Author: Charles Frank

Withdrawal from long-term benzodiazepine use: randomised trial in family practice PMC

how to taper off benzodiazepines

This patient has developed numerous concerning adverse effects, including tolerance, physiologic dependence, and withdrawal. Additionally, her use of supratherapeutic doses of alprazolam poses a safety concern. Because risks of continued use outweigh any potential benefits, tapering her down and off of the medication should be discussed.

  1. If people stop these medications suddenly, withdrawal can occur, and symptoms include anxiety, panic, and insomnia.
  2. If you have been using benzodiazepines for longer than six months, suddenly stopping your dose can cause grand mal seizures and delirium—this is why it’s best to involve your doctor or healthcare professional in your withdrawal process.
  3. Several types of benzodiazepines are sold under popular brand names like Valium, Xanax, and Klonopin.
  4. Thankfully, the correction of gut function can be accelerated safely and gently.

The long-term use of benzodiazepines is highly prevalent in developed societies and is not devoid of risks. Tapering off benzodiazepines has been shown to be a good strategy for discontinuing their long-term use. Adding a standardised interview to the tapering-off schedule is five times more likely to achieve withdrawal than usual practice. One out of every three interventions is successful, with the benefit persisting at least 12 months. Protracted withdrawalsymptoms are more common than previously appreciated.8 Further research is needed to better understand how to stratify whichpatients might be at particular risk for either acute or protracted benzodiazepinewithdrawal. For short-acting benzodiazepines, such as alprazolam, rebound symptoms may appear between doses,1 which typically leads to dose escalation with temporary relief of these symptoms,4 as in this case scenario.

Funding body

Common side effects include slurred speech, memory loss, confusion, sleepiness, and increased fall risk. If people become tolerant, and as the dose is increased to get more therapeutic benefit, the side effects get worse, too. Some people even start to crave these medications and use more than prescribed or develop an addiction to them. Some patients micro-taper using a scale by removing a small amount, perhaps between 0.001 and 0.003 grams, every day or every few days. This method can initially be intimidating to many, and a few different approaches exist.

We suspect that this may be due to a genetic polymorphism type called GAD1 and GAD2. While these polymorphisms are somewhat uncommon in the general population, it does show up in people with chronic anxiety.38,40 GAD has a lot to do with how the synthesis gating of GABA and glutamate occurs. For these people, they may have to take Trileptal or Trazodone if they are considering a temporary bridge medication. When converting a benzodiazepine like Xanax over to Valium (diazepam), the milligram levels are not equivalent, and the dosing level will have to be adjusted.

how to taper off benzodiazepines

As you do each cut, starting with the first, the symptoms you go through, and the time it takes to restabilize are generally a guide for each benzodiazepine taper that is to follow. This information will help your doctor and you to get a more predictive picture of the way your body will respond to each cut. Tapering of the upper milligram levels of benzodiazepines may be somewhat uncomplicated in many, but when getting down below the halfway point, things might get more difficult. Tapering at the lower dosing levels may require elongating the time frame between tapering steps and reducing by smaller amounts each step.

If you or a loved one is struggling with substance use, such as drugs and alcohol addiction, you’re not alone. Substance use disorders and substance-related problems affect millions of people each year, but the good news is that they are treatable. If you notice any of the following symptoms, reach out to one of 7 helplines in Finland. During your taper, you may still experience some of the symptoms of withdrawal. Estimates suggest that 10 to 25% of people who take benzodiazepines for extended periods experience what’s known as protracted withdrawal. While most respondents who wrote in comments expressed difficulty and despair, afew had fully or partially positive experiences with benzodiazepine treatmentand/or discontinuation.

Withdrawal from long-term benzodiazepine use: randomised trial in family practice

People wanting or needing to stop benzodiazepines can do it with appropriate help—and it may just take a handful of visits with a trained primary care provider or mental health provider. In conclusion, these results have implications for daily clinical practice, since they show that this intervention is both effective for achieving the withdrawal of long-term benzodiazepine use, and feasible in primary care practice. Its simplicity and the limited time needed for its application mean that it is a good strategy to discontinue benzodiazepine use and that it can be easily fitted into the daily routine of most physicians. Patients in the intervention group underwent a gradual reduction of benzodiazepine dose, with control visits every 15 days. The dose was reduced between 10 and 25% of the initial dose fortnightly. Buspirone is a noncontrolled prescription medication used to treat anxiety disorders.

how to taper off benzodiazepines

Alternative to Meds Center inpatient treatment would involve many of the methods found on our services page and certain parts would be fundamentally different in approach from what we are presenting here. For those of us working in the mental health field, it may not be surprising to hear that psychological support makes a big difference. However, studies like these are important as they establish that what we do works.

To establish the efficacy of an intervention programme for reducing the chronic use of benzodiazepines. On the other end of the spectrum, quitting cold turkey provides no such safeguard — withdrawals are at their worst, even deadly. For this reason, neither at-home detoxes nor stopping cold turkey are recommended by physicians.

How Long Does Withdrawal From Benzodiazepines Last?

The results of the present study suggest that a structured intervention consisting of a standardised interview together with a tapering-off process is five times more effective for discontinuing long-term benzodiazepine use than usual practice. There is one success for every three interventions, and the benefit persists for at least 12 months. Our goal was to appraise the efficacy of a structured intervention in primary care, consisting of a brief standardised advice and a stepwise dose reduction, for discontinuing benzodiazepine use.

A small number of respondents (3.1%) had no recollectionof whether or not they were told about benzodiazepine risks. Symptoms occurred in the majority of patients, with certain symptomspersisting for a year or more (see Table 2). A total of 1682 individuals started the survey, of whom 1207 respondents wereidentified by the source system as having finished the survey, although some ofthese ‘finishers’ did not answer every question. In this article, ‘respondents’ isthe term used to describe these identified finishers. Respondents were 71% female,26% male, and 2% who preferred not to state their gender identity or had othergender identity. In fact, 55.9%took a benzodiazepine and at least one other of these drugs.

an Internet survey

This will prevent you from altering the taper, but it might mean frequent trips to the pharmacy. Protracted withdrawal is a long-term withdrawal syndrome that may come and go for several months. One problem that respondents mentioned was their difficulty in findingknowledgeable and appropriate help to manage their physiologic dependence. Over 92 million prescriptions for benzodiazepines are dispensed in the UnitedStates annually, yet little is known about the experiences of those takingand discontinuing them. Another crossover approach would be converting one-half of the medication over to Valium in one or more steps. But then instead of converting the other half, cutting only the other benzodiazepine (Ativan, Xanax, Klonopin, etc) in 10-25% increments until to are only left with Valium.

Restoring a healthy gut aids benzo tapering greatly as the symptoms from having a dysfunctional gut-brain axis can be lessened or eliminated altogether by addressing the root causes. One crossover approach would be some version of converting half or less of the medication to Valium, and then waiting to see how well that was tolerated before switching over the rest. Some people may want to switch over a smaller portion of medication first, especially those who have truly struggled and need to play it extra safe.

Why Consider Tapering vs. Stopping Benzodiazepines Cold Turkey?

Losses — always counted as treatment failures — were limited to two subjects per group, so that results per protocol and by intention to treat were similar. Subsequent follow up surgery-based consultations lasted about 10 minutes. Abstinence symptoms were monitored throughout the study in the intervention group.

An example might be, a person is taking 1.5 mg a day of Ativan split up into 3 dosings of 0.5 mg at different times of the day. Switching over one of the 0.5 mg Ativan to 5.0 mg of Valium might be a good test. If well-tolerated, the rest can be converted over possibly a two-week period in two steps.

That is after we remove conflicting drugs like the stimulants listed above. So let’s say someone is one Wellbutrin, Seroquel, Ativan, Lamictal, and gabapentin. The remaining would involve more investigation into the individual presentation but might look like Seroquel, then Lamictal, and saving gabapentin for last.