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Benzodiazepine Withdrawal — MRCPsych Paper B MCQ

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ModerateSubstance MisuseBenzodiazepine WithdrawalMRCPsych Paper B

A 50-year-old woman has taken prescribed diazepam 20 mg daily for anxiety for 8 years and now wishes to stop. She is clinically stable, has no history of seizures or alcohol or drug misuse, and is not taking other sedative medication. What is the most appropriate approach to withdrawing diazepam?

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Correct answer: D — Reduce diazepam slowly in proportional steps, using smaller decrements at lower doses and adjusting the schedule to symptoms

The correct answer is D. After 8 years of daily diazepam, physiological dependence is likely, so abrupt cessation risks significant withdrawal symptoms, including anxiety, insomnia and seizures. NICE recommends a slow, stepwise reduction proportionate to the current dose, with progressively smaller decrements at lower doses. The schedule should be agreed with the patient, reviewed regularly and slowed or paused if withdrawal becomes intolerable; withdrawal may take months. Diazepam is already long-acting, so conversion to a short-acting benzodiazepine is inappropriate and may worsen withdrawal. Pregabalin should not replace an individualised benzodiazepine taper. Inpatient withdrawal is not routinely required in a stable patient without seizure, substance-misuse or other major clinical risks. The underlying anxiety should also receive appropriate psychological or other ongoing treatment.

Reference: National Institute for Health and Care Excellence. Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults, NG215, recommendations 1.5.10–1.5.14. 2022. https://www.nice.org.uk/guidance/ng215/chapter/recommendations