Pharmacological interventions for benzodiazepine mono-dependence management in outpatient settings

Denis C, Fatseas M, Lavie E, Auriacombe M

Published Online:

July 16, 2008

The improved safety profile of benzodiazepines compared to barbiturates has contributed to a high rate of prescription since the seventies. Prevalence of benzodiazepines use remains important worldwide. Although benzodiazepines are highly effective as short-term treatments for some disorders, they also are potentially addictive drugs. This review has shown that a gradual taper is preferable to abrupt discontinuation of benzodiazepines, and that carbamazepine may be an effective intervention for benzodiazepine gradual taper discontinuation. But, larger controlled studies are needed to confirm carbamazepine's potential benefit, to assess adverse effects and to identify when its clinical use might be most indicated.

Abstract (click to read)

Background:

The improved safety profile of benzodiazepines compared to barbiturates has contributed to a high rate of prescription since the seventies. Although benzodiazepines are highly effective for some disorders, they are potentially addictive drugs and they can provide reinforcement in some individuals.

Objectives:

To evaluate the effectiveness of pharmacological interventions for benzodiazepine mono-dependence.

Search strategy:

We searched the Cochrane Drugs and Alcohol Group' Register of Trials (October 2004), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2004), MEDLINE (January 1966 to October 2004), EMBASE (January 1988 to October 2004), PsycInfo (1985 to October 2004), CINAHL (1982 to October 2004), Pascal, Toxibase, reference lists of articles.

Selection criteria:

Randomized trials of benzodiazepines dependence management regardless of type, dose (daily and total) and duration of f therapy and type of therapy.

Data collection and analysis:

Reviewers independently assessed trials for inclusion, rated their methodological quality and extracted data.

Main results:

753 references were selected and 35 were eligible. Eight met the inclusion criteria for a total of 458 participants. The studies included could not be analysed cumulatively because of heterogeneity of interventions and participants' characteristics. Results support the policy of gradual rather than abrupt withdrawal of benzodiazepine. Progressive withdrawal (over 10 weeks) appeared preferable if compared to abrupt since the number of drop-outs was lower and the procedure judged more favourable by the participants. Short half-life benzodiazepine, associated with higher drop-out rates, did not have higher withdrawal symptoms scores. Switching from short half-life benzodiazepine to long half-life benzodiazepine before gradual taper withdrawal did not receive much support from this review. No benefits of Propanolol, Dothiepin, Buspirone, Progesterone or Hydroxyzine were found for managing benzodiazepine withdrawal or improving benzodiazepine abstinence. Carbamazepine might have promise as an adjunctive medication for benzodiazepine withdrawal, particularly in patients receiving benzodiazepines in daily dosages of 20 mg/d or more of diazepam (or equivalents).

Authors' conclusions:

All included studies showed that gradual taper was preferable to abrupt discontinuation. The results of this systematic review point to the potential value of carbamazepine as an effective intervention for benzodiazepine gradual taper discontinuation. But, larger controlled studies are needed to confirm carbamazepine's potential benefit, to assess adverse effects and to identify when its clinical use might be most indicated. Other treatment approaches to benzodiazepine discontinuation management should be explored (antidepressants, benzodiazepine receptors modulator).

This record should be cited as:

Denis C, Fatseas M, Lavie E, Auriacombe M. Pharmacological interventions for benzodiazepine mono-dependence management in outpatient settings. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005194. DOI: 10.1002/14651858.CD005194.pub2

Assessed as up to date:

May 11, 2006

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Primary Review Group:

Drugs and Alcohol Group

Health topics:

Tobacco, drugs, & alcohol dependence > Other drugs

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Pharmacological interventions for benzodiazepine mono-dependence management in outpatient settings

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