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Discontinuation of chronic benzodiazepine use in primary care: a nonrandomized intervention
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Orientador(es)
Resumo(s)
Background: Chronic benzodiazepine use is a challenge in primary care practice. Protocols to
support safe discontinuation are still needed, especially in countries with high utilization rates.
Objectives: To evaluate the feasibility, effectiveness, and safety of a benzodiazepine discontinuation
protocol in primary care setting.
Methods: Nonrandomized, 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.
Results: From 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.
Conclusion: The discontinuation protocol with standardized dosage reduction was feasible at
primary care and showed long-term effectiveness.
Descrição
© The Author(s) 2021. Published by Oxford University Press. All rights reserved.
Palavras-chave
Benzodiazepines Deprescribing Discontinuation protocol Primary healthcare Substance use Withdrawal symptoms
Contexto Educativo
Citação
Family Practice, 2022, 241–248
Editora
Oxford University Press