• Justine W Welsh, Valeria Tretyak, R Kathryn McHugh, Roger D Weiss, and Olivera Bogunovic.
• Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr. NE, Suite 200, Atlanta, GA 30329, USA. Electronic address: Justine.Welsh@Emory.edu.
• Drug Alcohol Depend. 2018 Aug 1; 189: 96-107.

BackgroundMany patients require discontinuation of benzodiazepines due to a reduction in drug efficacy over time, the development of a sedative use disorder, or unwanted side effects. Benzodiazepine discontinuation can pose a significant challenge for prescribing clinicians due to potential withdrawal symptoms and a recurrence of psychiatric complaints.MethodsA PubMed literature search was conducted using the medical subject heading of benzodiazepines in combination with the following key words: discontinuation, withdrawal, detoxification, cessation, dependence, addiction, substance use disorders, or long term. Twenty-one studies met the search criteria.ResultsFew medications facilitated the successful discontinuation of benzodiazepines or relief from benzodiazepine withdrawal symptoms.ConclusionsStudies were heterogeneous with respect to sample selection, sample size, and outcome measures. Medications targeting insomnia yielded mixed results. Similarly, studies of agents targeting anxiety symptoms demonstrated inconsistent findings in the reduction of anxiety, improvement in withdrawal symptoms, or enhancement of benzodiazepine completion rates. Anticonvulsants have supporting evidence from small case reports; carbamazepine shows some potential in assisting taper completion and reducing withdrawal severity. These conclusions should be considered in light of a number of inconsistencies across studies in the literature. The results of this review article highlight the need for additional research on optimal strategies for facilitating successful benzodiazepine tapers.Copyright © 2018 Elsevier B.V. All rights reserved.

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