The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the Editor
I congratulate the authors of the recent article on benzodiazepines1 for highlighting that, although not as bad as in the 1980s,2 benzodiazepine abuse and misprescribing remain a problem, especially in the area of polysubstance abuse.
I would like to make a suggestion. Regarding the Table, I tend to classify flunitrazepam (also now a Schedule 8 drug) and nitrazepam as long-acting benzodiazepines. There are usually three groups of benzodiazepine cited for clinical action: short-, intermediate- and long-acting. The authors have grouped short and intermediate, but this can give a misleading impression to prescribers, especially regarding these two benzodiazepines notorious for their accumulation and morning-after effects. For example, the product information for nitrazepam states ‘elderly debilitated patients may show a significant increase in elimination half-life.’
The other minor point I would make is that the approximate half-life of diazepam in the Table (20–80 hours) is misleading. Its active metabolite nordiazepam has a half-life of 96 hours according to the product information, and is marketed as an active compound in some countries.
Finally, a little mnemonic to help students, GP trainees and addiction trainees with outpatient benzodiazepine withdrawal is TTT i.e. Ten per cent reduction in dose per week over Ten weeks with an exponential/terminal Taper.
Mental health specialty services and Alcohol and other drugs
Gold Coast Hospital and Health Service
Associate professor and Mental health discipline lead
Faculty of Health Sciences and Medicine
Gold Coast, Qld
- Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescr 2015;38:152-5.
- McNamara K, Lewin T. General practitioners’ recognition and management of psychiatric illness. Med J Aust 1989;151:250-1.