Benzodiazepine dependence

Prescribing Notes:

• Specialist advice should be sought, the key aim of treatment is to provide a person-centred care plan providing harm reduction support tailored to the individual which may include: appropriate psychosocial/logical interventions, supported self-reduction of street benzodiazepines, medication assisted detox for abstinence or medication assisted stabilisation (maintenance prescribing).
• Only diazepam 5mg and 2mg tablets should be prescribed to minimise diversion (10mg diazepam tablets have a higher street value). The 2mg tablets allow for easier reduction regimens.
• It is inappropriate for patients to be prescribed more than one benzodiazepine at the same time. Patients already in receipt of a prescription of more than one type of benzodiazepine should normally be converted to diazepam only.
• Diazepam is first choice for managing benzodiazepine dependence because it has a long half-life. It is generally not advised to start above 30mg diazepam daily and doses above this should rarely be used.
• Diazepam 30mg is sufficient to prevent fits in the majority of cases, even if the dose of benzodiazepine being taken was higher than this.
• For patients already established on higher doses (over 30mg), a gradual reduction (to 30mg initially) should be undertaken on the basis of the potential for long term, dose dependent cognitive impairment. Consideration should be given to seeking a specialist opinion in the event of failure to tolerate a reduction.
• There is no role for the use of the ‘z drugs’ e.g. zopiclone, zolpidem in benzodiazepine detoxification.
• Alcohol should not be consumed concurrently with benzodiazepines.
• Prescribers should seek specialist advice and consider any new maintenance benzodiazepine prescriptions carefully. Specialists recognise for some patients maintenance prescribing may be required. However, there are no licensed indications for the prescribing of benzodiazepines for more than 2-4 weeks.