Inpatient Management of Benzodiazepine Withdrawal: A Narrative Review of a Systematic, Individualized Taper Design

After participating in this CME activity, the psychiatrist should be better able to.

Benzodiazepines are widely prescribed, yet long-term use carries risks of adverse clinical outcomes and challenging withdrawal syndromes. Although gradual outpatient tapering remains the standard recommendation for discontinuation, a subset of patients may require more rapid discontinuation in inpatient settings due to complex factors, such as misuse of multiple substances, prior failed tapering attempts, or co-occurring medical and psychiatric conditions.

This narrative review synthesizes contemporary literature on inpatient benzodiazepine withdrawal. We conducted a targeted review of clinical studies, guidelines, and expert opinion pieces published from 2000-2024, with a focus on real-world applicability.

We assess recent findings and best-practice recommendations on benzodiazepine discontinuation and propose a systematic, individualized tapering strategy to guide inpatient withdrawal management. Additionally, we review medication selection, long-acting benzodiazepines and phenobarbital protocols, adjunctive pharmacotherapy, and behavioral interventions while emphasizing co-occurring disorders, risk management, and protracted withdrawal symptoms.

Our proposed approach may enhance systematic and safe management of inpatient benzodiazepine withdrawal, especially for complex patient populations.