The benzodiazepine withdrawal syndrome and its management PMC

Additionally, according to several studies, BZD use increases with age, with long-term usage most prevalent in the 65 and older population [16]. Long-term use is defined as two or more months at a therapeutic dose and when used long-term, BZDs pose potential harmful effects. This is especially concerning in the elderly, who are at increased risk for psychomotor impairment, car accidents, and cognitive impairment such as anterograde amnesia-diminished short-term recall, and increased forgetfulness [11]. Some additional side effects of concern include aggressive behavior and expressing anger towards others in between 1% and 20% of users [17].

• In 2018, between 8.3% and 12.8% of BZD users in Switzerland have prescriptions from multiple physicians which resulted in the inability to track the number of prescriptions a patient is given yearly [40].
• Due to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy.
• Benzodiazepine Withdrawal is a group of symptoms experienced by patients who have taken benzodiazepines for a period of time and have developed a dependence and try to stop or reduce their dose.
• Since benzodiazepines have cross-tolerance within that drug class as well as with other sedative/hypnotic drugs, benzodiazepines can be substituted for other sedative/hypnotics and vice versa.
• This same mechanism is also thought to be the cause behind alprazolam’s strong rebound hyperadrenergic effects with cessation [54,55].

This is because they are shorter-acting and do not have active metabolites, making them less likely to cause residual or longer-term side effects. These risks are even greater if benzodiazepines are used in older people who have a history of falls or who are already receiving two or more other CNS drugs (such as opioids, muscle relaxants, sleeping pills, or barbiturates, among others). This article will cover how benzodiazepines work, their side effects and safe use, their possible drug interactions, and alternative medications.

Alternatives to Benzodiazepines

This drug has also been studied in the context of both BZD replacement and withdrawal as a potential treatment [70]. One study showed that replacing BZD with a 45 day captodiamine led to a decrease in severity of withdrawal symptoms in patients taking BZD for six months [70]. Another interesting finding was that after https://ecosoberhouse.com/article/benzodiazepine-withdrawal-symptoms-timeline-and-treatment/ the discontinuation of captodamine treatment, there was no emergence of withdrawal symptoms, suggesting that captodiamine might have a different mechanism of anxiolysis than BZD [70]. Additionally, during captodiamine treatment, psychomotor function improved in all areas tested from beginning to end of treatment [70].

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].

Pharmacotherapy for Withdrawal Syndromes

Use of these drugs in older adults comes with risks of dependence, cognitive deficits (or impaired thinking), falls, and car accidents. The American Geriatrics Society (AGS) lists benzodiazepines as a class of medications that should be avoided in people 65 and older. For example, midazolam is given by injection and https://ecosoberhouse.com/ often used alongside anesthesia medications because it works quickly to cause sleepiness. Patients may find that the symptoms of withdrawal (see Box) are typical of their previous problems such as insomnia or anxiety. This should be discussed with them, and psychotherapy or appropriate pharmacotherapy offered.

It is also worth mentioning the impact of the COVID-19 pandemic on abuse dynamics overall. PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository.

Article Sections

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]. Interestingly, a lower prevalence of withdrawal symptoms was noted in the experimental group without any change in pharmacologic treatment from control group [73].