GPAtlas🧭 When to suspect
Benzodiazepines and z-drugs (zopiclone, zolpidem) are licensed only for short courses of 2–4 weeks, because both tolerance and dependence – physical and psychological – develop within a few weeks of regular use. Suspect withdrawal in anyone on long-term or higher-dose treatment who develops new or worsening anxiety, insomnia, or physical symptoms after a dose is reduced, missed, switched, or stopped – and consider deprescribing in every patient still taking these drugs beyond the licensed period.
The core primary-care skills are fourfold: distinguish withdrawal and rebound from relapse of the original condition; recognise that the speed and severity of withdrawal track the drug’s half-life; never stop abruptly; and partner with the patient on a slow, flexible, patient-led taper. Withdrawal is a clinical diagnosis – routine tests are rarely needed.
| Half-life group | Examples | Withdrawal implication |
|---|---|---|
| Short-acting | Alprazolam, lorazepam, oxazepam, temazepam, loprazolam, lormetazepam; z-drugs (zopiclone, zolpidem) | Withdrawal symptoms appear quickly and can be more intense; a smooth decline in blood levels is hard to achieve – consider switching to diazepam. |
| Long-acting | Diazepam, chlordiazepoxide, nitrazepam, clonazepam | Smoother self-tapering owing to the long half-life; diazepam is the agent of choice for managed withdrawal. |
Source: NICE NG215
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.