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How To Taper Off Benzodiazepines | Taper Schedules & Strategies

Published on April 6, 2021
How To Taper Off Benzodiazepines | Taper Schedules & Strategies

Benzodiazepine tapering refers to gradual dose reduction of benzodiazepines (also known as benzos or BZDs) over time, to better manage benzodiazepine withdrawal and other adverse effects.

Tapering is usually a safer method than quitting cold turkey. Several effective treatment strategies exist for benzodiazepine tapering. The strategy and schedule that works for you will depend on your specific needs.

Dose Reduction Schedules

There is no single dosing schedule that works for every patient. Each schedule has its own benefits and risks. Most schedules start with a 5% to 30% dose reduction at the beginning, before branching off into different schedules.

Short Taper Schedule

A shorter benzodiazepine taper schedule, where doses are reduced more aggressively, may mean more intense withdrawal symptoms, like seizures and mental health problems. However, a successful taper means that you will be clean of the drug sooner.

Long Taper Schedule

A longer tapering schedule, where doses are reduced more gradually, usually means less intense withdrawal symptoms. However, some studies suggest tapering schedules that last over 6 months may be worse for your health in the long-term.

Monitoring A Long-Acting Benzodiazepine Prescription

Tapering schedules may involve switching to a long-acting benzodiazepine prescription. Long-acting benzos have long half-lives, and are usually less potent in the short-term. With proper monitoring, the high abuse potential of long-acting benzos can be avoided.

Long-acting benzodiazepines that may be prescribed in place of short-acting ones include forms of diazepam and chlordiazepoxide.

Adjunctive Medications

Prescribing other medications to manage withdrawal symptoms is common in benzo tapering. These adjunctive medications can reduce or eliminate sources of discomfort, pain, and other side effects that come with the discontinuation of benzodiazepines.

Medications that may be prescribed for these reasons include:

  • carbamazepine
  • anticonvulsants (to prevent seizures in high dose withdrawal patients)
  • antidepressants (for chronic pain)
  • trazodone

Prescribers will usually not give opioids to help with withdrawal symptoms. Mixing opioids and benzodiazepines can cause additive effects, leading to an overdose.

Concurrent Cognitive Behavioral Therapy

Cognitive behavioral therapy, or CBT, can be given alongside tapering. CBT usually involves setting up healthy coping mechanisms and identifying triggers that may lead to a relapse.

CBT can tackle benzodiazepine use as a mental health problem. Benzodiazepine dependence can be caused by a benzodiazepine use disorder (BUD), where continued use of benzos comes at the cost of your health.

CBT can help you identify and fix thoughts and behaviors that are contributing to BUD. Some studies suggest that CBT combined with tapering is more effective than tapering alone. A combination of physical and mental treatments can be an effective treatment plan.

Why Is Benzodiazepine Tapering Needed?

Long-term benzodiazepine use refers to taking benzodiazepines for more than a month at a time. Long-term use usually leads to physical dependence on benzodiazepines, where your body cannot function without the drug in your system.

Physical dependence almost always causes withdrawal symptoms when you try to discontinue the drug. Benzodiazepine withdrawal can be uncomfortable and even life-threatening in some cases.

Benzodiazepine Withdrawal Symptoms

People may continue taking benzos to avoid withdrawal symptoms, which can only worsen the cycle of drug use, withdrawal, and relapse. Withdrawal symptoms can last anywhere between a few hours and a few months, and include:

  • seizures
  • rebound anxiety (greater anxiety than before use of benzodiazepines)
  • panic attacks
  • hallucinations
  • delirium
  • severe cravings

Risks Of Not Tapering Off Benzodiazepines

Benzodiazepines can have severe long-term effects beyond withdrawal. As benzos affect your central nervous system, taking them long-term may change how your brain works.

There is evidence that long-term benzodiazepine use is connected to a decline in cognition or general brain function. This change may be permanent.

Generally, your health is at higher risk if you continue taking benzos without looking for treatment.

Benzodiazepine Detoxification

Detoxing refers to the cleansing of the drug from your body.

Detoxing on your own can be dangerous, as you may not be prepared to handle withdrawal symptoms without medical supervision. An at-home or outpatient detox may also expose you to triggers that can lead to a relapse.

Detoxing is an essential part of most recovery programs. It can be safer to do an inpatient detox at a treatment center, where a detox is usually done alongside other treatments.

Benzodiazepine Addiction Treatment

There is little evidence that benzodiazepines can treat anxiety disorders and panic disorders long-term. Despite their known risks and high abuse potential, benzodiazepines continue to be prescribed long-term. Effective treatments are needed as long as substance use remains high.

Treatment programs often involve many different people working together, including psychiatrists, primary care physicians, and other medical professionals. You should also be willing to work with other peers involved in your recovery.

To learn more about the benzodiazepine treatments that can work best for you, talk to your healthcare professional or contact us today.

Written by Ark Behavioral Health Editorial Team
This page does not provide medical advice.

American Family Physician - Tapering Patients Off of Benzodiazepines - Curbside Consultation - American Family Physician
U.S. Department of Veterans Affairs - Helping Patients Taper From Benzodiazepines
U.S. Food and Drug Administration - KLONOPIN TABLETS (clonazepam)
U.S. Food and Drug Administration - LIBRIUM (CHLORDIAZEPOXIDE HYDROCHLORIDE)
U.S. Food and Drug Administration - DailyMed - VALIUM - diazepam tablet
U.S. National Library of Medicine - Lorazepam | C15H10Cl2N2O2
Vancouver Acute Pharmaceutical Sciences - COMPARISON OF BENZODIAZEPINES

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