Overview of management of disorders of benzodiazepine, zolpidem and zopiclone use

Overview of substance use and addictive behaviours explains key principles of care for a person with a disorder of substance use. Establishing a therapeutic relationship that engages the person (and ideally those close to them) is central to the management of substance dependence.

Note: The most important element of treatment for substance use is a therapeutic relationship.

Specialist advice on any aspects of care for people with substance dependence is available and contact is encouraged; see Contact details for substance use clinical advisory services for clinicians.

Note: Specialist advice is available by phone on any aspect of the management of substance use; contact is encouraged.

Patients on higher doses of benzodiazepines, zolpidem or zopiclone may present with intoxication, particularly if using multiple substances. For general advice on managing their safety, see Ensuring the safety of a person with a disorder of substance use or addictive behaviour. Isolated overdose of benzodiazepines, zolpidem or zopiclone can generally be managed with supportive care, but ingestion with other sedative hypnotics, such as opioids, can be fatal. For further information on management of overdose, see Benzodiazepine poisoning. Do not use flumazenil to manage dependence on benzodiazepines, zolpidem or zopiclone because it can precipitate acute withdrawal and seizures.

Note: Do not use flumazenil in managing dependence on benzodiazepines, zolpidem or zopiclone.

The main elements of managing benzodiazepine, zolpidem or zopiclone dependence are:

weaning schedules for lower-dose dependence for patients with dependence on lower doses (estimated oral daily diazepam equivalent of 15 mg or less)
weaning schedules for higher-dose dependence, which often requires specialist input and may involve reducing the dose more quickly initially, followed by gradual dose reduction over months
management of unplanned withdrawal.

Psychological interventions add benefit to weaning in stopping useDarker, 2015.

Harm reduction strategies are relevant for all patients. Provide advice on driving, and avoiding intoxication while alone. Warn patients not to use other sedative drugs or alcohol concurrently with benzodiazepines, zolpidem or zopiclone. Discuss falls prevention, particularly for older patients.

Considerations for management of specific populations may apply. Seek specialist advice for any patient who is pregnant or breastfeeding and dependent on benzodiazepines, zolpidem or zopiclone.

Elements of long-term management are relevant to all disorders of substance use. Addressing the reasons why the patient has been using benzodiazepines, zolpidem or zopiclone (generally anxiety and/or sleep disturbance) is central to management.