Review: Adjunctive pharmacologic approaches for benzodiazepine tapers

Drug Alcohol Depend. 2018 Aug 1:189:96-107. doi: 10.1016/j.drugalcdep.2018.04.028. Epub 2018 May 31.

Abstract

Background: Many patients require discontinuation of benzodiazepines due to a reduction in drug efficacy over time, the development of a sedative use disorder, or unwanted side effects. Benzodiazepine discontinuation can pose a significant challenge for prescribing clinicians due to potential withdrawal symptoms and a recurrence of psychiatric complaints.

Methods: A PubMed literature search was conducted using the medical subject heading of benzodiazepines in combination with the following key words: discontinuation, withdrawal, detoxification, cessation, dependence, addiction, substance use disorders, or long term. Twenty-one studies met the search criteria.

Results: Few medications facilitated the successful discontinuation of benzodiazepines or relief from benzodiazepine withdrawal symptoms.

Conclusions: Studies were heterogeneous with respect to sample selection, sample size, and outcome measures. Medications targeting insomnia yielded mixed results. Similarly, studies of agents targeting anxiety symptoms demonstrated inconsistent findings in the reduction of anxiety, improvement in withdrawal symptoms, or enhancement of benzodiazepine completion rates. Anticonvulsants have supporting evidence from small case reports; carbamazepine shows some potential in assisting taper completion and reducing withdrawal severity. These conclusions should be considered in light of a number of inconsistencies across studies in the literature. The results of this review article highlight the need for additional research on optimal strategies for facilitating successful benzodiazepine tapers.

Keywords: Augmentation; Benzodiazepines; Dependence; Discontinuation; Taper; Withdrawal.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Anti-Anxiety Agents / adverse effects*
  • Anticonvulsants / therapeutic use*
  • Anxiety / drug therapy
  • Anxiety / epidemiology
  • Anxiety / psychology
  • Benzodiazepines / adverse effects*
  • Carbamazepine / therapeutic use
  • Humans
  • Hypnotics and Sedatives / therapeutic use
  • Randomized Controlled Trials as Topic / methods
  • Sleep Initiation and Maintenance Disorders / drug therapy
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Sleep Initiation and Maintenance Disorders / psychology
  • Substance Withdrawal Syndrome / drug therapy*
  • Substance Withdrawal Syndrome / epidemiology
  • Substance Withdrawal Syndrome / psychology
  • Substance-Related Disorders / drug therapy
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology
  • Withholding Treatment / trends*

Substances

  • Anti-Anxiety Agents
  • Anticonvulsants
  • Hypnotics and Sedatives
  • Benzodiazepines
  • Carbamazepine