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Slower sedative withdrawal recommended

Gold-standard advice for slower benzodiazepine withdrawal has been issued following a warning from the BMA.

medication informationThe association was concerned that patients with long-term addictions could suffer conditions such as confusion, toxic psychosis and convulsions under existing schedules.

As a result, the BNF (British National Formulary) published revised recommendations on the prescription medication last week.

Previous best practice advice stated that doses could be reduced by about an eighth – ranging from a tenth to a quarter – every fortnight. In practice, this often meant doctors and clinics were withdrawing patients at a rate of 25 per cent every two weeks.

A BMA meeting on addiction to prescribed medicines earlier this year agreed there was compelling evidence for change, leading then BMA board of science chair Averil Mansfield to write to BNF managing editor Rachel Ryan.


Abrupt end

In her letter, Professor Mansfield maintains: ‘Our concern is that for long-term users of benzodiazepines this rate of withdrawal is too rapid and many patients experience significant discomfort as a result. This is both in terms of severity of their symptoms and the time it takes to recover.’

The letter supports an earlier plea for change from Newcastle emeritus professor of clinical psychopharmacology Heather Ashton and several addiction charities.

The revised guidance by Professor Ashton, a world-renowned expert on benzodiazepine withdrawal, stresses the importance of longer withdrawal schedules for long-term patients.

It includes:

  • A new emphasis on withdrawal at a flexible rate that is tolerable to the patient
  • Differences in tapering needs for short- and long-term users
  • Recommendations to avoid the addition of new drugs during withdrawal
  • A link to Ashton’s manual Benzodiazepines: How they work and how to withdraw.

The amended text has been approved by the Joint Formulary Committee, under whose authority the BNF is published. The group comprises representatives of the BMA, Royal Pharmaceutical Society, UK health departments, the Medicines and Healthcare Products Regulatory Agency and a national guideline producer.

Go to the BNF