Withdrawal and detoxification from benzodiazepine dependence: a potential role for clonazepam

Alprazolam and triazolam dependence and withdrawal may be uniquely problematic. This paper describes current clinical approaches to benzodiazepine withdrawal, with a focus on recent experience with alprazolam. The withdrawal characteristics of the triazolobenzodiazepines are discussed, and the epidemiology of benzodiazepine dependence is reviewed. Estimates of the incidence of alprazolam abuse are provided from Drug Abuse Warning Network data. The only two case reports in the literature of failure of cross tolerance between alprazolam and other benzodiazepines are noted to be open to alternative interpretations. A case is reported in which a patient was successfully detoxified with clonazepam from a very high dose of alprazolam. The author concludes that clonazepam may have a role in withdrawal from high-dose alprazolam dependence.