Tapering benzos inpatient

[yanks26dmb]

It's been a while since I've done inpatient work and I'm curious what you all do.

Two different scenarios.

1. Patient who has been getting numerous benzos prn during their stay for mania. Long stay of over four weeks. Do you taper inpatient as they are getting ready to leave? Send them out with an outpatient valium taper?

2. Regarding alcohol withdrawal. Any benefit to starting a standing taper upon arrival rather than relying on ciwa based dosing?

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[Celexa]

It's been a while since I've done inpatient work and I'm curious what you all do.

Two different scenarios.

1. Patient who has been getting numerous benzos prn during their stay for mania. Long stay of over four weeks. Do you taper inpatient as they are getting ready to leave? Send them out with an outpatient valium taper?

2. Regarding alcohol withdrawal. Any benefit to starting a standing taper upon arrival rather than relying on ciwa based dosing?

True mania requiring benzos to control is something I am happy to send out to be continued in the outpatient for a several week taper, unless the pt has hx of benzo abuse or alcohol use disorder. Even in those cases I might still do it if a responsible family member has the meds.

Standing taper for alcohol, will do it if I can't trust that the nurses will follow ciwas well (have seen times nurses look for every reason to not give the pt Ativan, as well as the opposite, or pt is too good at knowing what to say to get high ciwa) and/or pt has a longstanding history and clearly needs a lot of meds during withdrawal. Might as well get started putting the fire out. Usually will start some scheduled amount based on previous withdrawal episodes and then add ciwa on top to finesse it.