Benzodiazepine Withdrawal
Quick Facts
Why can suddenly stopping benzodiazepines be dangerous?
Recent research on early-pregnancy benzodiazepine exposure offers reassurance about major birth defects, according to an American College of Physicians research announcement. That finding addresses a different question from whether stopping an established prescription is safe. A study of fetal malformations does not establish a safe withdrawal strategy or resolve every concern about exposure later in pregnancy. [American College of Physicians research announcement](https://www.eurekalert.org/news-releases/1146714)
The FDA warns that physical dependence can develop after steady use for days to weeks, even at prescribed doses. Suddenly stopping or reducing the dose too quickly can cause potentially life-threatening seizures. Physical dependence describes the body's adaptation to a medicine and does not, by itself, establish addiction. A positive pregnancy test should therefore prompt a medication review before a patient changes regular treatment. [FDA benzodiazepine safety communication](https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class)
How do clinicians plan benzodiazepine treatment changes during pregnancy?
The 2025 Joint Clinical Practice Guideline on Benzodiazepine Tapering recommends coordinating pregnancy care with the clinician managing the prescription. Decisions consider why the medicine is needed, previous withdrawal experiences and the consequences of symptoms returning. For some patients, destabilization during a taper may make continued treatment the better option after an individualized assessment. [Joint clinical guideline](https://doi.org/10.1007/s11606-025-09499-2)
When tapering is appropriate, reductions require monitoring and adjustment. Significant withdrawal may justify slowing or pausing the process. Some people with prolonged exposure need months to years to discontinue. Support can include cognitive behavioral therapy and treatment of the underlying condition. The guideline combines research evidence with clinical consensus; its recommendations do not establish one optimal pregnancy taper schedule. [ASAM guidance](https://www.asam.org/quality-care/clinical-guidelines/benzodiazepine-tapering)
Why does medication planning need to continue through birth?
MotherToBaby's lorazepam fact sheet describes possible temporary newborn symptoms after exposure during pregnancy, including jitteriness, irritability, sleep disturbances, breathing difficulties and muscle weakness. These effects do not occur in every exposed baby. When symptoms develop, they usually resolve within a few weeks. Families should tell the delivery team about treatment so the baby can receive appropriate assessment and care. [MotherToBaby: Lorazepam](https://mothertobaby.org/fact-sheets/lorazepam/)
Medication discussions also extend to feeding after delivery. Lorazepam enters breast milk in small amounts, and the fact sheet reports no side effects in the studies it summarizes. However, unusual sleepiness, slower breathing, poor feeding or inadequate weight gain warrant medical attention. These findings concern lorazepam specifically; decisions about another benzodiazepine require information about that medicine and the individual mother and baby. [MotherToBaby breastfeeding guidance](https://mothertobaby.org/fact-sheets/lorazepam/)
Frequently Asked Questions
Contact your prescriber and pregnancy care team before changing regular treatment. Abrupt discontinuation can cause serious withdrawal; the appropriate plan depends on your medicine, treatment history and health needs.
No. Physical dependence can occur during prescribed treatment. A substance use disorder involves additional behavioral and clinical features; withdrawal alone does not establish that diagnosis.
No. Treatment changes require an individualized plan and monitoring. Pregnancy does not create a universal deadline for stopping.
No. MotherToBaby states that some exposed newborns develop temporary symptoms, while others do not. Inform the newborn care team about exposure so symptoms can be recognized.
A seizure, severe confusion or hallucinations after stopping or reducing a benzodiazepine require emergency medical assessment. Contact the prescriber promptly about other new or worsening withdrawal symptoms.
References
- American College of Physicians. Benzodiazepine use in first trimester not associated with higher risk for major birth defects. Research announcement distributed through [EurekAlert](https://www.eurekalert.org/news-releases/1146714).
- U.S. Food and Drug Administration. [FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class](https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class). September 23, 2020.
- Brunner E, Chen CYA, Klein T, et al. [Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits](https://doi.org/10.1007/s11606-025-09499-2). Journal of General Internal Medicine. 2025;40:2814–2859.
- MotherToBaby, Organization of Teratology Information Specialists. [Lorazepam](https://mothertobaby.org/fact-sheets/lorazepam/). Fact sheet.