Applying benzodiazepine discontinuation strategies in everyday practice

Background: Although benzodiazepines are effective sedative and anxiolytic agents, their use in clinical practice remains controversial due to difficulties with adverse effects and significant dependency potential. Method: We reviewed relevant literature (scientific papers/clinical guidelines) addressing the issue of discontinuation strategies in long-term benzodiazepine users. This information was used to formulate a stepwise algorithm for managing benzodiazepine discontinuation. Results: Careful management of benzodiazepine initiation, with clear protocols around duration of treatment are an important means of preventing benzodiazepine dependence. In those receiving long-term or maintenance therapy, simple interventions can be useful in a minority of patients but more consistent reduction in benzodiazepine use across clinical populations warrants complex and multifaceted interventions that combine educational elements and a range of pharmacological and non-pharmacological interventions. Maintenance use may be necessary for those with severe and intractable anxiety but discontinuation is desirable for the majority of users. Conclusions: Excessive use of benzodiazepines remains a common problem. We describe guidelines for discontinuation in everyday clinical practice.