Assess suitability

Flowchart image - click on image to enlarge

The following narrative explains the flow chart in more detail.

Assess the individual’s readiness to reduce and/or stop

It is important that an individual’s motivation and readiness for reductions and/or discontinuation is adequately assessed, and where appropriate agreed and tailored dose reductions are planned, and where implemented, regularly reviewed. Signposting or referral for interventions to support changes to prescribing, including psychosocial and/or psychological interventions, should also be considered.

What is the risk-benefit balance of continuing current B-Z and doses? 

Continuing to prescribe beyond four weeks is unlicensed. The risk of falls for older adults, or negative cognitive effects for people with depression or other common mental health considerations, as well as the tolerance and loss of effect that can develop within two to four weeks in the treatment of insomnia/anxiety should be acknowledged in any risk-benefit discussions.⁶⁹

Prescribers may also consider that on balance some therapies may not benefit individuals and should explain their reasons to the individual and explore other options that might be available, including their right to seek a second opinion.⁸³

Has the individual completed the planned and agreed course or trial of treatment?

For example, was the B-Z initiated for short-term use and has evolved into long-term use? Has a prescriber discussed the potential harms of continuing treatment and that B-Z are only licensed for maximum of four weeks’ use, and therefore it may be appropriate to plan and agree gradual reduction in therapy?