Diazepam prescribing protocol

Following recent prescribing data it was decided to review our diazepam prescribing and a protocol for prescribing diazepam was developed.  This is detailed below.

1. New patients registering with Antrim Castle Surgery who are prescribed diazepam regularly from their previous surgery will be issued a letter advising of practice policy which will be to aim to reduce down to stop or PRN only over 6-8 weeks(see appendix1).  They will be invited to attend GP appointment to discuss this and diazepam will not be added to repeats. 
2. New prescriptions for diazepam will be for 2mg tablets only (exceptions may arise and 5mg may be issued at GP discretion for maximum 2 weeks only).
3. New prescriptions must be labelled for intended duration and never put onto repeat list.  Intended duration should be for maximum 6 weeks, ideally less.  Maximum amount per script should be 21 tablets, unless on weekly dispense.   BNF recommends ‘avoid prolonged use’ – practice interpretation of this is maximum 6-8 weeks.
4. Patients already established on diazepam LT should be reviewed on an ad-hoc basis.  The practice policy is to, following discussion with patients, reduce from 5mg to 2x2mg diazepam and gradually reduce by 1mg steps until patient is off diazepam completely or only on PRN and short quantities.  Prescriptions should not be put onto repeat list unless extenuating circumstances as outlined below.
5. If patients are invited to attend to discuss reduction via prescription note or letter and they do not attend, next prescription will be reduced to encourage attendance. 
6. If 5mg diazepam dose is deemed clinically essential for short term use then the maximum prescription should be 5mg tds for max 2 weeks with plan to reduce then to 2mg tablets.
7. Locum GPs will be advised not to prescribe any more than 7 tablets of diazepam 2mg at a time and refer patients to GP partner.
8. Admin staff should not issue diazepam as an acute prescription
9. If admin staff identify over-dispensing of diazepam from repeat list then this should be highlighted to GP who will remove from repeat list and invite patient to attend to discuss.