Benzodiazepines are commonly prescribed hypnotic and anxiolytic medications. Long-term use leads to tolerance and dependence. Patients who are dependent on benzodiazepines can develop withdrawal symptoms with abrupt discontinuation, similar to the withdrawal seen from ethanol. This occurs due to conformational changes of the GABA receptors in the setting of chronic benzodiazepine use, resulting in decreased GABA activity and a pro-excitatory baseline state. In patients still using benzodiazepines, this results in a "normal" baseline excitatory state. Benzodiazepine cessation results in a pro-excitatory baseline in which withdrawal symptoms present. These manifestations of benzodiazepine withdrawal are broad but typically include agitation, anorexia, tremors, dysphoria, and, in some instances, psychosis or seizures.

Patients with benzodiazepine use disorder are at highest risk for benzodiazepine withdrawal syndrome. These can include patients in the inpatient setting on benzodiazepines for sedation, patients in the outpatient setting dependent on benzodiazepines for a variety of medical conditions, or patients in the community using benzodiazepines as a drug of abuse.

Patients who abuse shorter-acting benzodiazepines are most susceptible to acute withdrawal symptoms. Conversely, patients who gradually wean their dose of benzodiazepines are less likely to develop withdrawal symptoms.

Related topics: benzodiazepine use disorder, poisoning caused by sedative