Benzodiazepine and Z-drug harms and dependence
How benzodiazepines and Z-drugs work, the harms of long-term use (falls, crashes, cognition, overdose with opioids), Australian scheduling, recognising dependence and withdrawal, diazepam conversion and tapering, and deprescribing in older people.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Benzodiazepines and Z-drugs work well for days to weeks. Taken for months, they cause falls, fractures, crashes, cognitive impairment, dependence and, with opioids or alcohol, overdose death.
- Hypnotic benefit fades within weeks through tolerance, while rebound insomnia on stopping keeps people taking them.
- Dependence occurs at therapeutic doses. Never stop abruptly after regular use: seizures and delirium follow.
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Sources
- Prescribing drugs of dependence in general practice, Part B: BenzodiazepinesAU/NZRoyal Australian College of General Practitioners, 2015
- Sweetman A et al. Management of adult insomnia in Australia: a joint position statement of the Australasian Sleep Association, Sleep Health Foundation, RACGP and others. Sleep Adv 2026;7(3):zpag086AU/NZSleep Advances, 2026
- Therapeutic Guidelines: PsychotropicAU/NZTherapeutic Guidelines Limited, 2026
- Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults (NG215)National Institute for Health and Care Excellence, 2022
- Horowitz MA, Taylor DM. The Maudsley Deprescribing Guidelines: antidepressants, benzodiazepines, gabapentinoids and Z-drugs. Wiley-Blackwell, 2024Wiley-Blackwell, 2024
- Tannenbaum C et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med 2014;174:890-8JAMA Internal Medicine, 2014
- Gomes T et al. Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case-control study. PLoS Med 2017;14:e1002396PLOS Medicine, 2017
- Last updated
- 14 November 2026
What changed
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