Related guidance:
- A clinically validated sleep improvement programme that can help people sleep better after just four sessions with free NHS access.
- Patient decision aid full version: Should I Stop my benzodiazepine or z-drug?
- Patient decision aid summary: Should I Stop my benzodiazepine or z-drug?
Anxiety disorders Quality standard (QS53 February 2014)
- It is now an offence to drive with any of 17 controlled drugs above a specified level in your blood – this includes illegal and medical drugs.
Prescription medicines include
- amphetamine, for example dexamphetamine or selegiline
- clonazepam
- diazepam
- flunitrazepam
- lorazepam
- methadone
- morphine or opiate and opioid-based drugs, for example codeine, tramadol or fentanyl
- oxazepam
- temazepam
All Prescriptions for hypnotics should be limited to 7-14 days supply and not transferred to repeat.
Tolerance can develop within 3 to 14 days of continuous use.
Benzodiazepines (STOPP Criteria)
- for ≥ 4 weeks (no indication for longer treatment; risk of prolonged sedation, confusion, impaired balance, falls, road traffic accidents; all benzodiazepines should be withdrawn gradually if taken for more than 4 weeks as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped abruptly).
NHS Somerset hypnotics and anxiolytics
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Hypnotics, sedatives and anxiolytics, non-benzodiazepine | Hypnotics, sedatives and anxiolytics cause physical and psychological dependence and tolerance. Should be reserved for short courses to alleviate acute conditions after causal factors have been established. | ||
| Taking zolpidem is associated with a risk of impaired driving ability the next day. See MHRA (December 2014) for Zolpidem: risk of drowsiness and reduced driving ability. | |||
| Zolpidem | 5mg tablet: £1.61 | 5mg (elderly) - 10mg (adult) to be taken at bedtime. | |
| 10mg tablet: £1.26 | |||
| Zopiclone | 3.75mg tablet: £1.45 | 3.75mg (elderly) - 7.5mg (adult) to be taken at bedtime. | |
| 7.5mg tablet: £1.33 | |||
| Melatonin | 2mg prolonged release tablet: £6.53 (30) | Indicated as monotherapy for the short-term treatment (up to 13 weeks) of primary insomnia characterised by poor quality of sleep in patients who are aged 55 or over. It is also approved for use off label in patients with Parkinson's disease related insomnia. NHS Somerset classify as Amber for hemicrania continua. NHS Somerset classify as Red (specialist prescribing only) for paediatric or mental health patients and Black (not recommended) for unlicensed preparations and other indications as per Traffic light guidance. |
|
| Hypnotics, sedatives and anxiolytics, benzodiazepine | Benzodiazepines and opioids can both cause respiratory depression, which can be fatal if not recognised in time. Only prescribe together if there is no alternative and closely monitor patients for signs of respiratory depression. See MHRA (March 2020) for Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression. | ||
| Benzodiazepines are indicated for the short term relief of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short term psychosomatic, organic or psychotic illness. The use of benzodiazepines to treat short term mild anxiety is inappropriate. Benzodiazepines should only be used to treat insomnia when it is severe, disabling or causing the patient extreme distress. |
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| Temazepam | 10mg tablet: £23.61 | 10mg (elderly) - 20mg (adult) to be taken at bedtime. | |
| 20mg tablet: £24.25 | |||
| Diazepam | 2mg tablet: £0.79 | 5-15mg (adult) to be taken at bedtime. | |
| 5mg tablet: £0.81 | |||