Benzodiazepines & Z Drugs


GP’s in this practice will prescribe hypnotics and anxiolytics (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, first line options should be:

  •  Anxiolytic: Diazepam
  • Hypnotic: 1st Zolpidem, 2nd Zopiclone, 3rd Temazepam

For patients who have not received these drugs regularly, GP’s will only prescribe hypnotics and anxiolytics for a maximum of 14 days and at the lowest effective dose. They will only be prescribed if the GP feels that the condition is sever, disabling and subjecting the patient to extreme distress and / or for those where other interventions have not been successful. The following guidance published by NICE will apply:

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

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 note be routinely available on repeat. However the practice accepts 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.
  • Lost prescriptions will not be replaced.

If a patient takes higher doses than prescribed and runs out of medication before the next prescription is due, they will not be prescribed extra tablets.

The practice will undertake a regular review and audit of the prescribing practice of benzodiazepines and “Z” drugs to ensure compliance with national and local guidelines.

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