The most important element of pharmacologic management of withdrawal from GABAergic agents is the restoration of CNS inhibitory tone with medications that demonstrate cross-tolerance with that agent. Benzodiazepines will effectively control symptoms of withdrawal from GABAergic agents. The pharmacological profile and kinetics of each benzodiazepine, as well as the patient’s route of access, age, and the presence of underlying liver or kidney disease should be considered when choosing which benzodiazepine to use.
The mainstay of treatment in sedative-hypnotic withdrawal is the gradual taper of a long-acting benzodiazepine.14,15 While benzodiazepines are considered first-line treatment for withdrawal, central alpha-2 agonists, beta blockers, carbamazepine, and neuroleptics may be used as adjunctive therapy, but they are not recommended as monotherapy, based on limited evidence and consensus guidelines.16,17
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