After weeks to months of regular benzodiazepine use, stopping suddenly can cause rebound anxiety, insomnia, and in more severe cases withdrawal seizures or delirium. The established approach is a gradual, planned taper over weeks to months, agreed with the patient, with slower steps towards the end, when withdrawal symptoms are often most troublesome. Switching to a longer-acting agent such as diazepam before tapering is a common strategy. Pair the taper with support for the underlying anxiety or insomnia, for example CBT.
- Agree a written taper plan with the patient before starting, with reductions every few weeks.
- Slow the taper towards the end, when withdrawal symptoms are often worst.
- Consider switching to an equivalent dose of a longer-acting benzodiazepine before tapering.
- Offer CBT or other support for the underlying anxiety or insomnia during the taper.
- Warn patients and families that abrupt stopping after long-term use can cause seizures.
Why it matters
Falling prescribing rates mean more clinicians will be withdrawing benzodiazepines, and how it is done determines whether it works.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for psychiatry, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free