic hyperstimulation
    • Decreased level of consciousness

See Also

External Links

References

  1. Marriott S, Tyrer P. Benzodiazepine dependence. Avoidance and withdrawal. Drug Saf. 1993 Aug;9(2):93-103. doi: 10.2165/00002018-199309020-00003. PMID: 8104417.
  2. Marriott S, Tyrer P. Benzodiazepine dependence. Avoidance and withdrawal. Drug Saf. 1993 Aug;9(2):93-103. doi: 10.2165/00002018-199309020-00003. PMID: 8104417.
  3. Chang  F: Strategies for benzodiazepine withdrawal in seniors. CPJ 138: 38, 2005.