6
Recommendations
Considerations for Tapering Benzodiazepines
1. Clinicians should ideally assess the risks and benefits of ongoing
BZD prescribing at least every 3 months for each patient taking BZD
medications (See Table 1 and Table 2) (CC-S).
a. At a minimum, clinicians should assess the risks and benefits with each new
BZD prescription or BZD prescription renewal (CC-S);
b. Clinicians should review the information in the relevant prescription drug
monitoring programs (PDMP) as part of the risk–benefit assessment (CC-S).
2. Clinicians should avoid abruptly discontinuing BZD medication in
patients who are likely to be physically dependent on BZDs and at
risk for BZD withdrawal (See Table 2) (L-S).
a. Tapering is indicated for patients who are likely to be physically dependent
when the risks of BZD medication outweigh the benefits (L-S);
b. Clinicians should consider either discontinuation or a short taper for patients
who are unlikely to be physically dependent when the risks of BZD medication
outweigh the benefits (CC-S).
3. If the BZD medication is discontinued without a taper in patients
who are unlikely to be physically dependent, clinicians should
counsel patients to report the emergence of withdrawal and/or
rebound symptoms (See Table 3) (CC-S).
a. If significant symptoms emerge, clinicians can consider using medications for
symptom management or restarting the BZD medication and initiating a taper
(CC-C).
Recommendation Grading
Certainty of Evidence Strength of Recommendation
H High certainty S Strong Recommendation
M Moderate certainty
C
Conditional Recommendation
L Low certainty W Weak Recommendation
VL Very low certainty
CC Clinical consensus
