Benzodiazepine high-doses: The need for an accurate definition

Jean Marc Cloos*, Christopher Y.S. Lim Cow, Valéry Bocquet

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)


Objectives: A clear definition of what we understand of high-dose misuse or of a ‘markedly increased dose’ (as stated by the DSM-5) is important and past definitions may be inadequate. The aim of this review is to describe the different definitions used and to test these definitions for their accuracy. Methods: A narrative PubMed literature review was conducted based on articles published between 1 January 1990 and 31 December 2020 describing benzodiazepines (in MeSH Terms or MeSH Major Topic) and high-dose (or high-dosage). Specific definitions were applied to a population sample to show how definitions affect high-dose benzodiazepine prevalence. Results: Multiples of an equivalent-diazepam dose or of the World Health Organization ‘defined daily dosage’ were used more frequently than the overstep of the recommended maximum therapeutic dosage as a cut-off point. Conclusion: High-dose use is rare but the prevalence in the general population varies among studies, mainly due to different definitions, making both clinical and epidemiological comparisons between studies difficult. Defining a high-dose user as a person who takes at least a higher dose than the maximum usual therapeutic dose over a defined period of time therefore appears to be clinically more consistent.

Original languageEnglish
Pages (from-to)e1888
JournalInternational Journal of Methods in Psychiatric Research
Issue number4
Early online date31 Jul 2021
Publication statusPublished - Dec 2021


  • anxiolytics
  • benzodiazepine
  • high-dose use
  • hypnotics
  • long-term use


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