[Managing benzodiazepine withdrawal using prazepam substitution: Retrospective study of 86 patients]

In France, the consumption of benzodiazepines (BZD) remains significant despite Haute autorité de santé (French National Authority of Health-HAS) recommendations. Various strategies are recommended: gradual dosage reduction of the BZD consumed or switch to diazepam in certain situations. Prazepam may also be an interesting molecule (long half-life, oral solution, less risk of abuse than diazepam). The aim of this study is to describe the efficacy, adverse events and feasibility of a BZD withdrawal program with prazepam.

Data were collected retrospectively among patients hospitalized at the Saint Barnabé clinic in 2022, which had a prescription of prazepam for withdrawal purposes. Withdrawal was considered successful at discharge if the initial prazepam dosage was reduced by more than 50 %, or if prazepam was stopped.

Most of the 86 patients had psychiatric or addictive comorbidities. Among them, 55 % had been using BZDs for over a year, 36 % consumed at least two BZDs, and 15 % took doses exceeding authorized indications. At discharge (median of 42 days), 29 % of patients were fully withdrawn, and 33 % had reduced their initial prazepam dosage by more than 50 %. The protocol was adapted in 38 % of patients, and 27 % experienced withdrawal symptoms. Several factors were significantly associated with partially successful or no success: presence of personality disorder, hospitalization in a context of cocaine use disorder, signs of withdrawal and protocol adaptation.

This study highlights the utility of prazepam in BZD withdrawal among a population at high risk for complicated withdrawal. The occurrence of clinical symptoms and protocol adjustments emphasize the importance of individualized management with regular medical reassessment.