Anxiety
The INESSS outil of 2 Oct 2026 is a usage-optimal tool for a first benzodiazepine prescription, not a GUO or a PMN. It does not apply to someone already taking a benzodiazepine.
Treat
Open the outil PDF for molecule choice and the milligram tables (annex III). The full list of situations where starting a benzodiazepine is discouraged is on Insomnia.
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Scope | |
| Who | Adults not currently taking a benzodiazepine, when considering a first benzodiazepine prescription for insomnia or an anxiety disorder. INESSS répertoire opens in a new tabINESSS outil PDF opens in a new tab |
| Exclusions | Does not apply to:pregnancy or breastfeeding; already on a benzodiazepine; critical care; palliative or end-of-life care; alcohol withdrawal; peri-procedural very short use; an acute psychiatric episode that needs a hospital stay. |
| First-line | |
| Anxiety | First-line for an anxiety disorder: interventions based on cognitive-behavioural approaches and/or antidepressants (SSRI or SNRI). |
| Severe symptoms | A rapid-acting anxiolytic may be considered short-term, as an add-on, when symptoms are severe. |
| First weeks | In an anxiety disorder, a benzodiazepine may be considered in the first weeks of care, to cover antidepressant or psychosocial onset delay and possible early anxiety worsening on an antidepressant. |
| Rapid-acting | Benzodiazepines are the only rapid-acting anxiolytics usable in severe anxiety disorders (per the outil). |
| If a benzodiazepine is chosen | |
| Stewardship | Shared decision. Choose the molecule and the dose appropriately. Prescribe the shortest possible duration (max. 4 weeks). Prefer PRN only. Plan the end of treatment from the first prescription. Avoid systematic renewals. |
| Continue | Continue first-line treatments even if a benzodiazepine is started. |
| Doses | Molecule selection, starting milligrams, and the annex III sedative-hypnotic table: open the outil PDF.
Check the live RAMQ Liste for coverage. INESSS outil PDF opens in a new tabINESSS annexes opens in a new tab |
| Already taking one | |
| Deprescribing | This outil covers a first prescription only. It does not replace deprescribing for someone already taking a benzodiazepine. CCSMH 2019 (older adults; BZRA duration, taper, and deprescribing) and CCSMH 2024 (late-life anxiety) remain in force for those scopes. |
Follow-up
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Follow-up | Follow up within 2 to 4 weeks after the first benzodiazepine prescription. |
Reviewed 5 October 2026 against the official sources below.
Sources
Blue square: Québec. The code names the body; each section's key gives its full name.