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Home > Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users.

Banndrup, Lone and Ebdrup, Bjorn J and Rasmussen, Jesper O and Lindschou, Jane and Gluud, Christian and Glenthoj, Birte J [The Cochrane Library] . (2018) Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users. London: John Wiley & Sons, Ltd. Cochrane Database of Systematic Reviews doi: 10.1002/14651858.CD011481.pub2

URL: http://onlinelibrary.wiley.com/doi/10.1002/1465185...


Benzodiazepines are widely prescribed for long-term use despite recommendations of only short-term use. It is often difficult to discontinue benzodiazepines after more than a few weeks of treatment due to the development of physical and psychological dependence. This review aimed to assess the effect and safety of medications to facilitate benzodiazepine discontinuation in chronic benzodiazepine users.

 

We extracted data on 18 different comparisons in a total of 2295 participants. We are uncertain whether valproate and tricyclic antidepressants increase the chance of discontinuing benzodiazepines, and whether benzodiazepine withdrawal symptoms are reduced by pregabalin, captodiame, paroxetine, tricyclic antidepressants, and flumazenil, as we assessed the quality of the evidence as very low. We are uncertain as to whether symptoms of anxiety after withdrawal of benzodiazepines are reduced by carbamazepine, pregabalin, captodiame, paroxetine, and flumazenil, as we assessed the quality of the evidence as very low. The effects of the evaluated medications were too uncertain to inform clinical practice due to risk of bias (systematic errors with overestimation of benefits and underestimation of harms) and risk of chance occurrence (random errors giving any result). Tolerability and safety were poorly reported across the included studies, making it impossible to assess the balance between possible benefits and adverse effects. Consequently, no conclusions can be drawn about the effectiveness of the interventions.

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