The benzodiazepine withdrawal syndrome

To avoid the risk of overdose in the first days of treatment methadone can be given in divided doses, for example, give 30mg in two doses of 15mg morning and evening. Because of its pharmacological action (partial opiate agonist), buprenorphine should only be given after the patient begins to experience withdrawal symptoms (i.e. at least eight hours after last taking heroin). Opioids are drugs such as heroin, opium, morphine, codeine and methadone. Opioid withdrawal can be very uncomfortable and difficult for the patient. If you or someone you know is having difficulties because of misusing benzodiazepines, treatment is available.

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• Equivalent doses can be calculated if the actual doses are known before beginning the tapering process (Table 4).
• Multivitamin supplements and particularly vitamin B1 (thiamine) supplements (at least 100mg daily during withdrawal) should also be provided to help prevent cognitive impairments9 that can develop in alcohol dependent patients.
• The symptoms of benzo withdrawal can vary, depending on many factors.

Acute withdrawal begins after the initial withdrawal symptoms, generally within a few days. Symptoms generally last 5–28 days, though some may last for several months. Family history of drug dependency or previous issues with substance abuse and/or dependency may increase the likelihood of developing a dependency on a benzodiazepine and may potentially add to the withdrawal timeline duration as well. Withdrawal symptoms, ranging from a return of uncomfortable psychological symptoms to physical manifestations such as nausea and diarrhea, may occur when the drugs are removed from the bloodstream.

Benzo Withdrawal Symptoms

The largest factor that might predict the length of the harm is how the patient discontinued the drug (slow, controlled taper or over-rapid or cold-turkey withdrawal). Apart from tapering rate, there are no other known predictors for the severity of the withdrawal syndrome. Slowly reducing the dose, less than 5 to 10% of the current dose monthly, can minimize the severity of the withdrawal symptoms and is the recommended way to discontinue benzodiazepines safely.

In general, benzodiazepines should be discontinued slowly to minimize symptoms. Use of sedatives like barbiturates and benzodiazepines can also produce withdrawal responses that resemble alcohol withdrawal syndrome. Autonomic and psychomotor benzodiazepine withdrawal dysfunction often characterize the withdrawal symptoms. The symptoms tend to develop 2 to 10 days after discontinuation of the agent. Gamma Hydroxybutyrate (GHB) is now a common club drug abused at nightclubs and all-night parties.

Serious Complications of Benzodiazepine Withdrawal

Emerging research also suggests acceptance and commitment therapy (ACT) could also have benefits during benzodiazepine withdrawal. This approach helps you learn to tolerate discomfort and distress, instead of avoiding it, and choose to live according to your values. If you experience unpleasant withdrawal symptoms during your taper, your care team can help you explore options to address those symptoms and get relief.

• As for management of mild alcohol withdrawal, with diazepam as in Table 11.
• Medications are, however, an important therapeutic adjunct when their use is combined with psychological treatments like cognitive and behavioral therapies.
• Because of its pharmacological action (partial opiate agonist), buprenorphine should only be given after the patient begins to experience withdrawal symptoms (i.e. at least eight hours after last taking heroin).
• Often individuals dependent on opiates should be started on methadone or buprenorphine.
• Patients for whom methadone is indicated include intravenous users, inpatients, those who have medical and psychiatric complications and patients with a history of poor compliance when withdrawing from opiates5,9,10 (Table 6).