Benzodiazepine Withdrawal - Methods

~ An introduction to tapering

The goal of any benzodiazepine withdrawal method is to slowly decrease benzo intake so as to avoid shocking the body. Whatever method you choose to use, it should allow you to taper off your benzodiazepine medications gently, tapering at a rate no faster than your brain is capable of recovering. It should also allow for flexibility, so you are in control of your medication. All of the withdrawal methods we actively support have these two core principles in common. We realize that there are other methods which members may use and discussion concerning these methods is acceptable within the Community. After all, it is your taper!

Taking control is the first step to recovery. If your doctor is forcing you to quit faster than you can cope with, we suggest that you consult with another doctor - this is your right! Being forced to taper faster than you can comfortably manage is both barbaric and unethical.

Within benzo circles, it is generally accepted that it is reasonable to reduce your benzos by about 10% of your dose every 1-2 weeks. However, this is only a rough guide. Some can manage much faster tapers, but there are also those who must taper much more slowly. There is no way to know how fast you will be able to taper at the outset. There is anecdotal evidence which suggests that the higher your dose when beginning to taper and the longer you have been regularly taking a benzodiazepine, the greater the chance that you will need to follow a more modest taper schedule.

So how do you know how fast to taper off? - Trial and error is the only way. As previously mentioned, it is generally accepted that when beginning a taper, one initially try a cut of about 10% of your current daily dose. You should continue with this new dosage for about 1-2 weeks. If you feel well, you might consider a larger cut the second time around. However, if you have experienced anything more than the very mildest of withdrawal symptoms, we would strongly caution against an increase in the speed of your taper. Listen to your body; if you have reacted badly to a cut, then you have cut by more than you can manage. You should think about making smaller cuts and perhaps giving yourself more time between them.

Gradual reduction involves two considerations: (1) How much will you reduce (cut) your daily dose of pills, and (2) how often will you make these cuts. It is fair to say that frequent, small reductions in your medication are more manageable than fewer, larger reductions. The two different paths might take the same amount of time to complete, but the smaller cuts approach will probably result in your having a much easier time withdrawing from benzodiazepines.

We recommend that you keep a diary of your taper. Generally, our memories are quite poor while taking benzos, and can be even worse during withdrawal. Should problems occur during your withdrawal process, you can refer to your diary and note any changes you have made in things like diet, food supplements, or medications. Please note: We have noticed that antibiotics in the quinolone family can severely escalate withdrawal symptoms in some people. We have also found that caffeine, sugar, and alcohol can be problematic for some during a benzo taper. Additionally, taking benzos with or without food can markedly change how benzos are absorbed. You should continue to take your benzo meds with or without food, as is applicable to your routine, throughout your withdrawal.

We have developed what we call the "Stepping-off" tables as an aid to tapering benzodiazepines. "Stepping-Off" is a guide or starting point that you can adjust to suit your needs. It alleviates the need for you to perform mathematical calculations when planning your taper. The Stepping-Off tables provide an easy reference to the most common tablet sizes, as well as the most common cuts used during a benzodiazepine taper. You will find an explanation of how to use the "Stepping-Off" tables on the Tables page.

The Direct Method

~ Keeping it simple

The "Direct" method is the simplest method and is at the heart of all withdrawal methods. When using the Direct method, you will taper off your present benzodiazepine by slowly reducing the amount you take. This is done by splitting the tablets into halves, quarters, or even smaller amounts. It can be tricky to determine by how many fractions of tablets you should be reducing by in order to achieve your desired cut. With this in mind, we have prepared tables that will help you easily determine your cuts. If you should choose to follow our "Stepping-Off" program, you will not have to make any calculations, as the reduction in your benzodiazepine dosage will be given as the number of tablets, and not figured in milligrams.

Benzodiazepines come in a variety of sizes. As you go lower in your daily dose, you should obtain the smallest dosage available in your particular benzo. When should you get the smaller dosage tablets? If you need to break your tablets into pieces smaller than you can practically manage to achieve your desired cut, it is time to get a prescription for those smaller dosage benzos. This will allow you to easily make smaller cuts to your dose. We provide a conversion table to help you switch between different strength tablets.

Please go to the Direct Method page for detailed help and instructions.

The Substitution Method

~ Crossing over to Valium

This method is actually much the same as the direct taper, with one important difference - you will be replacing one benzodiazepine with another. You will slowly switch to an alternative benzo. Most will substitute at the beginning of their taper, but you can switch-over at any point. Valium is the benzo most commonly used in substitution. There are two main reasons for this. Firstly, Valium has a long half-life. The amount of active Valium in your system does not drop much between doses; this helps to keep things on an even keel as you taper off, and can help smooth the way when making cuts in your dose. Secondly, it comes in relatively large, but low potency tablets, which enables you to make small cuts in your overall dose.

You should switch only a small fraction of your daily dose at a time. Although it is possible to taper at the same time as substituting, things can become tricky very quickly. It is important to understand that some benzos are much stronger than others; some being as much as twenty times more potent than Valium. We have provided equivalency tables to try to help you decide how much Valium is equivalent to your present benzo dose. Please note, however, that what is a true equivalent dose is hotly disputed. An equivalent benzo dose is accepted as an average or approximate figure. Individuals vary enormously in how they react to benzos. Two people taking the same dose of the same benzo can expect to have very different blood concentrations.

Keeping a diary will be especially important when using the substitution method. By tracking how you are faring during the process, you will be able to better judge what will be an equivalent dose for you. We would strongly advise that you keep your doctor (or other healthcare professional) well informed during your switch-over.

Switching to Valium can be very useful for those who find making even modest cuts very difficult. This method is often used successfully by those who have failed at a direct taper in the past. Sometimes, however, the switch itself can be hard to accomplish. Some breeze through it, while others suffer terribly. Perhaps this method can be used as a back-up plan? The choice about whether or not to attempt a switch-over is entirely in your hands.

A special note about Clonazepam (Klonopin, Rivotril): Occasionally, doctors will attempt to switch a patient to Clonazepam in the belief that it will be easier to taper off of because it has a relatively long half-life. Clonazepam is a very potent benzo and does not come in an equivalent dose anywhere near as small as the 2mg tablets of Valium. Clonazepam tablets are very small and therefore difficult to cut. Research indicates that Clonazepam binds very tightly to benzo receptors and can be slow to leave; this could possibly lead to protracted withdrawal symptoms. Professor Ashton has found that Valium has helped those who were previously taking Clonazepam. Valium competes to attach to GABA receptors and actually helps to dislodge the Clonazepam. Valium, itself, does not possess similar tight binding to GABA receptors.

Please go to the Substitution Method page for detailed help and instructions.

The Titration Method

~ Liquid benzos!

For our purposes, titration is the mixing of a dose of benzodiazepine in a measured amount of water and making small (sometimes daily) cuts to your dose. When using this method, the hope is that your brain will gently adjust to the tiny cuts you will be making in your benzo dose. For sensitivie individuals, this method can assist you in making a slow and tolerable taper, as users of this method typically report fewer or less intense withdrawal symtpoms.

A brief overview of this method is as follows: You crush your benzo tablet into a powder and mix it with water. The tablet will not dissolve, but with the help of a small blender, the minute pieces will be suspended evenly in the liquid. You would then remove a measured amount of the mixture in order to "cut" your dose.

For example, if you think you can taper in three months, you convert the time into days. For each day it will take you to taper, in this example the number of days will be 90, you will use 1 millilitre (ml.) of water. On day one of your titration, you will fill a cylinder (which is marked in millilitres) with the amount of water that coincides with the number of days you have chosen; using our example, the amount of water would be 90 milliliters. This will be the amount of water you will start with every day of your taper. On the first day, you will pour this measured amount of water into a small blender along with your dose of crushed benzodiazepine. After blending, you will remove 1 ml. of the mixture with a dropper and drink the remaining amount. On the second day, you will remove 2 ml. of mixture and drink the remaining amount. You will continue in this manner and remove one additional millilitre of mixture each day until you have finished your taper.

You should attempt to stabilize as much as possible before you begin titrating. If you become symptomatic during the titration process, you should hold for a few days at the same dose and attempt to stabilize. Remeber, you can always recalculate the days/milliliters you should be using if you decide more time is needed for your taper due to holding.

Please go to the Titration Method page for detailed help and instructions.

The Compounding Method

~ Making your own pills

When your prescription is "compounded" by a Compounding Pharmacist, your medication is formulated to precise specifications from raw ingredients. This allows for complete control of your dosage. While many doctors are willing to write such a prescription for you, these compounded formulations can be more expensive than an ordinary prescription. In addition, you are stuck with a fixed strength capsule which does not give you the flexibility that could be achieved with a compounded benzo. A compounded benzo prescription can be useful, but is not always the full solution for those looking to gain greater control over their dose. You can instead "compound" your own capsules using standard benzodiazepine tablets.

Compounding offers two major advantages over titration. Because you will be dealing with dry ingredients, you can prepare doses for many days in advance, while it unadvisable to keep titrated benzos for more than a day or two. Compounded benzos also give you the freedom of taking your meds away from home. The one disadvantage is the purchasing of scales accurate enough for compounding. Both titration and compounding offer similar amounts of control over your taper; they both allow you to make cuts of 1%, or smaller. This is not possible by merely splitting pills.

The basic idea behind compounding your own benzos is to grind your tablets for a set number of doses into powder. You then bulk this powdered benzodiazepine with a neutral filler, such as lactose. It is much easier to divide and measure a relatively large amount of powder (as compared to the original tablets), allowing you greater control over your dosage. You can easily remove and dispose of a small amount of your compounded benzo, which would represent the cut you would like to make. For each 1% reduction your make to the whole benzo powder, there will be a corresponding 1% reduction with each dose.You will divide the remaining powder into the same number of doses you began with to achieve your needed doses.

You will need the following equipment:

• A pestle and mortar (If necessary, you could simply crush your tablets with back of a spoon.)
• Electronic scales which are accurate to at least 0.1 grams
• A bulking agent (lactose, sugar, or granulated Splenda)

Please go to the Compounding Method page for detailed help and instructions.

The Cold Turkey Method

~ No method in this madness!

It is a bit of a stretch to refer to this as a "method", but some may decide to quit "Cold Turkey". Dropping your entire dose in one go is usually an act of desperation. We will keep reiterating this advice because it is so important - quitting cold turkey can have life-threatening consequences! Instead of feeling better faster, you are more likely to suffer severe withdrawal symptoms for weeks, and you may continue to suffer some level of symptoms for perhaps months or even possibly years afterwards. We would always advise you in the strongest possible terms - do not quit your benzos cold turkey.