Purpose

This protocol outlines the safe prescribing, monitoring, and ongoing management of benzodiazepine medications. It is designed to promote patient safety, ensure regulatory compliance, and clearly define expectations for continued treatment.

Medications Covered

This protocol applies to all benzodiazepines, including but not limited to:

• Alprazolam (Xanax)

• Lorazepam (Ativan)

• Clonazepam (Klonopin)

• Diazepam (Valium)

• Temazepam (Restoril)

What Benzodiazepines Do

Benzodiazepines act on the central nervous system by enhancing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces brain activity.

Clinical effects may include:

• Reduction of acute anxiety and panic symptoms

• Muscle relaxation

• Sedation and calming effect

• Short-term relief of severe insomnia

• Seizure prevention in specific conditions

Benzodiazepines are typically intended for short-term or intermittent use and are not considered first-line long-term treatments for anxiety or insomnia.

Risks and Potential Side Effects

Patients should be aware of the following risks associated with benzodiazepine use:

Common risks:

• Drowsiness or sedation

• Impaired concentration, memory, or judgment

• Slowed reaction time

• Increased risk of falls or accidents

Serious risks:

• Physical dependence and tolerance

• Withdrawal symptoms if stopped abruptly (anxiety, insomnia, tremor, seizures)

• Cognitive impairment with long-term use

• Increased risk of overdose when combined with opioids, alcohol, or other sedating medications

• Worsening depression or emotional blunting in some individuals

Benzodiazepines should never be combined with alcohol, opioids, or other sedatives unless specifically approved by the prescribing clinician.

Clinic Visit Requirements

To continue benzodiazepine treatment through Miles Med Management, patients must adhere to the following:

• Avtelehealth visits every 3–4 months (minimum requirement)

• Visits will include:

  • Review of symptoms and medication effectiveness

  • Assessment of side effects and functional status

  • Review of continued medical necessity

  • Discussion of alternative or adjunctive treatments when appropriate

Failure to attend required follow-up visits may result in delayed refills or discontinuation of benzodiazepine prescribing.

Monitoring and Safety Expectations

Patients agree to:

• Take medications exactly as prescribed

• Use one prescribing provider for benzodiazepines

• Use one designated pharmacy when possible

• Notify the clinic of all other prescribed or over-the-counter sedating medications

• Avoid early refill requests

Random or scheduled urine drug screening and prescription monitoring program (PMP) reviews may be conducted as clinically indicated.

Discontinuation and Tapering

If benzodiazepines are no longer clinically indicated, or if safety concerns arise, the clinician may recommend:

• Gradual dose reduction (taper)

• Transition to alternative treatments (e.g., SSRIs, SNRIs, buspirone, psychotherapy)

Abrupt discontinuation is avoided whenever possible due to withdrawal risk.

Patient Acknowledgment

By continuing benzodiazepine treatment, the patient acknowledges:

• Understanding the benefits and risks of benzodiazepines

• Understanding the requirement for clinic visits every 3–4 months

• Agreement to follow clinic safety and monitoring policies

Patient Acknowledgment and Initials

Please initial each section below to confirm understanding and agreement:

Understanding of Benzodiazepines

Risks and Side Effects

Clinic Visit Requirement (Every 3–4 Months)

Monitoring and Safety Expectations

Discontinuation and Tapering Policy

Patient Signature

By signing below, I confirm that I have reviewed this Benzodiazepine Treatment Protocol, had the opportunity to ask questions, and agree to follow the outlined requirements.

Miles Med Management

This protocol is intended to support safe, responsible benzodiazepine prescribing and patient care.