• Milene Fernandes, Inês Neves, Joana Oliveira, Osvaldo Santos, Pedro Aguiar, Paula Atalaia, Fátima Matos, Maria Carina Freitas, António Alvim, and Vasco Maria.
• Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina-Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal.
• Fam Pract. 2022 Mar 24; 39 (2): 241-248.

BackgroundChronic benzodiazepine use is a challenge in primary care practice. Protocols to support safe discontinuation are still needed, especially in countries with high utilization rates.ObjectivesTo evaluate the feasibility, effectiveness, and safety of a benzodiazepine discontinuation protocol in primary care setting.MethodsNonrandomized, single-arm interventional study, at primary care units. Family physicians (FPs) recruited patients (18-85 years-old) with benzodiazepine dependence and chronic daily use ≥3 months. Patients with daily dosages ≥30 mg diazepam-equivalent, taking zolpidem, with a history of other substance abuse or major psychiatric disease were excluded. After the switch to diazepam, the dosage was gradually tapered according to a standardized protocol. Primary endpoint was the percentage of patients who stopped benzodiazepine at the intervention last visit. Dosage reduction, withdrawal symptoms, patients' and FPs' satisfaction with the protocol were evaluated.ResultsFrom 66 enrolled patients (74% female; 66.7% aged >64 years; median time of benzodiazepine use was 120 months), 2 withdrew due to medical reasons and 3 presented protocol deviations. Overall, 59.4% of participants successfully stopped benzodiazepine (60.7% when excluding protocol deviations). Men had higher probability of success (relative risk = 0.51, P = 0.001). A total of 31 patients reported at least 1 withdrawal symptom, most frequently insomnia and anxiety. Most of participating FP considered the clinical protocol useful and feasible in daily practice. Among patients completing the protocol, 77% were satisfied. For the patients who reduced dosage, 85% kept without benzodiazepines after 12 months.ConclusionThe discontinuation protocol with standardized dosage reduction was feasible at primary care and showed long-term effectiveness.© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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