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.
• Consider deprescribing in every patient still taking these drugs beyond the licensed period.
• Distinguish withdrawal and rebound from relapse of the original condition.
• Recognise that the speed and severity of withdrawal track the drug’s half-life.
• Partner with the patient on a slow, flexible, patient-led taper, and never stop abruptly.
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
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