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Heroin Addiction and Related Clinical Problems: 2000, 02, 2 (pages: 1 - 18)

Menaging benzodiazepine withdrawal

Frare F., Perugi G.

Summary: The long-term use of Benzodiazepines (BZs) is currently a source of growing concern, owing to increasing doubts about their efficacy, and evidence of important adverse effects, including physical dependence and neuropsychological impairment. The long-term use of BZs in patients with anxiety and mood disorders calls for special concern; in these patients, in fact, interepisodic chronicity and residual symptoms often appear to be related to inappropriate long-term use of BZs. The problem of dependence on benzodiazepines has been aggravated by iatrogenic physiological dependence on these medications and by polysubstance-abusing patients using them in addition to other agents, in particular opioids or cocaine. A safe, rapid, and effective way to detoxify patients from benzodiazepines is of prime importance in facilitating further treatment of their psychiatric or substance use disorder. Correct withdrawal strategies should combine gradual dosage reduction, psychological support and adjuvant medications in selected patients. The tapering schedule should be individually titrated and adjusted according to the patient's reactions; substitution with a long-acting BZ is often useful. Psychological support should include information about BZ withdrawal, general encouragement and the correction of misconceptions about discontinuing medicines; it should be available both during tapering and after withdrawal. Some antiepileptics and sedative antidepressants may be useful to mitigate withdrawal phenomena. Adequate dosages of antidepressants should be used to treat the re-emergence of an underlying mood or anxiety disorder. Success rates of withdrawal are high (54-92%); the follow-up studies, however, indicate that long-term discontinuation of BZ is a slow process, taking many weeks or months - in some cases years - with a protracted clinical course after drug cessation.