Benzodiazepine Withdrawal Syndrome: A Literature Review and Evaluation

Abstract

The capacity of the benzodiazepine drugs to produce dependence and addiction has been associated with what has recently been recognized as a benzodiazepine withdrawal syndrome. Abrupt discontinuation of benzodiazepine treatment may show a spectrum of symptoms similar to those observed from withdrawal of alcohol or barbiturates. Such reactions have been reported with and are reviewed for the following drugs: chlordiazepoxide, diazepam, oxazepam, lorazepam, nitrazepam, temazepam, and clobazam. Generally, the higher the dose and the longer the benzodiazepine is taken, the greater the risk of developing withdrawal symptoms. However, withdrawal symptoms may occur in patients receiving recommended doses and/or short-term therapy. Although most withdrawal reactions have been reported with the long-acting benzodiazepines having psychoactive metabolites, reactions may also occur with the short-acting agents. In contrast, rebound insomnia occurs with greater frequency and severity with the short-acting agents. Benzodiazepine therapy should be stopped as early as possible, with tapering after moderate dose and/or prolonged use therapy.

The effects of carbamazepine and lorazepam on single versus multiple previous alcohol withdrawals in an outpatient randomized trial

“…However, withdrawal phenomena from longacting benzodiazepines can occur as well. 45 Furthermore, the use of a long-acting benzodiazepine in the outpatient setting could lead to drug accumulation and higher blood levels of the benzodiazepine. This might result in an increased risk of impaired motor coordination, a liability we noted with lorazepam in the present trial.…”

Withdrawal symptoms in children after long-term administration of sedatives and/or analgesics: a literature review. “Assessment remains troublesome”

“…Classical characteristics of benzodiazepine withdrawal described for the domains of adult psychiatry and drug addicts care are: severe anxiety, involuntary muscle tremors, confusion, insomnia, perception disorders, depression, and generalized convulsions [4,9]. In contrast to opioids, a systematic classification of benzodiazepine withdrawal symptoms is not available in the literature.…”

“…This single case report provides insufficient evidence to include this symptom as a benzodiazepine withdrawal symptom. Dysfunction of the gastrointestinal tract as a symptom of benzodiazepine withdrawal has not been described in adults [9,12]. In summary, the major symptoms of benzodiazepine withdrawal in children are anxiety, tremors, and other involuntary muscle movements, irritability, perspiration and insomnia.…”

“…In summary, the major symptoms of benzodiazepine withdrawal in children are anxiety, tremors, and other involuntary muscle movements, irritability, perspiration and insomnia. These correspond to the classical manifestations of benzodiazepine withdrawal in adults [4,9].…”

“…Benzodiazepine withdrawal is also reported in adult psychiatric and drug-addicted populations [8][9][10]. Two retrospective and one prospective randomized controlled trial have been reported on opioid and/or benzodiazepine withdrawal after long-term administration of analgesics or sedatives in the adult ICU setting [11][12][13].…”