In the March issue of The Nurse Practitioner, the article, "Best practices in benzodiazepine prescribing and management in primary care," stated with regard to benzodiazepine dosage that, "The dose may be reduced by 50% every week, or between 10% and 25% every 2 weeks, depending on the patient's tolerance to symptoms.1-3 It is, however, recommended that tapering last less than 8 weeks to prevent withdrawal treatment from becoming the patient's "morbid focus.""1,4
To be more accurate, the sentences should have read, "Recommendations for tapering vary, and are dependent on the patient-specific situation, such as the current dose, and may be affected by the indication for which the medication is prescribed. Generally, gradual tapering is recommended; some sources suggest a dose reduction of 10-25% every 1-2 weeks, although many recommend different rates for different points in the taper, and the rate will also depend on the patient's tolerance to symptoms.1,4-8 Providers should refer to the package insert of the individual medication as well as relevant guidelines for guidance on tapering.5-8"
REFERENCES
1. Soyka M. Treatment of benzodiazepine dependence. N Engl J Med. 2017;376(12):1147-1157. [Context Link]
2. Nafti M, Sirois C, Kroger E, Carmichael P-H, Laurin D. Is benzodiazepine use associated with the risk of dementia and cognitive impairment-not dementia in older persons? The Canadian study of health and aging. Ann Pharmacother. 2020;54(3):219-225.
3. Bighelli I, Trespidi C, Castellazzi M, et al. Antidepressants and benzodiazepines for panic disorder in adults. Cochrane Database Syst Rev. 2016;9(9):CD011567. [Context Link]
4. Lader M. Benzodiazepine harm: how can it be reduced. Br J Clin Pharmacol. 2014;77(2):295-301. [Context Link]
5. Pottie K, Thompson W, Davies S, et al Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline. Can Fam Physician. 2018;64(5):339-351. [Context Link]
6. Croke L. Deprescribing benzodiazepine receptor agonists for insomnia in adults. Am Fam Physician. 2019;99(1):57-58.
7. VA/DoD clinical practice guideline for the management of substance use disorders. Department of Veterans Affairs and Department of Defense. 2015. http://www.healthquality.va.gov/guidelines/MH/sud/VADODSUDCPGRevised22216.pdf.
8. Effective treatments for PTSD: helping patients taper from benzodiazepines. National Center for PTSD. 2015. http://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Academic_Detailing_. [Context Link]
An NCPD test question and answer associated with the article should also be updated to reflect this change. Question 9, which is associated with Case Scenario #2, of the test should read:
9. H.C. returns to the office 6 months later. She has been taking diazepam prescribed by another provider. She is taking 32 mg of diazepam each day. She will no longer be receiving prescriptions from that provider and is in agreement with discontinuation of the diazepam. You recommend to H.C. that with discontinuation of the diazepam, she should
A. A. stop it immediately.
B. B. reduce it quickly over the next couple days.
C. C. follow provider instructions to taper it slowly while being monitored for symptoms.