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Benzodiazepine deprescribing — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)Benzodiazepine deprescribingUSMLE Step 3

A 78-year-old woman has taken diazepam 10 mg nightly for 8 years and now has falls and daytime cognitive slowing. She agrees that harms outweigh benefits but had tremor and insomnia after a previous 50% dose reduction. Which deprescribing plan is most appropriate?

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Correct answer: C — Reduce diazepam by 5% to 10% every 2 to 4 weeks

The best answer is “Reduce diazepam by 5% to 10% every 2 to 4 weeks”. Long-term physiologic dependence makes abrupt or rapid withdrawal unsafe. A slow, patient-responsive taper beginning with small percentage reductions minimizes withdrawal; the pace can be slowed near the end. CBT-I addresses the underlying insomnia without substituting another sedative-hypnotic.

Reference: ASAM Joint Clinical Practice Guideline on Benzodiazepine Tapering: https://www.asam.org/quality-care/clinical-guidelines/benzodiazepine-tapering