Many patients are able to safely take short courses of benzodiazepines, or to use them intermittently longer term, on a ‘as required’ basis and to stop them when no longer needed.25,113
In a situation where the clinical decision is that the ongoing use of a benzodiazepine is the most appropriate management, this requires ongoing monitoring of health outcomes and continuing vigilance for potential hazards throughout treatment.25
The responsible specialist or GP should clearly outline a prescribing plan that should be documented in the patients’ notes or management plan.
The prescribing plan may include instructions that:
- regular prescription reviews take place
- no repeat prescriptions will be made without face-to-face contact
- all prescriptions will be made by one doctor within a single practice
- one pharmacy will dispense all medication.
Benzodiazepine prescriptions should be at the lowest effective dose and given intermittently, with regular reviews of the treatment plans and regular attempts at withdrawal.
At the time of benzodiazepine prescription renewal or medication review, GPs should continue to discuss the risks of long-term benzodiazepines and the benefits of discontinuation (eg cognition, mood, sleep and energy level) and advise the patient to reduce or discontinue the benzodiazepines if there are issues. GPs should document this communication.
Patients should be monitored closely for problematic use or any therapeutic dose dependence behaviour. Any escalation of dose or inappropriate use would lead to a complete review of prescribing and attempted withdrawal of benzodiazepine, along with a review of alternative therapy.
Refer to Resource E.2 in the PDF version for an example of a prescription plan/agreement.
All GPs should develop strategies to manage inappropriate requests for benzodiazepines.