Benzodiazepines and Z Drugs

Benzodiazepines and Z Drugs Policy

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Benzodiazepines and Z Drugs Policy

BENZODIAZEPINES AND Z DRUGS

Benzodiazepines are medicines such as diazepam and temazepam and nitrazepam. Z drugs are medicines such as zopiclone and zolpidem.

PRESCRIBING POLICY FOR BENZODIAZEPINES AND “Z” DRUGS

Prescriber’s in this practice will prescribe benzodiazepines and “Z” drugs in line with national and locally developed guidelines:

First line treatment should be non-pharmacological measures.

Where benzodiazepines or “Z” drug treatment is indicated, options may include;

 Diazepam, zopiclone, zolpidem or temazepam

For patients who have not received these drugs regularly, we will only prescribe these medicines for a maximum of 14 days and at the lowest effective dose. The following guidance published by NICE will apply (1):

  • The indication for starting such a medication will be documented.
  • Other possible causes of sleep disturbance will be recorded ( eg. Pain, chronic breathlessness, depression) and treated appropriately.
  • All patients will receive advice on non-drug therapies for anxiety and insomnia, available via text.
  • Patients will be advised on the potential problems of dependence (i.e addiction).
  • A second prescription will not be issued without a follow-up appointment.
  • Benzodiazepines or “Z” drugs should not be taken for more that 2 – 4 weeks (including tapering off).

If being prescribed for back spasm (2)

  • The dose is diazepam 2 mg up to three times a day when required to relieve muscle spasm. If necessary, the dose can be titrated up to 5 mg three times a day.A short course (2–5 days) is recommended because the risk of adverse effects is high, and habituation can occur.
  • Use caution if considering prescribing diazepam in elderly or frail people — the manufacturer advises halving the recommended dose.

 

Patients who are already on a regular benzodiazepine or “Z” drug prescription will be assessed and if appropriate, counselled for a withdrawal scheme with the aim to gradually reduce drug dosage to zero.

Patients who are unable or unwilling to reduce drug dosage via a managed withdrawal scheme (or who use more than one drug of abuse, or who are dependent on alcohol) will be referred to the substance misuse service.

 

Prescriptions for hypnotics and anxiolytics should not be routinely available on repeat. However the practice recognises that there may be a small minority of people who need to be on small maintenance dose of benzodiazepine. Examples are people:

  • With severe mental health problems under care of a psychiatrist.
  • On benzodiazepines for treatment of epilepsy
  • Who are seriously or terminally ill.

 

POLICY FOR THE REQUEST OF BENZODIAZEPINES TO TREAT PHOBIAS, SUCH AS FEAR OF FLYING.

Diazepam will not be prescribed for the treatment of phobias such as fear of flying. According to the BNF Diazepam is contra-indicated (not appropriate) to be prescribed for phobic states (3).

Benzodiazepines are only licensed short term for a crisis in generalised anxiety. If you are in crisis, you should be getting expert care and support for your mental health and not going on a flight.

Diazepam is a sedative, which means when prescribed it may cause you to feel sleepy and more relaxed. If there is an emergency during the flight, it may impair ability to concentrate, follow instruction and react to situations. This could have serious safety implications for the patient and those around them.

Many people find benzodiazepines like diazepam sedating, however an uncommon side effect is agitation and a rare side effect is increased aggression. This may cause you to behave in a way in which you wouldn’t normally. A change in behavior may negatively impact on your safety as well as that of other passengers.

We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines. We have listed a number of these below.

Easy Jet   Easyjet fearless flyer course
British Airways BA flying with confidence course
Virgin Virigin flying without fear course

 

MISUSE OF MEDICATION

Benzodiazepines and Z drugs have the potential for misuse. They may result in dependence, where any risk factors are identified for a patient an appointment with a GP or pharmacist will be made before any further medication is prescribed.

LOST PRESCRIPTIONS WILL NOT BE REPLACED.

PRESCRIPTIONS REQUESTED EARLY FOR TRAVEL; WILL REQUIRE PROOF OF TRAVEL


If you take higher doses than prescribed and run out of medication before the next prescription is due, you will NOT be prescribed extra tablets.

These medicines are controlled drugs and will not be prescribed early.

 

Please see the DVLA website for information on driving when taking prescription medicines such as benzodiazepines. DVLA advice drug- driving

 

PRESCRIPTION WAITING TIME REMINDER.

The practice endeavors to fulfil the following.

PRESCRIPTION REQUESTS; Prescription requests take up to two full working day’s to action. Please be aware this will only lead to a prescription if it is appropriate to prescribe.

Please refrain from waiting in the reception area for the prescription process to take place. It will not result in prescriptions being fulfilled any quicker.

Thank you for your co-operation.