Weaning schedules for lower-dose benzodiazepine, zolpidem or zopiclone dependence

In these guidelines, lower-dose dependence is use of an estimated oral daily diazepam equivalent of 15 mg or less. For advice on quantifying use and estimating the oral daily diazepam equivalent, see Screening and assessment. Seek specialist advice for any queries on weaning, particularly for patients with any of the features outlined in Features requiring specialist advice in weaning benzodiazepines, zolpidem or zopiclone.

See Overview of weaning of benzodiazepines, zolpidem or zopiclone for other issues to consider before starting treatment. These include identifying and developing a treatment plan for the underlying reasons for use and specifies how dispensing and monitoring (including fitness to drive) will occur.

In patients using a benzodiazepine, zolpidem or zopiclone at an oral daily diazepam equivalent of less than 15 mg daily, wean the drug dose by 10 to 25% every 1 to 4 weeks, with a goal of completing the reduction in 12 weeksNSW Health, 2008NSW Therapeutic Advisory Group, 2018. The New South Wales Therapeutic Advisory Group has a deprescribing tool and patient information leaflets for use in weaning. Slower weaning may be needed if withdrawal symptoms are troublesome; sometimes a period of maintenance on a stable dose is required before weaning is resumed.

Psychological treatment improves outcomes in helping patients stop their use; offer psychosocial interventions such as cognitive behavioural therapy (CBT) .