{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:21:56Z","timestamp":1791174116578,"version":"4.1.0"},"reference-count":98,"publisher":"Georg Thieme Verlag KG","issue":"10","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Benzodiazepine (BZD) receptor agonists, commonly known as Z-drugs, are non-BZD hypnotics primarily prescribed for the treatment of insomnia. Their use is recommended for no longer than four weeks to minimize the risk of adverse effects, including dependence and withdrawal. However, these guidelines are frequently disregarded, and the abuse of and dependence on Z-drugs has emerged as a growing public health concern in Brazil. The present article reviews the current evidence on Z-drug use disorder\u2014including dependence and withdrawal\u2014and proposes clinical guidelines for the management of discontinuation. The recommendations were developed based on a systematic review of the literature and refined using the Delphi methodology. The consensus was developed by a multidisciplinary task force, with coordination and voting led by a steering committee. An advisory committee, consisting of neurologists from the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN, in Portuguese) and psychiatrists specializing in substance-use disorders, contributed to the selection and organization of the scientific literature and took part in the voting process. Key recommendations were established: 1) prior to discontinuation, a comprehensive assessment of mental status, psychiatric and sleep comorbidities, and the degree of pharmacological dependence is essential; 2) gradual tapering is advised; 3) non-pharmacological interventions, such as cognitive behavioral therapy for insomnia, are recommended, and acceptance and commitment therapy, which is optional, may be incorporated; 4) for zolpidem withdrawal, adjunctive pharmacotherapy, which is optional, may include trazodone, other antidepressants, quetiapine or other antipsychotics, alpha-2-delta (\u03b12\u03b4) ligands, or alternative hypnotics (such as ramelteon, zopiclone, and eszopiclone); 5) for Z-drug discontinuation, intermediate- or long-acting BZDs are recommended; and 6) short- or ultra-short-acting BZDs and immediate-release melatonin are not recommended.<\/jats:p>","DOI":"10.1055\/s-0045-1812323","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:17:35Z","timestamp":1762301855000},"page":"001-024","source":"Crossref","is-referenced-by-count":1,"title":["Z-drug abuse and dependence: clinical guideline of the Brazilian Academy of Neurology for diagnosis and management"],"prefix":"10.1055","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7261-0735","authenticated-orcid":false,"given":"Fernando Gustavo","family":"Stelzer","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina de Ribeir\u00e3o Preto, Departamento de Neuroci\u00eancias e Ci\u00eancias do Comportamento, Ribeir\u00e3o Preto SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5450-8983","authenticated-orcid":false,"given":"Andrea","family":"Bacelar","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Bacelar, Rio de Janeiro RJ, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5691-7158","authenticated-orcid":false,"given":"Alan Luiz","family":"\u00c9ckeli","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina de Ribeir\u00e3o Preto, Departamento de Neuroci\u00eancias e Ci\u00eancias do Comportamento, Ribeir\u00e3o Preto SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8133-6723","authenticated-orcid":false,"given":"Andr\u00e9 Brooking","family":"Negr\u00e3o","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Instituto Perdizes, Departamento de Psiquiatra, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6750-6477","authenticated-orcid":false,"given":"Carlos Maur\u00edcio Oliveira","family":"Almeida","sequence":"additional","affiliation":[{"name":"Universidade Estadual do Amazonas, Curso de Medicina, Disciplina de Neurologia e Neurocirurgia, Manaus AM, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8877-2790","authenticated-orcid":false,"given":"Cl\u00e9lia Maria Ribeiro","family":"Franco","sequence":"additional","affiliation":[{"name":"Universidade Federal de Pernambuco, Servi\u00e7o de Neurologia, Hospital das Cl\u00ednicas, EBSERH. Recife PE, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0411-0111","authenticated-orcid":false,"given":"Gabriel Natan","family":"Pires","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Departamento de Psicobiologia, S\u00e3o Paulo SP, Brazil."},{"name":"Instituto do Sono, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6223-0931","authenticated-orcid":false,"given":"L\u00edvia Leite Go\u00e9s","family":"Gita\u00ed","sequence":"additional","affiliation":[{"name":"Universidade Federal de Alagoas, Faculdade de Medicina, Macei\u00f3 AL, Brazil."},{"name":"Centro Universit\u00e1rio CESMAC, Macei\u00f3 AL, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9619-6551","authenticated-orcid":false,"given":"Manoel 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