Has anyone had experience stopping benzodiazepines?

Care by pharmacists and doctors

Such an approach was pursued with the model project "Outpatient withdrawal of benzodiazepine-dependent patients by pharmacists and general practitioners" funded by the Federal Ministry of Health, for which the ABDA had taken over the sponsorship. Pharmacists from Baden-Württemberg and Hamburg were able to take part. The project manager trained interested pharmacists in small groups. The training courses usually lasted two to two and a half hours. The objectives of the model project, the planned process, the procedure for the intervention and the correct handling of the documentation were explained.

In the first step, the pharmacists had to win over patients and their doctors to participate. To do this, they informed the doctors in the vicinity of the pharmacy about the project. The decision as to which doctors should be contacted was at the discretion of the pharmacist. In addition, they were able to ask patients who might have been eligible to participate due to frequent prescriptions of benzodiazepines for their consent to consult their doctor.

Patients who met the inclusion criteria and for whom the doctor approved participation, were offered the opportunity to make an appointment for a detailed information and counseling interview in one of the participating pharmacies (Table 2). The pharmacist first explained the positive effects of the benzodiazepine. At the same time, he pointed out that this - like other drugs - can have undesirable effects, especially if it is used over a long period of time. Using a questionnaire in which possible complaints were asked about, the patient should recognize that these are very likely related to long-term use of the benzodiazepine.

The aim was to make the patient aware of the risks of long-term use without questioning the previous therapy.

Since terms like “addiction”, “dependency” and “withdrawal” have a negative connotation for many people, it is advisable to use terms like “getting used to” and “reducing the dose” when talking to the person concerned. This can prevent defense reactions.

The pharmacist then presented the project and offered the patient to participate. If this agreed, the doctor and pharmacist discussed the withdrawal process and the dosing plan.

According to the project plan, the dosing should be done with oxazepam or clonazepam if possible (for the conversion of the benzodiazepines, see Table 3). Oxazepam is particularly suitable because it has a half-life of around eight hours, so that both concentration peaks and accumulation are largely avoided. In addition, tablets with 10 mg of active ingredient are available, which can be quartered with little effort. This enables small dosing steps of 2.5 mg. Clonazepam in liquid dosage form is suitable for patients with swallowing difficulties and can be dosed drop by drop.

At the beginning of withdrawal, the dose of the drug can usually be reduced at short intervals, e.g. weekly. Since experience has shown that the last dosing steps are the most difficult, it is advisable to increase the time intervals between the reduction steps a little towards the end. In addition, personal circumstances such as vacation, acute infectious diseases or planned operations should be taken into account as well as possible (Table 4).