Flumazenil is contraindicated in patients who have received a benzodiazepine for control of a potentially life-threatening condition (e.g., status epilepticus). If the decision is made to use flumazenil, it should be used as an adjunct to, not as a substitute for, supportive management of benzodiazepine overdosage. Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. In patients already receiving an opioid analgesic, prescribe a lower initial dose of diazepam tablets than indicated in the absence of an opioid and titrate based on clinical response.
- It has been estimated that perhaps per cent of long-term benzodiazepine users develop a “post-withdrawal syndrome”.
- Long-term use of benzodiazepine trains the body to rely on external relaxation methods.
- The background risk of major birth defects and miscarriage for the indicated population is unknown.
- Secondly, benzodiazepine withdrawal may uncover life problems that have never been fully addressed.
Other drugs
There have been Twelve-step program some reports that gabapentin (Neurontin), tiagabine (Gabitril) and possibly pregabalin (yet to be licensed) help with sleep and anxiety in withdrawal. However, there have been no controlled trials and it is not clear whether these drugs themselves cause withdrawal effects. In practice additional drugs are seldom needed with very slow benzodiazepine tapering.
Abuse, Misuse, and Addiction
If you take benzodiazepines infrequently, such as once a week or once every few weeks to treat panic attacks, you can take them for a longer period of time. This is because inconsistent use doesn’t pose the same risk of dependence or withdrawal. Emotional and psychological support is a vital part of the Benzo detox process. abrupt withdrawal of benzodiazepines may result in These programs also focus on teaching individuals coping strategies to reduce dependence on benzos and lead a drug-free life.
Abrupt from long-term benzodiazepine use can produce uncomfortable, and sometimes dangerous, side effects, including:
From 20mg diazepam a day, reductions of 1 mg in daily dosage every week or two might be preferable. These factors don’t guarantee you’ll have severe withdrawal symptoms, but they can increase your vulnerability. Withdrawal from benzodiazepines is a result of the body’s reliance on the medication, which develops over time. Upon suddenly decreasing their dose or stopping them altogether, the nervous system reacts to the absence of benzos, causing a process of adjustment.
In some cases, especially with high doses or in elderly patients, benzodiazepines can lead to respiratory depression, a potentially life-threatening effect. When combined with other central nervous system depressants, such as opioids or alcohol, benzodiazepines can heighten the risk of overdose. Forms of psychosis, such as hallucinations, delusions, and depersonalization are severe withdrawal symptoms caused by benzodiazepines. Psychosis is a less common symptom of benzodiazepine withdrawal compared to other symptoms.
- Abrupt (cold-turkey) or over-rapid withdrawal, especially from high dosage, can give rise to severe symptoms such as convulsions, psychotic reactions, acute anxiety states and even death.
- There are three possible phases for benzo withdrawals, each with an estimated timeline.
- They may involve a primitive brain mechanism similar to the “freezing” of some animals when presented with an inescapable danger.
- However, medical opinions differ and, even if complete withdrawal is not advised, it may be beneficial to reduce the dosage or to take intermittent courses with benzodiazepine-free intervals.
- Most people do okay with tapering their benzodiazepines at home with the help of their primary care doctor or psychiatrist.
Unfortunately, flumazenil does not at present offer a practical cure for protracted symptoms. The drug has to be infused intravenously and is very short acting so that symptom relief is only temporary. The drug cannot be given to a person who is still taking benzodiazepines as it precipitates an acute withdrawal reaction. However, although protracted sensory and motor symptoms may sometimes seem to be almost permanent, they do in fact decline in severity over the years, even without flumazenil, and they do not signify a major neurological illness. Such symptoms may be partially alleviated by relaxation techniques; some motor and sensory systems may respond to carbamazepine (Tegretol) and motor symptoms may respond to propranolol (Inderal).
- Benzodiazepines are effective medications for acute anxiety, panic disorders, insomnia, and certain medical conditions but require careful monitoring and management due to their potential for dependence and misuse.
- Diazepam tablets are also contraindicated in patients with myasthenia gravis, severe respiratory insufficiency, severe hepatic insufficiency, and sleep apnea syndrome.
- Depression may be caused or aggravated by chronic benzodiazepine use, but is also a feature of the withdrawal syndrome.
- Diazepam is a benzodiazepine that exerts anxiolytic, sedative, muscle-relaxant, anticonvulsant and amnestic effects.
- However, not everyone is able to devote the mental and physical concentration required for these techniques.
Why and How Does Benzodiazepine Withdrawal Occur?
Withdrawal symptoms from short-acting drugs, such as Xanax, may come on faster than withdrawal symptoms from long-acting drugs, such as Valium. Estimates suggest that 10 to 25% of people who take benzodiazepines for extended periods experience what’s known as protracted withdrawal. Longer-acting benzodiazepines like Klonopin (clonazepam) can stay in the system longer, which means it can be one to two days or even longer before withdrawal symptoms start. Gastrointestinal symptoms may be prolonged after withdrawal, usually in people who have a previous history of digestive troubles. Such people may develop apparent intolerance to certain foods, https://ecosoberhouse.com/ although reliable tests for true food allergy (e.g. antibodies against specific food constituents) are nearly always negative.
Is benzodiazepine withdrawal life-threatening?
You may be at risk of seizures and convulsions after you quit benzodiazepines. Your risk of seizures may be high during the acute withdrawal period, which can last for between two weeks to one month. If a family member or a loved one is complaining about a lack of sleep, they may be experiencing benzodiazepine withdrawal symptoms. It is a good idea to make out a dosage reduction schedule for the initial stages (see below) and to give your doctor a copy. You may need to mention the importance of flexibility, so that the rate of dosage tapering can be amended at any time. There may even be circumstances when you need to stop for a while at a certain stage.
It is sometimes claimed that very slow withdrawal from benzodiazepines “merely prolongs the agony” and it is better to get it over with as quickly as possible. However, the experience of most patients is that slow withdrawal is greatly preferable, especially when the subject dictates the pace. Nevertheless there is no magic rate of withdrawal and each person must find the pace that suits him best. People who have been on low doses of benzodiazepine for a relatively short time (less than a year) can usually withdraw fairly rapidly. Those who have been on high doses of potent benzodiazepines such as Xanax and Klonopin are likely to need more time. Benzodiazepine withdrawal is a complex but necessary step toward recovery from dependence or misuse.