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]

References20Show ledgerHide ledger

1. [1]Soyka M Treatment of Benzodiazepine Dependence N Engl J Med, 2017.PMID 28614686
2. [2]Brett J, Murnion B Management of benzodiazepine misuse and dependence Aust Prescr, 2015.PMID 26648651
3. [3]Ashton H The diagnosis and management of benzodiazepine dependence Curr Opin Psychiatry, 2005.PMID 16639148
4. [4]Voshaar RC, Couvée JE, van Balkom AJ, et al. Strategies for discontinuing long-term benzodiazepine use: meta-analysis Br J Psychiatry, 2006.PMID 16946355
5. [5]Darker CD, Sweeney BP, Barry JM, et al. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence Cochrane Database Syst Rev, 2015.PMID 26106751
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10. [10]Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits BMJ, 2005.PMID 16284208
11. [11]Barker MJ, Greenwood KM, Jackson M, et al. Cognitive effects of long-term benzodiazepine use: a meta-analysis CNS Drugs, 2004.PMID 14731058
12. [12]Pottie K, Thompson W, Davies S, et al. Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline Can Fam Physician, 2018.PMID 29760253
13. [13]Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial JAMA Intern Med, 2014.PMID 24733354
14. [14]Brunner E, Chen CA, Klein T, et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits J Gen Intern Med, 2025.PMID 40526204
15. [15]Guina J, Merrill B Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives J Clin Med, 2018.PMID 29385731
16. [16]Billioti de Gage S, Bégaud B, Bazin F, et al. Benzodiazepine use and risk of dementia: prospective population based study BMJ, 2012.PMID 23045258
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18. [18]Olfson M, King M, Schoenbaum M Benzodiazepine use in the United States JAMA Psychiatry, 2015.PMID 25517224
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