Benzodiazepine withdrawal syndrome - often abbreviated to benzo withdrawal -
is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence
stops taking benzodiazepine drug(s) or reduces the dosage too rapidly. Benzodiazepine withdrawal is similar to the alcohol withdrawal
syndrome and barbiturate withdrawal syndrome and can in severe cases provoke life threatening withdrawal symptoms such as seizures,
but usually only if withdrawal is carried out in too abrupt a manner.
Chronic exposure to benzodiazepines causes physical adaptations
in the brain to counteract the drug's effects. This is known as a tolerance and physical dependence. When the drug is removed or dosage
reduced in an individual physically dependent on benzodiazepines, numerous withdrawal symptoms both physical and psychological may
appear and will remain present until the body reverses the physical dependence by making adaptions to the drug-free environment and
thus returning the brain to normal function. Generally the higher the dose and the longer a benzodiazepine is used and the more rapidly
a benzodiazepine is discontinued then the more likely severe withdrawal symptoms will occur. However, severe withdrawal symptoms can
still occur during gradual dose reduction or from relatively low doses.
In certain selected patient groups the occurrence of
withdrawal symptoms is as high as 100%, whereas in unselected patient groups more than 50% of subjects are able to discontinue benzodiazepines
with mild or even no withdrawal symptoms at all. Withdrawal symptoms may persist for weeks or months after cessation of benzodiazepines.
In a smaller subset of patients withdrawal symptoms may continue at a sub acute level for many months or even a year or more (Protracted
Withdrawal Syndrome, Professor H Ashton, Univeristy of Manchester). Long term use of benzodiazepines may lead to withdrawal like symptoms
emerging despite a constant therapeutic dose. Correctly attributing previously misdiagnosed withdrawal symptoms such as anxiety to
the withdrawal effects of benzodiazepines, individualised taper strategies according to withdrawal severity, the addition of alternative
strategies such as reassurance and referral to benzodiazepine withdrawal support groups increase the success rate of withdrawal.
Alprazolam, Bromazepam, Chlordiazepoxide, Cinolazepam, Clonazepam, Cloxazolam, Clorazepate, Diazepam, Estazolam,
Flunitrazepam, Flurazepam, Flutoprazepam, Halazepam, Ketazolam, Loprazolam, Lorazepam, Lormetazepam , Medazepam, Midazolam, Nimetazepam,
Nitrazepam, Nordazepam, Oxazepam, Phenazepam, Pinazepam, Prazepam, Premazepam, Quazepam, Temazepam , Tetrazepam, Triazolam
Alodorm, Alopam, Alprox, Anxon, Apozepam, Apzepam, Ativan, Bromam, Centrax, Dalmadorm, Dalmane, Domar, Doral, Dormicum, Dormonid,
Dormonoct, Dumolid, Erimin, Euhypnos, Flunipam, Fluscand, Frontal, Gerodorm, Halcion, Hexalid, Hypnovel, Iktorivil, Klonopin, Klopoxid,
Lexomil, Lexotan, Lexotanil, Librium, Lorabenz, Loramet, Lysanxia, Madar, Mogadon, Mylostan, Nobrium, Noctamid, Normison, Olcadil,
Oxabenz, Oxapax, Oxascand, Pacisyn, Paxipam, Pronoctan, ProSom, Restas, Restoril, Rilamir, Risolid, Rivotril, Rohydorm, Rohypnol,
Ronal, Serax, Serenid, Serepax, Seresta, Sobril, Somalium, Stesolid, Stilny, Tafil, Temesta, Tenox, Tranxene, Tropium, Valaxona, Valium,
Versed, Vival, Xanax, Xanor.
Individual benzodiazepines may have different interactions with certain drugs.
Many drugs reduce the rate of elimination of the benzodiazepines in the body, leading to possibly excessive drug accumulation and
increased side effects.
Drugs that can have this effect include: oral contraceptives, some antibiotics, antidepressants (including
SSRI and SNRI) and antifungal agents.
Conversely some drugs, such as St John's wort, the antibiotic rifampicin and the anticonvulsants
carbamazepine and phenytoin, accelerate elimination of many benzodiazepines and decrease their action. This may possibly include other
antibiotics and antifugals.
Taking benzodiazepines with alcohol, opioids and other central nervous system depressants amplifies
their action. This often results in increased sedation, impaired motor coordination, suppressed breathing and other adverse effects
that may potentially be lethal.
Antacids may slow down absorption of some benzodiazepines; however, this effect is worth considering
because the proton pump inhibitors such as omeprazole and lansoprazole are so widely prescribed and may affect benzodiazepines.
such as lorazepam, oxazepam and temazepam generally have few drug interactions.
The following sites have been used
as sources of information: