Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review

Pollmann, André S.; Murphy, Andrea L.; Bergman, Joel C.; Gardner, David M.

doi:10.1186/s40360-015-0019-8

Cited by 114Pharmaceutical Practices and Patient OutcomesSubstance Abuse Treatment and OutcomesSleep and related disorders

Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review

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Pollmann, André S., Murphy, Andrea L., Bergman, Joel C., Gardner, David M.·2015·BMC Pharmacology and Toxicology

DOI 10.1186/s40360-015-0019-8PMC PMC4491204

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Abstract

BACKGROUND: Long-term sedative use is prevalent and associated with significant morbidity, including adverse events such as falls, cognitive impairment, and sedation. The development of dependence can pose significant challenges when discontinuation is attempted as withdrawal symptoms often develop. We conducted a scoping review to map and characterize the literature and determine opportunities for future research regarding deprescribing strategies for long-term benzodiazepine and Z-drug (zopiclone, zolpidem, and zaleplon) use in community-dwelling adults. METHODS: We searched PubMed, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, CINAHL, TRIP, and JBI Ovid databases and conducted a grey literature search. Articles discussing methods for deprescribing benzodiazepines or Z-drugs in community-dwelling adults were selected. RESULTS: Following removal of duplicates, 2797 articles were reviewed for eligibility. Of these, 367 were retrieved for full-text assessment and 139 were subsequently included for review. Seventy-four (53%) articles were original research, predominantly randomized controlled trials (n = 52 [37%]), whereas 58 (42%) were narrative reviews and seven (5%) were guidelines. Amongst original studies, pharmacologic strategies were the most commonly studied intervention (n = 42 [57%]). Additional deprescribing strategies included psychological therapies (n = 10 [14%]), mixed interventions (n = 12 [16%]), and others (n = 10 [14%]). Behaviour change interventions were commonly combined and included enablement (n = 56 [76%]), education (n = 36 [47%]), and training (n = 29 [39%]). Gradual dose reduction was frequently a component of studies, reviews, and guidelines, but methods varied widely. CONCLUSIONS: Approaches proposed for deprescribing benzodiazepines and Z-drugs are numerous and heterogeneous. Current research in this area using methods such as randomized trials and meta-analyses may too narrowly encompass potential strategies available to target this phenomenon. Realist synthesis methods would be well suited to understand the mechanisms by which deprescribing interventions work and why they fail.

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Dependence and withdrawal still commonly occur with z-drugs even after brief or intermittent use.
“however, dependence, and withdrawal still commonly occur (Nice, 2004; Pollmann et al., 2015) even after brief or intermittent use (Kales et al., 1991).”
From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Pollmann et al., 2015
The Background (page unavailable) discusses withdrawal experiences as a factor in continued benzodiazepine and Z-drug use, supporting the withdrawal concern. It does not establish that dependence and withdrawal commonly occur specifically with Z-drugs. In the citing sentence, the separate claim about brief or intermittent use is attributed to Kales et al., not Pollmann et al. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Guidelines universally recommend tapering benzodiazepines.
“Guidelines universally recommend tapering benzodiazepines, yet there is no definitive method, and most advice is based on expert consensus rather than empirical evidence or pharmacological principles, resulting in conflicting advice (Brunner et al., 2025; Pollmann, Murphy, Bergman, & Gardner, 2015).”
From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Pollmann, Murphy, Bergman, & Gardner, 2015
In Results > Deprescribing strategies (page unavailable), the review says that most review articles and clinical practice guidelines—60 of 65 (92%)—recommended gradual dose reduction. This supports tapering as a common recommendation, but the combined figure does not establish that guidelines universally recommend it. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Most advice on tapering benzodiazepines is based on expert consensus rather than empirical evidence or pharmacological principles.
“Guidelines universally recommend tapering benzodiazepines, yet there is no definitive method, and most advice is based on expert consensus rather than empirical evidence or pharmacological principles, resulting in conflicting advice (Brunner et al., 2025; Pollmann, Murphy, Bergman, & Gardner, 2015).”
From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Pollmann, Murphy, Bergman, & Gardner, 2015
The Results (Deprescribing strategies; page unavailable) report that tapering regimens varied dramatically among trials, supporting the claim that there is no single established method. The Discussion (page unavailable) notes differences between interventions studied in trials and those discussed in guidelines. Neither passage establishes that most tapering advice rests on expert consensus rather than empirical evidence or pharmacological principles. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Most original investigations and guidelines employed linear reductions of 10%-25% every 1-2 weeks and then discontinuation.
“In two scoping reviews of benzodiazepine tapering studies (Brandt et al., 2024; Pollmann et al., 2015), most original investigations and guidelines employed reductions of 10%–25% every 1–2 weeks in linear fashion (i.e. 75% of the original daily dose, then 50% of the original dose, 25% of the original dose), and then discontinuation (Pollmann et al., 2015).”
From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Pollmann et al., 2015
The Results (Deprescribing strategies; page unavailable) identify a linear reduction of 25% of the original dose each week, followed by discontinuation, as the most common reported taper rate—but it appeared in only 16 trials, not most investigations. The same section says regimens varied dramatically, many trials used flexible plans, and guideline recommendations varied widely; it does not establish that most investigations and guidelines used a linear 10%–25% reduction every 1–2 weeks. (LLM, conf=0.88)
Experimental — accuracy not yet measured
The use of pharmacological strategies involving the addition of a second agent is among the most commonly-employed approaches in Z-drug deprescription.
“The use of pharmacological strategies involving the addition of a second agent is among the most commonly-employed approaches in the process of Z-drug deprescription.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [81]
The Results (Deprescribing strategies) report that 33 studies investigated adding a pharmacologic therapy, and the Discussion calls this the most commonly studied intervention in randomized trials. The review covers benzodiazepines and Z-drugs together and measures what was studied, not how commonly the approach was employed in Z-drug deprescribing specifically. (LLM, conf=0.86)
Experimental — accuracy not yet measured

There is a scarcity of clinical trials and studies exploring therapeutic strategies to manage zolpidem dependence in adults and older populations.
“Despite this growing concern, there is a scarcity of clinical trials and studies exploring therapeutic strategies to manage zolpidem dependence in adults and older populations. 81”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [81]
The Results (Description of articles; page not provided) report that only three of 74 original studies exclusively examined strategies for stopping Z-drugs. The Discussion also says trial participants were often younger than the older adults targeted by deprescribing efforts. These findings support a research gap, but the review does not establish the scarcity of studies specifically on treating zolpidem dependence. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Tapering advice for benzodiazepines is conflicting.
“Guidelines universally recommend tapering benzodiazepines, yet there is no definitive method, and most advice is based on expert consensus rather than empirical evidence or pharmacological principles, resulting in conflicting advice (Brunner et al., 2025; Pollmann, Murphy, Bergman, & Gardner, 2015).”
From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Pollmann, Murphy, Bergman, & Gardner, 2015
There is no definitive method for tapering benzodiazepines.
“Guidelines universally recommend tapering benzodiazepines, yet there is no definitive method, and most advice is based on expert consensus rather than empirical evidence or pharmacological principles, resulting in conflicting advice (Brunner et al., 2025; Pollmann, Murphy, Bergman, & Gardner, 2015).”
From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Pollmann, Murphy, Bergman, & Gardner, 2015
The final dose before complete cessation in linear tapering studies was generally 25% or 50% of the original dose, with some implying 5%-10% of the original dose.
“The final dose before complete cessation was generally 25% or 50% of the original dose, when reported, in these studies (Pollmann et al., 2015), with some implying a final dose of 5%–10% of the original dose (Brandt et al., 2024).”
From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Pollmann et al., 2015
The division among documents is likely explained by the limited number of randomised controlled trials and lower quality heterogenous evidence variably supporting their use.
“This is likely explained by the limited number of randomised controlled trials and lower quality heterogenous evidence variably supporting their use, as reviewed in further detail elsewhere.163,169,170”
From Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review (2024) · cites this paper as [163]
The focus of BZD deprescribing, especially among older adults, has become more prominent in Western and European nations in recent years given an aging demographic trend and the known risks of these agents in this population.
“The focus of BZD deprescribing, especially among older adults, has become more prominent in Western and European nations especially in recent years given an aging demographic trend and the known risks of these agents in this population.163,164”
From Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review (2024) · cites this paper as [163]

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RESEARCH ARTICLE Open Access Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review
Pollmann, A. S., Murphy, A. L., Bergman, J. C., & Gardner, D. M. (2016)
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Authors: Pollmann, A. S., Murphy, A. L., Bergman, J. C., & Gardner, D. M.
Affiliations: Dalhousie University (CA)
Corresponding author: Pollmann, André S.
ORCID: Pollmann, André S.
Murphy, Andrea L.
Bergman, Joel C.
Gardner, David M.
Venue: BMC Pharmacology and Toxicology
Publisher: Springer Science and Business Media LLC
Published: 2015-07-04
Volume: 16
Issue: 1
Pages: 19-19
ISSN: 2050-6511 (ISSN-L)
DOI: 10.1186/s40360-015-0019-8
PMC: PMC4491204
OpenAlex: W2170043108
Cited by: 114
References: 189
Citations by year: 2026: 7 · 2025: 7 · 2024: 7 · 2023: 14 · 2022: 18 · 2021: 16 · 2020: 6 · 2019: 13 · 2018: 16 · 2017: 6 · 2016: 4
FWCI: 4.34
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
Locations: BMC Pharmacology and Toxicology (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Funders: Dalhousie University
College of Pharmacy, Dalhousie University
Topics: Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords: deprescribing, benzodiazepines, Z-drugs, zopiclone, zolpidem, zaleplon, community-dwelling adults, benzodiazepine withdrawal, gradual dose reduction, behaviour change interventions, psychotherapy, realist synthesis
MeSH terms: Deprescriptions, Zolpidem, Acetamides, Benzodiazepines, Humans, Piperazines, Pyridines, Pyrimidines, Azabicyclo Compounds

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