Clinical Institute Withdrawal Assessment Scale-Benzodiazepines (CIWA-B)

Evaluates the severity of benzodiazepine withdrawal.

Clinical Observations

Behavior (restlessness, agitation)

Select 1 or 3 when the patient’s symptoms fall between the adjacent anchor descriptions, with higher scores reflecting greater severity.

Tremor

Sweating

For each symptom, select the severity level that best applies to the patient at the time of evaluation.

Do you feel irritable?

Do you feel fatigued?

Do you feel tense?

Have you noticed any difficulty concentrating?

Do you have any loss of appetite?

Do you have any numbness or burning on your face, hands, or feet?

Do you feel your heart racing (palpitations)?

Does your head feel full or achy?

Do you have any muscle aches or stiffness?

Do you feel anxious, nervous, or jittery?

Do you feel upset?

How restful was your sleep last night?

Do you feel weak?

Do you think you didn’t get enough sleep last night?

Do you have any visual disturbances (sensitivity to light, blurred vision)?

Are you fearful?

Have you been worrying about possible misfortunes lately?

Result:

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Advice

Use scores to guide the intensity and pace of benzodiazepine tapering alongside clinical judgment.
Serial trending of scores is often more clinically meaningful than any single assessment.

Management

We are not aware of any validated symptom-triggered dosing algorithms based on this tool; scores can indicate symptom severity, which may guide benzodiazepine selection, route, dosing, and frequency, as well as the need for alternative therapy (e.g., phenobarbital).
All patients with benzodiazepine withdrawal should receive:
- Supportive care (e.g., IV fluids, antiemetics, airway management, oxygen and suctioning as needed).
- Cardiac monitoring.
- Seizure precautions.
- Frequent vital signs and neurologic status exams.

Critical Actions

Patients with seizures or status epilepticus should receive appropriate benzodiazepine therapy immediately, regardless of prior CIWA-B scoring.