31st January 2024

Management

The dependence-inducing properties are related to the dose and duration of sedative use, and long-term prescribing of these drugs is not considered to be beneficial. To prevent withdrawal, clinicians should continue a current prescription but gradually taper the dose down, until the medication has been stopped. Benzodiazepines specifically can be tapered down by ⅛ of the daily dose every 2 weeks; however, this should be guided by the patient’s symptoms and may take several months to achieve.

Benzodiazepine overdose specifically can be treated with flumazenil, which acts as a benzodiazepine antagonist; however, it can provoke seizures and is quite short-acting. Withdrawal can produce sudden and severe symptoms, hence the need for gradual tapering and cessation. In emergency presentations, such as where an airway is compromised, an A to E approach should be followed in the first instance, and senior help sought.

If methadone is being taken concurrently with sedatives, this dose should be kept stable whilst sedative dosing is altered, if needed, to avoid dual detoxification. Physical and mental health issues that may have prompted sedative use initially should also be addressed as part of wider management and to support abstinence, e.g., psychosocial therapies, counselling and support groups.