16
Management of Severe or
Complicated Withdrawal
12. Clinicians should manage patients experiencing severe or
complicated withdrawal in inpatient or residential medically
managed settings (e.g., residential withdrawal management
program) (See Table 3) with:
a. Monitoring for signs and symptoms of BZD withdrawal, including regularly
measuring vital signs and using structured assessment tools (CC-S);
b. Assessments for seizure risk, managed as appropriate (CC-S).
13. Tapering with very long-acting agents such as phenobarbital:
a. Can be considered for BZD withdrawal management in inpatient settings (L-S);
b. Should only be conducted by or in consultation with clinicians experienced in
the use of these agents for the purpose of BZD withdrawal management (See
Table 7) (CC-S).
14. Clinicians should avoid rapid BZD reversal agents such as flumazenil
for the purpose of BZD tapering due to risks for refractory seizure,
cardiac dysrhythmias, and other adverse effects (CC-S).
15. Clinicians should avoid general anesthetics such as propofol or
ketamine for the purpose of BZD tapering (CC-C).
