Benzodiazepine Dependence

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

Long–term maintenance prescribing of benzodiazepines is rarely appropriate and unlicensed. Licensed treatment duration is 2 – 4 weeks.

Diazepam is first choice for managing benzodiazepine dependence because it has a long half–life. It is not advised to start above 30mg diazepam daily. A reduction should be considered, consisting of gradual withdrawal to zero. For patients already established on higher doses, a gradual reduction should be encouraged and may, if necessary, be imposed by the prescriber.

 

Acute Benzodiazepine Withdrawal Symptoms

Preferred list (P)

SUPPORTIVE MEASURES

DIAZEPAM 2mg tablets

  • Maximum 30mg daily for 3 days and then review.
  • Preferred formulation is 2mg tablets.
  • Based on clinical decision making, the 5mg tablets may only be used in exceptional circumstances. The 10mg tablets should not be prescribed
  • Diazepam 30mg is sufficient to prevent fits in the majority of cases, even if the dose of benzodiazepine being taken was higher than this.
  • Diazepam should only be prescribed if there is an actual clinical risk of withdrawal seizures (e.g. previous documented seizures on abrupt withdrawal).

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.