Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users.

Abstract

Benzodiazepines are an effective pharmacological intervention for the management of insomnia and anxiety, and also the prevention and treatment of epileptic seizures. While benzodiazepines are indicated for the short-term management of such conditions, their use may become prolonged, leading to drug dependence in an individual. Individuals may deliberately abuse benzodiazepines, or inadvertently become dependent, physically and/or psychologically. Prescribers are, at present, encouraged to provide the lowest effective dose to individuals, limit prescribing benzodiazepines to 4 weeks of use or less and to consider the risks of dependency in the individual being prescribed for. Individuals who become dependent, chronic users of benzodiazepines may experience physical symptoms such as flu-like illness and muscular cramps, and also psychological symptoms such as irritability and insomnia. Often, the symptoms of withdrawal mimic the symptoms of the original complaint that the benzodiazepines were prescribed for, leading to an exaggerated effect of rebound symptoms. This complicates the discontinuation of benzodiazepines as individuals mistakenly believe there is a need for continued prescription. To assist individuals with discontinuing long-term use of benzodiazepines, gradual withdrawal, psychological support and pharmacological intervention are recommended. The Cochrane review aims to assess the benefits and harms of pharmacological interventions to facilitate discontinuation of chronic benzodiazepine use. The authors of this review examined whether pharmacological interventions may facilitate the discontinuation of benzodiazepines. Pharmacological interventions are centred on the symptomatic management of withdrawal; however, no drugs are, at present,