Do you have any references about using a benzodiazepine antagonist like flumazenil for benzodiazepine withdrawal? Because of the risky nature of even cold turkey benzodiazepine withdrawal, I cannot imagine a procedure equivalent to UROD with opiates where an antagonist is administered. Even using an NMDA antagonist like ketamine will likely not completely abolish all proconvulsant activity associated with this. Other proconvulsants like picrotoxin, PTZ and lidocaine (yes, in large doses lidocaine has proconvulsant activity) do not lose all of their activity when the NMDA receptor is blocked with a strong irreversible NMDA antagonist like ketamine or MK-801, although their seizure threshold does decrease.
It is also important to consider that inverse agonists like RO19-4603 exist for the omega (BZD) receptors. An inverse agonist causes the abstinence syndrome to occur even when there is no agonist around. The way pharmacologists have putatively accounted for this is by noting that receptors that have inverse agonists have an essential underlying basal level of activity, so a standard antagonist would appear to act like an inverse agonist, and a partial agonist would appear like an antagonist; thus flumazenil is likely a partial agonist at the omega receptor, having enough intrinsic activity that when it binds to the receptor, it stimulates it and then stays bound, blocking additional transduction until it dissociates from the receptor.
While I have used ketamine during opiate withdrawals very successfully to completely stop the withdrawal syndrome (except for their short duration of action, they would be ideal), I would expect it to help ameliorate benzodiazepine withdrawals, but I would still be concerned about seizures.
Clonazepam is a very good choice to use to taper off of benzodiazepines. Not only is it a benzodiazepine agonist, it also has serotonergic activity, and the 5-HT1a receptor (which is the one that Buspar binds to) helps alleviate anxiety. In addition, clonazepam has a moderate elimination half-life of the parent drug, is not very euphorigenic, has a high volume of distribution and a high alpha-distribution half-life: it is in essence the methadone of benzodiazepines.
The idea that all benzodiazepines and barbiturates all substitute for one another is being rethought. I taught this concept myself up until I tried to detox myself off of a 3 year alprazolam addiction. Staple drugs like phenobarbital and clorazepate (Tranxene) are not the best medications to use when dealing with issues like depression and rebound anxiety or panic disorder. Diazepam, which has a long half-life and a primary metabolite, desmethyldiazepam, whose elimination half-life is around 72 hours, may work well for patients who have GAD (Generalized Anxiety Disorder), but not for those who have had panic disorder. Plus Valium (diazepam) is one of the most euphorigenic benzodiazepines available. Clonazepam appears to be a good first line drug for benzodiazepine detox, and depending on the level of length of dependence, can be decreased slowly with a 20-25% decrease being well tolerated once a patient is stabilized at a given dose.
MobiusDick