Utilization of adjunctive anti-seizure medications to facilitate chronic benzodiazepine discontinuation.

INTRODUCTION

When discontinuing benzodiazepines, treating withdrawal symptoms can be challenging. Some anti-seizure medications (ASM) may mitigate withdrawal symptoms. This article reviews the literature regarding adjunctive ASM use during benzodiazepine tapering and discontinuation.

METHODS

A PubMed search focusing on the use of ASMs as adjunctive agents to mitigate benzodiazepine withdrawal symptoms was conducted. Key search teams identified relevant articles, and the references of included articles were evaluated to identify potential additional publications for inclusion. In total, 21 articles met the inclusion criteria, and 44 articles were excluded for various reasons.

RESULTS

Several clinical trials, observational studies, case reports, and case series were identified. Carbamazepine was more effective than placebo at 3 months (74% benzodiazepine free vs 52% for placebo). Oxcarbazepine enabled successful rapid detoxification with minimal withdrawal symptoms in a small, noncontrolled study. Valproate, pregabalin, and gabapentin showed improvements in benzodiazepine-free rates, but the results were inconsistent.

DISCUSSION: Evidence for ASM in benzodiazepine withdrawal is limited, emphasizing the need for provider discretion. Additional larger clinical trials are warranted to identify optimal agents to mitigate withdrawal symptoms and enhance successful benzodiazepine cessation.