Synopsis
Prevent avoidable long-term benzodiazepine exposure, distinguish dependence from addiction and relapse, recognise overdose and dangerous withdrawal, and plan collaborative individual tapering without abrupt cessation or blame.
- Before prescribing, discuss non-drug options, define the severe short-term indication, use the lowest effective dose for the shortest duration and agree the reduction or end strategy.
- Lorazepam product information restricts anxiety use to severe disabling distress for two to four weeks only and gives 1 to 4 mg daily in divided doses for adults.
- NICE advises no benzodiazepine for panic disorder and only a short-term crisis measure for GAD; do not use benzodiazepines to prevent PTSD.
- Physical dependence can occur at therapeutic doses and is not identical to addiction; discuss tolerance, withdrawal and loss of control without stigmatising the person.
- Do not stop abruptly except in exceptional medical circumstances; reduce slowly in steps proportionate to the current dose, making decrements smaller as the dose becomes lower.
- Make the taper flexible: agree review intervals, pause or reduce the next decrement when withdrawal is intolerable, and consider returning to the previous tolerated dose.
- For a short-half-life benzodiazepine, NICE says consider a switch to a longer-half-life agent, but individual contraindications, interactions and uncertain conversion require careful clinical planning.