ASAM Pocket Guidelines and Patient Guide

Benzodiazepine Tapering

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2 Key Points Background Î Benzodiazepines (BZDs) are approved by the US Food and Drug Administration (FDA) to treat a wide range of conditions, including anxiety and panic disorders, social phobia, insomnia, and seizures and are commonly prescribed. Î Use of these medications is associated with increased risk for adverse events, including falls, motor vehicle accidents, cognitive impairment, delirium, overdose, and death, particularly when BZDs are used in combination with central nervous system (CNS) depressants such as alcohol or opioids. Î When BZDs are used regularly, abrupt discontinuation (i.e., stopping the medication without a taper) or precipitous dose decreases can lead to serious and potentially life-threatening withdrawal symptoms (See Table 3). Î Physical dependence is a biological phenomenon that develops in response to repeated use of a medication and is distinct from BZD use disorder. Nearly all patients who regularly use BZD for more than a month will develop physical dependence. Only 1.5% of people who use BZD meet criteria for BZD use disorder. Î While there are some limited indications for longer term BZD use (e.g., severe treatment-resistant generalized anxiety disorder (GAD) or bipolar spectrum disorders, complex seizure disorders, spasticity, sleep disorders involving abnormal movements), it is generally recommended to limit BZD use to 2-4 weeks.

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