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How to Safely Taper Off Benzodiazepines

To safely taper off benzodiazepines, follow a doctor-prescribed tapering schedule in which you will gradually lower your dose of a long-acting benzodiazepine over a period of weeks to months.

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On average, it takes 15 weeks to safely taper off benzodiazepines.

How Benzodiazepines Work 

Benzodiazepines are sedatives that are commonly used to treat anxiety, panic attacks, and seizure disorders. These drugs work by enhancing the activity of the neurotransmitter gamma-aminobutyric acid (GABA), which causes a decline in the activity of the central nervous system. The result is a calming effect that can provide relief from any condition that causes muscular or nervous system tension, such as anxiety. 

However, these drugs can be habit-forming and may also cause side effects. It is ideal to taper off benzodiazepines, particularly if you have been taking them for more than three days and/or in high doses.

Benzodiazepine Tapering Guidelines & Schedule

According to the National Center for Post-Traumatic Stress Disorder, the following tapering guidelines and schedule should be used in order to prevent withdrawal symptoms and severe side effects associated with an immediate cessation of benzodiazepines. 

Milestone RecommendationsActionDosage
Week 135 mg/day
Week 2Decrease dose by 25%30 mg/day (25%)
Week 325 mg/day
Week 4Decrease dose by 25%20 mg/day
Week 5–8Hold dose for 1–2 monthsContinue 20 mg/day for 1–2 months
Week 9–1015 mg/day
Week 11–12Decrease dose by 25% by week 1110 mg/day
Week 13–14Decrease dose by 25% by week 135 mg/day
Week 15Discontinue use

Dangers of Tapering Off Benzodiazepines Incorrectly

Ensure that you adhere to the specific recommendations of your doctor when tapering off benzodiazepines. A failure to do so can present some risks. 

Some of the dangers and risks that have been identified when tapering off benzodiazepines incorrectly or too quickly include the following:

  • Symptoms of withdrawal, such as shakiness, nervousness, sleeplessness, irritability, and increased tension
  • Suicidal ideation and self-harming behaviors
  • Panic attacks
  • Weight loss
  • Headaches
  • Difficulty concentrating
  • A failure to discontinue usage
  • Seizures
  • Relapse

Withdrawal Symptoms & Why They Occur

Withdrawal symptoms are unpleasant physical reactions that occur within the body following the cessation of a drug for which a physiological dependence has developed. These symptoms occur because the body has grown accustomed to the presence of a foreign chemical in the body and adapted to this presence at the cellular level. 

The consumption of benzodiazepines impacts the brain’s dopaminergic reward system and influences the production and uptake of neurotransmitters like GABA. The sudden discontinuation of this drug disrupts the homeostasis that has been established through prolonged use. Time is needed before it can achieve a sense of balance again.  

The following withdrawal symptoms have been reported with benzodiazepine discontinuation:

  • Appetite changes
  • Nausea 
  • Depression
  • Anxiety
  • Chills and shivering
  • Fatigue
  • Sleep disturbance 
  • Restlessness
  • Shakiness
  • Irritability
  • Changes in mood
  • Sweating
  • Tremors

Can Properly Tapering Off Benzodiazepines Help With Withdrawal Symptoms?

It may not always be possible to completely avoid symptoms of withdrawal when discontinuing the use of benzodiazepines, particularly if you have been using high doses or taking them for extended periods of time, such as more than four weeks. However, you can avoid and/or reduce the severity of many of these symptoms if you adhere to a proper tapering schedule. 

Tapering is not just important because of the physiological dependence that has developed with extended use, but also due to the psychological difficulty of managing a dopaminergic reward system that has been significantly impacted. Over time, through cessation of use, the brain will achieve homeostasis in regard to its balance of neurotransmitters. But initially, the depression and anxiety that can result from withdrawal can be unbearable for many people. 

Withdrawing gradually according to a tapering schedule can help to reduce the severity of both psychological and physical aspects of dependence. 

Why Is Medical Supervision Needed for Benzodiazepine Tapering?

Medical supervision is critical when tapering off benzodiazepines. This supervision is necessary to monitor your dosage and its impacts on your central nervous system. Since some symptoms of benzodiazepine can be dangerous, medical supervision is essential to keep you safe. 

With medical supervision, symptom relief can be provided, so you are more comfortable throughout the withdrawal process. When symptoms are controlled, the urge to relapse is mitigated. 

Medical supervision also enables practitioners to modify the dosage based on your specific reactions, and additional support can be provided based on how the tapering schedule is working. 

If considering benzodiazepines or discontinuing their use, make sure to speak with your health care provider first and to establish a tapering schedule that is customized to your specific needs and circumstances. You should never attempt to quit benzodiazepine use suddenly on your own. Doing so is not safe.

Updated October 31, 2023
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