What are the withdrawal symptoms of diazepam (Benzodiazepine)?

From the Guidelines

Diazepam withdrawal should always be managed through gradual tapering under medical supervision, typically reducing the dose by 25% every 1-2 weeks, as recommended by the most recent and highest quality study 1.

Introduction to Diazepam Withdrawal

Diazepam withdrawal symptoms can range from mild to severe and potentially life-threatening. Common symptoms include anxiety, insomnia, irritability, tremors, headaches, muscle pain, and increased sensitivity to light and sound. More severe symptoms may include sweating, nausea, vomiting, heart palpitations, increased blood pressure, and sensory disturbances. In serious cases, patients may experience seizures, psychosis, or delirium.

Factors Influencing Withdrawal Severity

The severity of withdrawal depends on factors like dosage, duration of use, and individual characteristics. Withdrawal typically begins within 1-4 days after stopping diazepam and can last for weeks or months due to the drug's long half-life.

Management of Withdrawal

The withdrawal process occurs because the brain becomes dependent on diazepam to enhance GABA activity, and when the drug is removed, the brain needs time to readjust its natural GABA function, leading to these uncomfortable and potentially dangerous symptoms.

• Gradual tapering is essential to minimize the risk of severe withdrawal symptoms, as abrupt discontinuation is dangerous and should be avoided 1.
• A commonly used tapering schedule involves reducing the benzodiazepine dose by 25% every 1-2 weeks, as suggested by Mugunthan and colleagues 1.
• The EMPOWER trial demonstrated success in tapering benzodiazepines by targeting education about benzodiazepine risks and benefits of tapering, with a gradual reduction over many weeks 1.
• Nonpharmacological psychosocial interventions, such as cognitive-behavioral therapy, can also be effective in reducing benzodiazepine use and mitigating withdrawal symptoms 1.

Key Considerations

• Gradual tapering under medical supervision is crucial to ensure a safe and successful withdrawal process.
• The tapering schedule should be individualized based on the patient's needs and response to tapering.
• Close monitoring and support are essential to manage potential withdrawal symptoms and prevent complications.
• Education and self-empowerment can play a significant role in the success of benzodiazepine tapering, as demonstrated by the EMPOWER trial 1.

From the FDA Drug Label

Abuse and misuse of benzodiazepines may lead to addiction Acute withdrawal signs and symptoms associated with benzodiazepines have included abnormal involuntary movements, anxiety, blurred vision, depersonalization, depression, derealization, dizziness, fatigue, gastrointestinal adverse reactions (e.g., nausea, vomiting, diarrhea, weight loss, decreased appetite), headache, hyperacusis, hypertension, irritability, insomnia, memory impairment, muscle pain and stiffness, panic attacks, photophobia, restlessness, tachycardia, and tremor More severe acute withdrawal signs and symptoms, including life-threatening reactions, have included catatonia, convulsions, delirium tremens, depression, hallucinations, mania, psychosis, seizures, and suicidality Protracted withdrawal syndrome associated with benzodiazepines is characterized by anxiety, cognitive impairment, depression, insomnia, formication, motor symptoms (e.g., weakness, tremor, muscle twitches), paresthesia, and tinnitus that persists beyond 4 to 6 weeks after initial benzodiazepine withdrawal.

The withdrawal symptoms of diazepam include:

• Acute withdrawal signs and symptoms: abnormal involuntary movements, anxiety, blurred vision, depersonalization, depression, derealization, dizziness, fatigue, gastrointestinal adverse reactions, headache, hyperacusis, hypertension, irritability, insomnia, memory impairment, muscle pain and stiffness, panic attacks, photophobia, restlessness, tachycardia, and tremor
• More severe acute withdrawal signs and symptoms: catatonia, convulsions, delirium tremens, depression, hallucinations, mania, psychosis, seizures, and suicidality
• Protracted withdrawal syndrome: anxiety, cognitive impairment, depression, insomnia, formication, motor symptoms, paresthesia, and tinnitus that persists beyond 4 to 6 weeks after initial benzodiazepine withdrawal 2

From the Research

Withdrawal Symptoms of Diazepam

• The withdrawal symptoms of diazepam are related to its potential for addiction and misuse, as well as its effects on the central nervous system 3.
• Regular use of benzodiazepines, including diazepam, can cause severe and harmful psychological and physical dependence, leading to withdrawal symptoms similar to those of alcohol withdrawal 3.
• Some of the withdrawal symptoms of benzodiazepines can be life-threatening, and the current treatment for withdrawal is through tapering with clonazepam 3.
• The dependence on benzodiazepines, including diazepam, generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed 3.
• Adverse effects of chronic benzodiazepine use, including diazepam, are sedation, tolerance, and potential for addiction and misuse in some patients 4.

Treatment of Withdrawal Symptoms

• The current treatment for benzodiazepine withdrawal, including diazepam, is through tapering with clonazepam 3.
• Many drugs have been tested as a treatment for withdrawal, but few have proven efficacious in randomized control trials 3.
• Future research is warranted for further exploration into alternative methods of treating benzodiazepine withdrawal, including diazepam 3.