Three Methods of Benzodiazepine Withdrawal

Direct Taper

Overview: straightforward taper by gradually reducing the number of tablets (or fractions of tablets - pill-splitting) you take per day. You should obtain the lowest dose tablet available in your particular benzodiazepine.

Advantages: simple; wide support from doctors; probably all that's required by the majority of people in the general community looking to quit benzos.

Disadvantages: many benzos are too potent to allow a smooth taper for some people (or the pills prescribed are too large in dose for successful pill-splitting); many benzos have too short a half-life to allow a smooth taper (interdose withdrawal is often a problem); can be tricky to split pills accurately.

We suggest that unless past experience of attempted tapering indicates otherwise, members should initially try cutting their dose by no more than about 10%, and will probably make new cuts (about 10% of their dose at the time of the new cut) every 7-14 days. These figures are intended as ballpark estimates - mileage will vary.

Substitution Taper

Overview: gradually reducing your dose of one benzodiazepine while, at the same time, introducing a second, more suitable benzodiazpine. Some benzodiazepines are easier to taper than others. So, switching to another benzodiazepine might aid withdrawal. You must talk to your doctor about substitution. Valium (diazepam) is usually considered the benzo-of-choice (for the purposes of substitution) of the vast majority of our members.

Advantages: switching to an equivalent dose of Valium from a short half-life benzo (this must be carried out gradually) virtually guarantees that you will experience no interdose withdrawal effects; switching from a very potent benzo to Valium allows for much smaller cuts to your dose (more frequent small cuts are better tolerated than less frequent large cuts); if you have had problems sleeping, you may benefit from the sedating effects of Valium.

Disadvantages: some planning is required with a switch to Valium; an equivalent dose must be calculated and tweaked where necessary to suit the individual; many doctors (particularly in the USA) do not support a switch to Valium; switching will likely add to the overall time taken to withdraw; a small number of people appear to not tolerate the switch to Valium very well (this sometimes might be due to the wrong equivalent dose being prescribed or a failure to tweak the dose for the individual concerned according to how they react).

Prof. Ashton achieved very good results in her clinic by switching patients to Valium. Usually, her patients had already failed to quit benzos via the Direct route. If your doctor is supportive, and willing to adjust the equivalent dose as required, you are more likely to benefit from substitution.

Titration Taper

Overview: In the context of benzodiazepine withdrawal, titration involves making ‘small enough’ reductions in dose to keep withdrawal symptoms tolerable with the goal of discontinuing the benzodiazepine. Ways to titrate one’s dose include using:

a) Manufacturer’s oral liquid

b) Compounded liquid

c) Compounded capsules and tablets (e.g. Tapering Strips*)

d) Precision scale or balance (powder weighing, pill shaving)

e) Homebrew liquid

Note: At higher doses, individuals may find it helpful to use the above dosage forms in combination with commercially available tablets.

Advantages:

- potential to improve symptom tolerability

- finer adjustments in dose

Disadvantages:

- a, b, e: require knowledge/skills to use an oral syringe properly; may require refrigeration

- d: requires precision scale or balance as well as knowledge/skills to use it properly; also may require other gear (e.g. mortar and pestle, file, razor, weighing paper, gelatin capsules)

- e: requires ‘kitchen chemistry’ knowledge/skills as well as gear (e.g. mortar and pestle, graduated cylinder, mixing and dose containers, stirring rods)

- d, e: subject to dose accuracy issues

* Available in the Netherlands and certain other countries, a tapering strip consists of custom-compounded benzodiazepine tablets, packaged in a roll of daily pouches, each with the same or slightly lower dose than the one before. To learn more visit: Tapering Strips