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Prescribing drugs of dependence - Benzodiazepines

Duration of benzodiazepine therapy

Guidelines and formularies typically give durations of 1–4 weeks for benzodiazepine therapy, depending on the indication. Short-term therapy is generally advised to reduce the risk of dependence and withdrawal, as well as other potential harm such as cognitive impairment. Short-term therapy does not reduce the risk of accidents or falls.

Dependence is recognised as a risk in some patients who receive treatment for longer than 1 month, and health professionals should be conscious of this when considering the relative benefits and risks of treatment.

While the optimum duration of therapy is not clear from the evidence, there are very few specific indications for the chronic use of benzodiazepines. The decision to prescribe benzodiazepines longer term should be uncommon and made with caution.

Assume that all patients are at risk of dependence.

In a situation where the clinical decision is that the ongoing use of a benzodiazepine is the most appropriate management, this requires ongoing monitoring of health outcomes and continuing vigilance for potential hazards throughout treatment.

The responsible specialist or GP should clearly outline a prescribing plan that should be documented in the patients’ notes or management plan.

The prescribing plan may include instructions that:

  • regular prescription reviews take place

  • no repeat prescriptions will be made without face-to-face contact

  • all prescriptions will be made by one doctor within a single practice

  • one pharmacy will dispense all medication.

Benzodiazepine prescriptions should be at the lowest effective dose and given intermittently, with regular reviews of the treatment plans and regular attempts at withdrawal.

At the time of benzodiazepine prescription renewal or medication review, GPs should continue to discuss the risks of long-term benzodiazepines and the benefits of discontinuation (eg cognition, mood, sleep and energy level) and advise the patient to reduce or discontinue the benzodiazepines if there are issues. GPs should document this communication.

Patients should be monitored closely for problematic use or any therapeutic dose dependence behaviour. Any escalation of dose or inappropriate use would lead to a complete review of prescribing and attempted withdrawal of benzodiazepine, along with a review of alternative therapy.


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