Short course
6.3
Benzodiazepines
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MHIC 6.3-->
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| Prescribing benzodiazepines
| Indications: | Generalised anxiety disorder, panic attacks, insomnia, anxiety secondary to some medical conditions (eg, gastrointestinal or cardiovascular disease). |
| Contraindications: | Myasthenia gravis, respiratory disorders (may be aggravated by benzodiazepines), pregnancy, other drug dependence or a history of drug dependent behaviour. |
| Choice of drug: | Clinical efficacy is the same, but different benzodiazepines have widely varying elimination half-lives (see 6.4). Drugs with long half-lives generally have a long duration of action, and can be given as a single daily dose. |
Duration of
treatment: | For anxiety or insomnia, plan brief courses of treatment (2-4 weeks), with a tapered withdrawal of the drug. In panic disorder, longer treatment may be necessary (up to 6 months), but patients should be monitored to prevent dose escalation. |
Side effects and
drug interactions: | Main side effect is excessive sedation, and patients must be warned (eg, of possible effects on driving ability). See 6.5 for other side effects and 6.6 for drug interactions. |
Dependence and
withdrawal: | Many patients taking benzodiazepines at high or normal doses will develop dependence, and a withdrawal syndrome is common (see 6.7). Withdrawal should be managed by tapering the dose over 4-8 weeks, and using a long-acting drug (eg, diazepam). |
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