Slow vs. Standard Taper — PROS AND CONS?

Hi Everyone,

And finally, my last thread for today! Thanks ONCE AGAIN for your awesome patience and support.

Will you all offer the pros an cons of a standard taper (5-10% every 14 days) versus a slower taper (5-10% per month)? As noted in the other thread, I have a very supportive physician and will prescribe as long as I need to taper at my own speed. My priorities are:

1. Limited symptoms during the taper (I’ve only only mild symptoms tapering 3% this week); and

2. Limiting my risk for protracted symptoms when I VERY slowly walk off K at the end of the taper. This is my NUMBER ONE priority and will do what it takes to get there.

So, any suggestions, input, advice, criticism, etc. would be greatly appreciated! Thank you all!

Let me begin by saying I’m delighted you have a supportive physician - you are very fortunate. I also want to be clear that the following is my personal opinion.

Re: your request for pros/cons of the two taper rates you identified, my response is “It depends on the individual.”

If you are tapering at a rate of 3% with mild (i.e. tolerable) withdrawal symptoms then you have your answer ... for you ... for this week. (As I’m sure you’ve read here on the forum, it is not uncommon for members to adjust their taper rates throughout their tapers.)

Re: your implied question about minimizing the risk of protracted symptoms ...

In the absence of high-quality and robust empirical evidence for each of the different benzodiazepines, we simply do not know what could/should be done to minimize risk for protracted symptoms. 

If anyone claims otherwise, ask them to provide you with the citations and quality ratings (e.g. the guideline-based ratings Cochran Review uses to evaluate the quality of health evidence) for each and every piece of evidence they are using to support their claim.

Will you all offer the pros an cons of a standard taper (5-10% every 14 days) versus a slower taper (5-10% per month)? As noted in the other thread, I have a very supportive physician and will prescribe as long as I need to taper at my own speed.

My priorities are:

1. Limited symptoms during the taper (I’ve only only mild symptoms tapering 3% this week); and

2. Limiting my risk for protracted symptoms when I VERY slowly walk off K at the end of the taper. This is my NUMBER ONE priority and will do what it takes to get there.

 

So, any suggestions, input, advice, criticism, etc. would be greatly appreciated! Thank you all!

pan,  see the above bold lettering.  Your plan is very well thought out. 

Standard or slow - I'm sure you'll choose which is best for you.

If anyone claims otherwise, ask them to provide you with the citations and quality ratings (e.g. the guideline-based ratings Cochran Review uses to evaluate the quality of health evidence) for each and every piece of evidence they are using to support their claim.

Are there any guideline-based ratings Cochran Review uses to evaluate the quality of health evidence regarding Benzos and tapering? 

I am asking because I don't know.  It seems to me that there is a serious lack of studies on benzos and tapering. 

thanks

Are there any guideline-based ratings Cochran Review uses to evaluate the quality of health evidence regarding Benzos and tapering? 

Excellent question! I just conducted a quick search and found the following:

Medications for discontinuation of long-term benzodiazepine use | Cochrane

https://www.cochrane.org/CD011481/ADDICTN_medications-discontinuation-long-term-benzodiazepine-use

Quoting directly from the above review (evidence is current to October 2017):

This review aimed to assess the effect and safety of medications to facilitate benzodiazepine discontinuation in chronic benzodiazepine users.

The quality of the evidence was generally low or very low due to the small number of trials including a limited number of participants for each comparison; dissimilar results across studies; poor study design; and pronounced financial involvement of the pharmaceutical industry. Randomised controlled trials are therefore needed without risk of bias and random significant results involving long-term assessments of participants conducted without involvement of industry.

Given the low or very low quality of the evidence for the reported outcomes, and the small number of trials identified with a limited number of participants for each comparison, it is not possible to draw firm conclusions regarding pharmacological interventions to facilitate benzodiazepine discontinuation in chronic benzodiazepine users. Due to poor reporting, adverse events could not be reliably assessed across trials. More randomised controlled trials are required with less risk of systematic errors ('bias') and of random errors ('play of chance') and better and full reporting of patient-centred and long-term clinical outcomes. Such trials ought to be conducted independently of industry involvement.