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Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review
Open accessAbstract
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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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measured
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“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]
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In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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
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“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
In the citing paper
“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”
In the citing paper
“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”
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“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).”
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Metadata
- Authors
- Pollmann, A. S., Murphy, A. L., Bergman, J. C., & Gardner, D. M.
- Affiliations
- Dalhousie University (CA)
- Corresponding author
- Pollmann, André S.
- Venue
- BMC Pharmacology and Toxicology
- Published
- 2015-07-04
- Volume
- 16
- Issue
- 1
- Pages
- 19-19
- ISSN
- 2050-6511 (ISSN-L)
- 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
- 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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