The Down Low on Benzo(diazepines): Update on Tapering and Withdrawal

Abstract Purpose. This article describes history of benzodiazepine use, increased use in recent years, and addressing misuse and chronic use of benzodiazepines to give medical professionals a guide to benzodiazepine tapering options and avoidance of withdrawal symptoms. Method. PubMed search with the terms benzodiazepines, taper, anxiety, and withdrawal. Results. Various guidelines regarding taper schedules and avoidance of withdrawal with benzodiazepines. Most prevalent evidence demonstrates switching to an equivalent long-acting benzodiazepine and then tapering dose by 25% every two weeks until cessation along with cognitive behavioral therapy and possible selective serotonin reuptake inhibitor initiation manages symptoms of withdrawal and anxiety well. Conclusion. Significant risks with continuation of benzodiazepine prescriptions, particularly in the elderly. The most prevalent research regarding benzodiazepine tapering and withdrawal suggests switching the prescription to a long acting benzodiazepine and then decreasing the dose over the course of at least 8-12 weeks until cessation while cognitive behavioral therapy is initiated with or without serotonin reuptake inhibitor initiation. Support groups, further education, and motivational interviewing also play a role in successful taper and cessation. Further promoting and cultivating a culture of deprescription and not initiating new prescription of benzodiazepines while giving support to those patients tapering with shared decision-making leads to better outcomes