Pharmacist Toolkit: Benzodiazepine Taper

Long-term use of benzodiazepines has been known to produce complications related to discontinuation, withdrawal symptoms, increased risk of accidental overdose when combined with other central nervous system depressants, persistence of benzodiazepine related side-effects, physical dependence, and benzodiazepines use disorders. There were nearly 272,000 emergency department encounters within the United States involving nonmedical use of benzodiazepines in 2008. In many of these visits (40%), benzodiazepines were used in conjunction with alcohol. The number of nonmedical benzodiazepine emergency department visits increased to 426,000 in 2011. The use of alcohol was present in 24.2% of these visits.

From 1996 to 2013, the number of adults that obtained a prescription for a benzodiazepine increased by 67%. The amount of benzodiazepines dispensed more than tripled during that same time period, from 1.1-kg to 3.6-kg lorazepam-equivalents per 100,000 adults. Based on information from the National Institute on Drug Abuse, the number of overdose deaths involving a benzodiazepine increased from 1135 in 1999 to 8791 in 2015. Three quarters of the deaths involving a benzodiazepine also involved an opioid. Because of concerns regarding patient safety, several guidelines and expert consensus statements have cautioned against chronic benzodiazepine use, especially in the elderly and other at-risk populations. Though benzodiazepines remain first-line treatments for acute alcohol withdrawal and may be used acutely as anticonvulsants, they should generally be avoided for anxiety disorders, panic disorder, and insomnia. 

Pharmacists can play a key role in providing education to patients and providers about the value of avoiding benzodiazepines, alternative, safer and more effective agents, and often in helping to directly or indirectly assist in the difficult process of tapering such agents. Contents include: 

• Populations at Risk for Complications
• Screening and Diagnosis
• Benzodiazepine Withdrawal
• Treatment
• Special Populations
• Harm Reduction
• Clinical Pearls
• Authors’ Experience
• References