Benzodiazepines are categorized as "sedative-hypnotics," due to their ability to calm down overly-excited, anxious patients, as well as help patients feel drowsy and fall asleep. They are used medically to treat anxiety and insomnia, but may also be abused, often by people trying to prevent alcohol withdrawal. Long-term benzodiazepine use increases the risk of withdrawal syndrome. This may occur if a patient decreases her dose too rapidly or stops taking the medication too suddenly. Withdrawal from benzodiazepines includes symptoms such as tremors and seizures; it may be life-threatening, so rapid recognition and treatment are essential.
Diazepam
Diazepam is known as a long-acting benzodiazepine; it is one that the body metabolizes, or breaks down, slowly, so it stays within the bloodstream for a long time. According to the medical reference UpToDate, diazepam and its active metabolite, or breakdown product, can stay active within the body for several days -- up to 100 hours. In contrast, the duration of a short-acting benzodiazepine, such as alprazolam, also known as Xanax, is much shorter -- only about 15 hours. Since diazepam takes longer to be eliminated from the body, it is a good potential option to use in the treatment of withdrawal from shorter-acting benzodiazepines. Patients who are experiencing withdrawal symptoms are given diazepam via an intravenous line, with the goal of giving enough of the benzodiazepine needed to eliminate symptoms, while making sure that the patient is not overly-sedated or having breathing difficulties. Once symptoms are improved, the dose of the long-acting benzodiazepine is slowly decreased; this is called tapering the dose. If the decrease in dosage is done gradually, -- over the course of months if needed -- the withdrawal syndrome risk is minimized.
Clonazepam
Clonazepam is another possibility when considering an appropriate treatment for benzodiazepine withdrawal. Similarly to diazepam, clonazepam, brand name Klonopin, takes a couple days to be fully eliminated from the circulation. For a patient who has abruptly discontinued, or rapidly decreased, her use of shorter-acting benzodiazepines, using such a longer-acting formulation may help treat the symptoms of withdrawal, which may become life-threatening. As in the case of diazepam usage, the amount of clonazepam given should be based on the severity of withdrawal symptoms the patient is experiencing, but care should be taken so that too much respiratory depression -- a decrease in the breathing rate of the patient -- does not occur.
Other Medication to Treat Withdrawal
According to Dr. Howard Greller, of the New York University School of Medicine, and his colleague Dr. Amit Gupta, writing in the medical UpToDate, a variety of other medications have been studied as possible treatments of benzodiazepine withdrawal. Because benzodiazepines do have the potential for both physical and psychological abuse and dependence, it is reasonable to investigate other methods of treatment of the potentially fatal withdrawal syndrome. The medications that have been studied include beta blockers such as propanolol, antipsychotics, antidepressants and even antiseizure medications such as carbamazepine. However, a large review done in 2006 published in the "Cochrane Database of Systematic Reviews" found that none of these medications were as effective as using benzodiazepines for benzodiazepine withdrawal. As of 2010, UpToDate contributors conclude that medications other than benzodiazepines are not recommended for the safe and effective treatment of withdrawal syndrome due to long-term use of benzodiazepines.
References
- "UpToDate;" Benzodiazepine Poisoning and Withdrawal; H. Greller and A. Gupta; June 2010
- "Cochrane Database of Systematic Reviews;" Pharmacological interventions for benzodiazepine mono-dependence management in outpatient settings; C. Denis et. al.; July 2006
- Medline Plus: Diazepam
