Weaning schedules for higher-dose dependent use of benzodiazepines, zolpidem or zopiclone

In these guidelines, higher-dose dependence on benzodiazepines, zolpidem or zopiclone is defined as use of an estimated oral daily diazepam equivalent of more than 15 mg. For advice on quantifying use and estimating the oral daily diazepam equivalent, see Screening and assessment of benzodiazepines, zolpidem and zopiclone.

Limited evidence guides the management of patients with higher-dose dependence on benzodiazepines, zolpidem or zopiclone; advice in these guidelines is based on the consensus view of the Addiction Guideline group.

Stabilisation on oral daily diazepam is generally recommended before weaning because elimination of diazepam is slow, which may make weaning smootherRoyal Australian College of General Practitioners (RACGP), 2019; see Oral dose equivalents of benzodiazepines, zolpidem and zopiclone for dose calculations. However, the stabilisation step may need to be omitted or modified in patients who are more likely to accumulate diazepam (those with severe liver disease) or more susceptible to neuropsychiatric adverse events (eg those with pre-existing cognitive impairment).

Seek specialist advice for any queries on weaning and for patients with any features outlined in Features requiring specialist advice in weaning benzodiazepines, zolpidem or zopiclone, including an oral daily diazepam equivalent exceeding 40 mg.

Note: An oral daily diazepam equivalent exceeding 40 mg requires specialist advice for weaning benzodiazepines, zolpidem or zopiclone.