Benzodiazepine prescribing and tapering

Meet the patient

A 68-year-old retired teacher brings her repeat prescriptions to clinic in a plastic bag. Temazepam 10 mg nocte, started for grief eleven years ago by a locum nobody can name. Two falls this year, one with a wrist fracture. She has never once taken more than she was told to take.^{[2][9][10][19]}

She reads the referral letter upside down on your desk. It says "benzodiazepine dependence", and she starts to cry, because she believes that phrase means she is an addict.^[1][3]

Two questions are now live, and examiners ask both: whose prescribing produced this? and how do you get her off it without harming her? Everything below answers those two.^[8][14]

This leaf is prescribing craft and taper craft. Use-disorder nosology and dual-diagnosis depth live in the benzodiazepine-dependence topic; the wider non-GABAergic class map (buspirone, pregabalin, Z-drugs, melatonin) lives in anxiolytics and hypnotics. What you must be able to do here is initiate safely, convert equipotently, deprescribe in evidence language, and refuse the classic traps.^[1][8][15]

References20ShowHide

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2. [2]Brett J, Murnion B Management of benzodiazepine misuse and dependence Aust Prescr, 2015.PMID 26648651
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19. [19]By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults J Am Geriatr Soc, 2023.PMID 37139824
20. [20]Wilson S, Anderson K, Baldwin D, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update J Psychopharmacol, 2019.PMID 31271339