Home' Australian Pharmacist : Australian Pharmacist Oct 2013 Contents Australian Pharmacist October 2013 I © Pharmaceutical Society of Australia Ltd.
Across Australia, there is also a free
24-hour online counselling service:
Case scenario continued
Mrs Wilson may be reassured to
know that around half of people on
benzodiazepines can withdraw without
problems, and that the rate of reduction
can be adjusted if required.
A patient-centred motivational
interviewing approach may be helpful.
It would be good to talk to Mrs Wilson
about her concerns. Asking open-ended
questions will provide information to
help you understand why she feels that
she may not be able to discontinue
the temazepam. It would also be
good to explore what she feels are the
benefits she will gain from stopping
When considering recommended
benzodiazepine reduction rates, it
is possible that the reduction rate
prescribed for Mrs Wilson may be too
rapid. The concerns she has about
attempting withdrawal may increase her
anxiety. Support and advice regarding
possible withdrawal symptoms,
particularly insomnia, would be helpful.
A review of Mrs Wilson’s other medicines,
1. Therapeutic Guidelines Limited. eTG complete: Psychotropic
Guidelines . Melbourne. Melbourne2013 [cited 2013]; Available
2. Barker MJ, Greenwood KM, Jackson M, Crowe SF. Cognitive effects
of long-term benzodiazepine use: a meta-analysis. CNS Drugs.
3. Larson EB, Kukull WA, Buchner D, Reifler BV. Adverse drug reactions
associated with global cognitive impairment in elderly persons.
Annals of internal medicine. [Research Support, Non-U.S. Gov’t
Research Support, U.S . Gov ’t, P.H .S.]. 1987 Aug;107(2):169-73.
4. Salzman C FJ, Nobel K, Glassman R, Wolfson A, Kelley M. . Cognitive
improvement following benzodiazepine discontinuation in elderly
nursing home residents. Int J Geriatr Psychiatry. 1992;7:89-93.
5. Ashton H. The diagnosis and management of benzodiazepine
dependence. Curr Opin Psychiatry. 2005 May;18(3):249-55.
6. Bateson AN. Basic Pharmacologic Mechanisms Involved in
Benzodiazepine Tolerance and Withdrawal. Current Pharmaceutical
7. Denis C, Auriacombe M, Fatsas M, Lavie E. Pharmacological
interventions for benzodiazepine mono-dependence
management in outpatient settings. Cochrane Database Syst Rev.
8. Otto MW, McHugh RK, Simon NM, Farach FJ, Worthington JJ,
Pollack MH. Efficacy of CBT for benzodiazepine discontinuation in
patients with panic disorder: Further evaluation. Behav Res Ther.
9. Morin CM, Bastien C, Guay B, Radouco-Thomas M, Leblanc J,
Vallières A. Randomized Clinical Trial of Supervised Tapering
and Cognitive Behavior Therapy to Facilitate Benzodiazepine
Discontinuation in Older Adults With Chronic Insomnia. American
Journal of Psychiatry. 2004;161(2):332-42.
10. Mental Health and Drug & Alcohol Office. Drug and Alcohol
Withdrawal Clinical Practice Guidelines - NSW. NSW Department
of Health; 2008.
11. Cormack MA, Sweeney KG, Hughes-Jones H, Foot GA. Evaluation of
an easy, cost-effective strategy for cutting benzodiazepine use in
general practice. British Journal of General Practice. 1994;44(378):5-
12. Oude Voshaar RC, Couvee JE, Van Balkom AJLM, Mulder PGH,
Zitman FG. Strategies for discontinuing long-term benzodiazepine
use: Meta-analysis. British Journal of Psychiatry. 2006 September 1,
13. Onyett SR. The benzodiazepine withdrawal syndrome and its
management. J R Coll Gen Pract. [Review]. 1989 Apr;39(321):160-3.
14. Pharmaceutical Society of Australia. Staged Supply. 2013; Available
15. Westbury J, Jackson S, Gee P, Peterson G. An effective approach
to decrease antipsychotic and benzodiazepine use in nursing
homes: the RedUSe project. Int Psychogeriatr. [Research Support,
Non-U.S . Gov’t]. 2010 Feb;22(1):26-36 .
diet and lifestyle factors, and their
potential contribution to her sleep
problems would also be helpful.
Knowing that she has the option of
slowing down the rate of reduction if
she has difficulties could be reassuring.
As temazepam is only available in 10 mg
tablet formulations, the use of a tablet
cutter may be required to allow for
smaller dose reductions. Changing to a
longer-acting benzodiazepine may not
be recommended in this case, given Mrs
COUNSELLING IN PRACTICE
Benzodiazepines are recommended
for short-term use (2-4 weeks).
However, people often use these
medicines for many months or even
years. The benefits of discontinuing
benzodiazepines include improved
cognition and reduced risk of falls,
in addition to no longer taking
a medicine that has ceased to
be effective. Withdrawing from
benzodiazepines can be difficult for
some people. A support plan with a
gradual taper is ideal.
1. Which of these may improve after
a) cognitive impairment
2. For which of these conditions are
benzodiazepines first-line for long-
d) panic attack
e) none of the above
3. What is the recommended rate of
dose reduction of benzodiazepines?
a) 5–10% of the daily dose every week
b) 10% of the daily dose every alternate
c) 5–10 mg of diazepam equivalents
d) 25% of the dose every week
e) 50% dose reduction every week or two
4. What percentage of people are
likely to be able to withdraw from
benzodiazepines without negative
a) above 80%
c) 60– 70%
e) less that 30%
5. For which treatments are there
evidence to support their efficacy
in assisting benzodiazepine
a) anticonvulsants such as sodium
b) herbal supplements such as St John’s
Wort and chamomile
c) Cognitive Behavioural Therapy
d) OTC sedating antihistamines
e) none of the above
Links Archive Australian Pharmacist Sept 2013 Australian Pharmacist Nov 2013 Navigation Previous Page Next Page