Abstract
Abstract
Most guidelines recommend that benzodiazepines and z‐drugs used continuously for more than 4 weeks should be withdrawn, if the patient is agreeable, because of the unfavourable balance of harms (including physical dependence, addiction, tolerance and withdrawal effects) and benefits. Withdrawal effects arise due to adaptation to chronic use of benzodiazepines and z‐drugs – often termed physical dependence, distinct from addiction. Addiction is an issue only for a small minority of benzodiazepine users whilst withdrawal effects and physical dependence affect a much larger group of patients taking medication as prescribed. Withdrawal effects can manifest as either physical or psychological symptoms and can often be mistaken for a return of an underlying condition or onset of a new physical or mental health condition. The most severe withdrawal effects are suicidality, akathisia and protracted withdrawal syndromes which can last for months or years and can sometimes be debilitating. Careful tapering can minimise these effects. After long‐term use tapering should be gradual (months or years), and adjusted to a rate that the individual can tolerate. Dose reduction should be conducted in a hyperbolic pattern (so that decrements become smaller and smaller as the total dose gets lower) to reflect the hyperbolic relationship between dose and receptor occupancy. In order to facilitate gradual hyperbolic tapering sometimes formulations other than widely available tablets will be required, including liquid versions, compounded versions or off‐label use of existing formulations. Switching from one benzodiazepine to a longer‐acting drug like diazepam can sometimes be helpful.