18
Treatment – Ambulatory
(3) Benzodiazepine use
Î Recommendation IV.20: While no particular benzodiazepine agent is
more effective than another, longer-acting benzodiazepines are the
preferred agents due to the clinical benefits of their longer duration of
action.
Î Recommendation IV.21: If waiting for lab test(s) results or if the
test(s) are unavailable, if a patient has signs of significant liver
disease, use a benzodiazepine with less hepatic metabolization.
Î Recommendation IV.22: Clinicians should monitor patients taking
benzodiazepines for signs of over-sedation and respiratory depression.
Î Recommendation IV.23: A benzodiazepine prescription to treat
alcohol withdrawal should be discontinued following treatment.
Î Recommendation IV.24: Clinicians can manage benzodiazepine
misuse or diversion risk in ambulatory settings by dispensing or
prescribing the minimum amount necessary given patients' level of
stability and timing of their next in-person clinic visit. Alternative
medications can also be considered such as carbamazepine or
gabapentin.
Î Recommendation IV.25: In ambulatory settings, benzodiazepines
should not be prescribed to patients with a history of even mild
adverse events with benzodiazepine use because rapid intervention
is not typically available. Benzodiazepines can be used with caution
in patients with a high risk of benzodiazepine diversion including
patients with a current or past benzodiazepine use disorder for the
short period of acute alcohol withdrawal. Risk can be managed by
dispensing or prescribing a small number of doses.
Î Recommendation IV.26: Patients who are taking benzodiazepines, and
their caregivers, should be educated regarding:
• The danger of drug-drug interactions between benzodiazepines and other CNS
depressants (impairment and respiratory depression)
• The risks associated with combining alcohol and benzodiazepines and importance
of abstinence from alcohol
• The risks associated with driving or use of heavy machinery for the first few days of
benzodiazepine administration
• Instructions to reduce their benzodiazepine dose if drowsiness occurs
