As above, provide 20mg diazepam every 1-2 hours until symptoms are controlled. In cases of severe dehydration, provide intravenous fluids with potassium and magnesium salts. Generally, benzodiazepine withdrawal symptoms fluctuate; the intensity of the symptoms does not decrease in a steady fashion as is the case with most other drug withdrawal syndromes. It is not recommended to increase the dose when symptoms worsen; instead, persist with the current dose until symptoms abate, then continue with the dose reduction schedule.
Benzodiazepine withdrawal syndrome
While a therapeutic dose has not been proven teratogenic, use during pregnancy has been linked to low birth weight, preterm labor, and intrauterine growth restriction. The unborn fetus is at high risk for “floppy infant syndrome,” characterized by muscle laxity, failure to suckle, and oversedation. Approximately two weeks after birth, the infant experiences withdrawal consisting of continued difficulty feeding, high pitched cries, hyperexcitability, and consequently possible failure to thrive. The ultimate concern is that such fetuses will later be susceptible to autism, learning difficulties, attention deficit disorder, and general hyperactivity [24]. One of the most well-studied BZDs in the setting of withdrawal is alprazolam.
The Treatment Process for Benzo Addiction
Provide 10-20ng of diazepam every 30 minutes until the patient is adequately sedated. The patient should be observed during sedation and no more diazepam given if signs of respiratory depression are observed. Patients should be allowed to sleep or rest in bed if they wish, or to do moderate activities such as walking. Offer patients opportunities to engage in meditation or other calming practices. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The medications listed below are related to or used in the treatment of this condition.
Benzodiazepine Overdose
- The term ‘withdrawal management’ (WM) has been used rather than ‘detoxification’.
- Inpatient rehab is one of the more intensive parts of the rehabilitation program.
- The current treatment for withdrawal is through tapering with clonazepam.
- Many people who previously suffered from substance use disorders, enrolled in rehab and learned how to cope with their illness.
- One of the most well-studied BZDs in the setting of withdrawal is alprazolam.
Many people who previously suffered from substance use disorders, enrolled in rehab and learned how to cope with their illness. They now live free from addiction, in large part because they completed an extensive rehabilitation program that focuses on both physical and psychological recovery. Current treatment for withdrawal is through tapering with clonazepam, and overdose should be treated with flumazenil [67].
Another study that tested a different standardized education protocol showed more promising results [73]. The experimental group in this study was counseled on the first visit for 15–20 min on the effects, dangers, and alternatives to chronic BZD use and dependence [73]. severe benzodiazepine withdrawal syndrome The subjects were interviewed with surgery-based consultations for approximately 10 min [12]. This study found that patients undergoing this structured intervention were 5-fold more likely to successfully discontinue BZD than those who just tapered off the drug [73].
Information for patients
- The antiepileptic oxcarbazepine has also shown potential to ameliorate withdrawal symptoms more than older-generation antiepileptics such as carbamazepine [71].
- However, the outcome may be improved by careful pharmacological and psychological handling of withdrawal and post-withdrawal phases.
- Opioids are drugs such as heroin, opium, morphine, codeine and methadone.
- Table 3 provides guidance on medications for alleviating common withdrawal symptoms.
- During withdrawal, the patient’s mental state should be monitored to detect complications such as psychosis, depression and anxiety.
Chronic use of BZD leads to a small but significant change in fluid intelligence, while long-term use of BZD correlates with worse cognitive decline when compared to the effects of using a high dosage [21]. Acute opioid withdrawal is followed by a protracted withdrawal phase that lasts for up to six months and is characterised by a general feeling of reduced well-being and strong cravings for opioids. To reduce the risk of relapse, patients should be engaged in psychosocial interventions such as described later in these guidelines. Patients who repeatedly relapse following withdrawal management are likely to benefit from methadone maintenance treatment or other opioid substitution treatment.
Management of benzodiazepine misuse and dependence
This is supported in a similar study of elderly adults on a BZD for six months with drug discontinuation one month later. The study found no significant cognitive impairment in adults with long-term use of BZD [20]. A study of over 2000 older adults assessed the effects of chronic BZD use on cognition [21].
In general, the optimal treatment of these conditions in primary care is non-pharmacological, particularly psychological and behavioural, therapies. Because of tolerance and withdrawal symptoms, long-term use of benzodiazepines can lead to dose escalation and worsening of the underlying condition. Although patients do not stay at a facility, The Recovery Village continues treatment for benzodiazepine addiction during outpatient rehabilitation. This includes meeting with counselors in individual or group sessions, planning aftercare treatment, and continuing any medication to mitigate lingering withdrawal symptoms. The Recovery Village strives to create unique treatment plans for each client and provide them with the necessary resources for their recovery.
Side Effects of Benzodiazepines
Interestingly, a lower prevalence of withdrawal symptoms was noted in the experimental group without any change in pharmacologic treatment from control group [73]. However, this study included a small sample size, so a larger study using this standardized counseling method would increase the validity of the results of this study [73]. More studies will need to be carried out on the non-pharmacologic treatment of BZD withdrawal, as it is showing some promise for the successful discontinuation of the drugs. Other studies have assessed different methods of counseling on BZD dangers and alternatives to patients alongside a gradual taper off the drugs. One study compared the mainstay of treatment with a standardized interview/counselling approach to treatment [72]. The experimental group in this study had a weekly 1/10-dose reduction after a 2 week stabilization period [72].
- Interestingly, a lower prevalence of withdrawal symptoms was noted in the experimental group without any change in pharmacologic treatment from control group [73].
- Attempting an at-home or rapid detox method could lead to relapse due to cravings during detox and in the following weeks.
- When used appropriately they are very effective in treating these disorders.
- For example, temazepam and oxazepam are metabolites of diazepam, which may lead the practitioner to conclude that the patient had been taking other benzodiazepines during diazepam treatment.
- Each of these studies received mixed results, with no statistically significant advantage to BZD therapy.
The patient should commence psychosocial treatment as described in these guidelines. Symptomatic treatment can be used in cases where residual withdrawal symptoms persist (Table 3). This dose of diazepam (up to a maximum of 40mg) is then given to the patient daily in three divided doses. Even if the patient’s equivalent diazepam dose exceeds 40mg, do not give greater than 40mg diazepam daily during this stabilisation phase.