Module 4: Therapeutics

Lesson 4

Benzodiazepine rotation and tapering

Benzodiazepine rotation is usually only required when considering a taper. Caution must always be taken to avoid oversedation as equivalencies are approximate and affected by medication metabolism and patient condition. There is no impact of rotation on the development or management of dependence or tolerance to these medications. Please consider benzodiazepine equivalency using one of the following tables:

• Benzodiazepine Equivalent Table (NOUGG, 2017).
• Benzodiazepine Equivalence Table (The Ashton Manual, 2002)

Benzodiazepine tapering is indicated when adverse effects, a lack of treatment benefit, the requirement of additional sedating medications (eg. opioids), and the presence of patient safety concerns exists. The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain provides an excellent resource and protocol for benzodiazepine tapering that should be reviewed prior to prescribing benzodiazepines.