Insomnia
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).
- 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 | |
| Insomnia | First-line for insomnia: interventions based on cognitive-behavioural approaches for insomnia (CBT-I). |
| Severe symptoms | A rapid-acting anxiolytic or sedative-hypnotic may be considered for a short duration, as an add-on to first-line treatment, when symptoms are severe (major impairment of social, work, or family function, or significant psychological distress). |
| Maintenance | Do not use a benzodiazepine as first-line maintenance treatment for insomnia. |
| 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 |
| Discouraged start | |
| Situations | Benzodiazepine initiation is discouraged if: close follow-up is not possible; geriatric profile; high fall risk; untreated OSA-hypopnea; severe respiratory conditions; taking opioids; neurocognitive disorder; myasthenia gravis; angle-closure glaucoma; tasks that need mental alertness or fine motor coordination (for example driving); current or past dependence, abuse, or substance use disorder. |
| Combinations | Avoid combining a benzodiazepine, Z-drugs, and opioids (deep sedation, respiratory depression, coma, death). If absolutely necessary: minimize dose and duration, and monitor closely. |
| Vulnerability | |
| Adverse effects | Higher adverse-effect risk: advanced age; respiratory comorbidity; renal or hepatic insufficiency; other sedatives or CNS depressants. |
| Misuse | Misuse or benzodiazepine use-disorder risk factors: current or past (or family) dependence, abuse, or substance use disorder; age 16 to 45; psychiatric comorbidity (notably anxiety disorders); traumatic life experiences. |
| 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.