Benzos - Safe Tapering

[plecosaur]

Benzodiazepines are a class of medication that has somewhat torrid history regarding past use and current use of the class of medication.  Many pdocs are unwilling to prescribe a benzo to current patients, because alternative treatments are available that may keep your anxiety under control, or they do not want to risk addiction issues with their patient, or benzos are not indicated for their type of anxiety or prior history (which could include drug abuse).

Not everyone develops a dependency to benzodiazepines.  Many people can stop taking them and are just fine.  If you only take your benzo on an as-needed basis, or you are on a low dose, you should be able to stop taking your benzo with no problems whatsoever.  Psychiatrists and patients may argue the particulars of addiction, tolerence, and dependency but some clear facts are true regardless of what you or your pdoc may or may not think.

1) You will gain tolerence to your benzo.  This is different than dependency or addiction.  Everyone will gain a tolerence to most medications, for most people this will stop at a reasonable level and one can stay on this dose for years.  For some people tolerence continues to rise, and this indicates that benzodiazepine usage is not an optimal solution for them.

2) You may become addicted to your benzo.  This is a risk you take when you decide to take this class of medication, you should know the possible risks involved and how to come a benzo properly before commiting to the use of a benzo in your treatment plan.

There are reasons why there is a warning on the bottle telling you to not stop taking your medicine without talking to your doctor.  Sudden discontinuation of benzos, esp. if you have taken them for a long time and at a high dosage, can cause seizures and other withdrawl symptoms (your withdrawal symptoms mainly would consist of those that you were treating with the benzo in the first place). But withdrawal symptoms may also include: poor concentration, insomnia, confusion, decreased appetite, diarrhea, blurred vision, numbness or tingling, headache, Lack of coordination, perspiration, lack of energy, muscle aches, cramping or twitching (i.e. shaking hands).

 

To avoid these nasty things... Taper off the medicine.

If you have a substance abuse problem along with addiction with your benzo, then please check the Substance Abuse board here for further help with that aspect.

If you have stima problems with your addiction or possible addiction to a benzodiazepine, please mention it.  Or anything relating to the issue of addiction in general, feel free to relate here (as it relates), or in the Substance Abuse forum.

Please note, that some people advocate only tapering off xanax (alprazolam) with xanax, due to some differing action in the striatum from alprazolam, but I, personally, do not subscribe to that unless you are on high daily dose of xanax (higher than 6mg) -- other moderators may agree or disagree with this opinion and recommend a discontinuation solely on xanax.

As a general guideline to reduce your dose, set a goal of one to two weeks as a reduction period for each of your dose reductions.  Reduce your doses in this order, morning dose first, 1-2 weeks wait, afternoon dose (if present) 1-2 weeks, and then finally reduce your night dose and wait another 1-2 weeks, before continuing this reduction cycle.  Your withdrawal will be the worst at night when you need sleep, and a night of insomnia, makes withdrawal that much more difficult  -- so remember, reduce morning and afternoon before night dose.  You want to reduce your dosage in the amount you feel comfortable with.  For some people this will be the lowest possible a mount, requiring you to split the smallest pill sizes, or even quartering them.  For other people, especially those on higher doses, they may find they can reduce their dose by larger amounts in the beginning before having real withdrawal problems.  Regarding your benzodiazepine you are withdrawing from, it is much easier to switch over to an equivelent amount of valium (diazepam) and taper down from that drug.  Some people find it more comfortable to do the first one or two dose reductions on their current drug -- if this is you, then do so.  Dosing reduction can become more complicated as the situation dictates, but valium eases the side effects you will encounter, and the half-life of the drug is extremely long, letting it stay in your system much longer than alprazolam or lorazepam.

For a sample of dose reduction on xanax, 6mg a day, here is what I would do, and I believe it is fairly similar (or the same to the Ashton manual). Due to the drug being xanax, I'd switch the night doses to valium first with concurrent reduction of overall benzodiazepine usage, before reducing morning and then afternoon doses. I would use a similar schedule for any benzodiazepine, unless you are taking a diazepine for sleep which would require dose reduction, along with a switch to a different sleep aid.

X will stand for Xanax. V will stand for valium. AM, Noon and PM are used as dosing times.

Week 1 - 1mgX AM, 1mgX Noon, .5mgX & 10mgV

Week 2 - 1mgX AM, 1mgX Noon, 10mgV PM

Week 3 - .5mgX 10mgV AM, 1mgX Noon, 10mgV PM

Week 4 - 10mgV AM, 1mgX Noon, 10mgV PM

Week 5 - 10mgV AM, .5mgX 10mgV Noon, 10mgV PM

Week 6 - 10mgV AM, 10mgV Noon, 10mgV PM

At this point we're completely off xanax and taking valium. Some might point out that the above schedule is aggressive with the xanax reduction, and if it is for you, then by all means modify it so the xanax/valium ratios occur at a more moderate rate.

Valium in most contries in available in 2mg, 5mg, and 10mg pills. So you can titrate down by 1mg, but unless you feel extremely addicted, a titrate of the valium down in steps of 2mg works well at this point. Now that we are on a long-half life drug, we can eliminate the afternoon dose as the next goal, this is not as hard as you are thinking, as there is overlap between your AM and PM doses with the noon dose. If you don't like this idea you can reduce morning, afternoon, and night, by 2mg, and continue by that schedule, but what I list and advocate is what I find to be the easiest route.

Week 7 - 10mgV AM, 8mgV Noon, 10mgV PM

Week 8 - 10mgV AM, 6mgV Noon, 10mgV PM

Week 9 - 10mgV AM, 4mgV Noon, 10mgV PM

Week 10 - 10mgV AM, 2mgV Noon, 10mgV PM

Week 11 - 10mgV AM, 10mgV PM

Now we have no afternoon dose of medication. You may or may not be scared at this point, you probably are, but often times you won't even miss that dose (other than craving, etc.), and if you are having bad withdrawal at this point, then take a break, take more than 2 weeks, take 3 or 4 on this current dose until you feel strong enough to go lower. Remember all the taper guidelines I've listed are at 1 week schedules, you can always take 2 weeks at each stage, or even a month if you feel it is that necessary.

Week 12 - 8mgV AM, 10mgV PM

Week 13 - 8mgV AM, 8mgV PM

Week 14 - 6mgV AM, 8mg V PM

Week 15 - 6mgV AM, 6mgV PM

Week 16 - 4mgV AM, 4mgV PM

Week 17 - 2mgV AM, 4mgV PM

Week 18 - 1mgV AM, 2mgV PM

Week 19 - 1mgV PM

Week 20 - Nothing.

To help you along in this process, it is best to tell your pdoc that you are doing this, and have their support along with required prescriptions of multiple pill sizes that you will be using for dose reduction.  Having them available to call to deal with any transient withdrawal symptoms may also help and they in some cases may prescrbe things that could help for some withdrawal symptoms (such as muscle pain & stiffness, severe insomnia, fast heart rate, etc.).

For futher reading, please refer to these articles on Crazy Meds.

Benzodiazepines

How to Discontinue Medication

Benzodiazepines: How They Work and How To Withdraw

Please note that the above site, is chock full of good information, none of which I can off-hand disagree with.  It is pro for the continued non-use of benzodiazepines, of which moderators of this forum are not for (if a medication helps you, then it helps you and your problem, end of story.), but for withdrawal information and taper schedules, it is a great resource.

(BENZO MODS PIPE IN HERE IF SOMETHING I SAY GOES AGAINST WHAT YOU THINK!) -- so we can make this multi-mod based, and not entirely my opinion after the source material, unless only certain parts you feel need to be changed/edited/removed.

Please note: That much of the original source material (and yes writing) is from a post on the old board from a former member donnareed.  We as moderators would like to thank her for original post, and I as a person would like to apologize for mangling your easy to read language.

[chimpmaster]

Excellent work Pleco.

Just one comment.

My p-doc has recently advised me that new studies are consistently showing that there are 2 types of tolerance to benzodiazepenes.

1) Tolerance to the solomnent effect.  This is the effect that makes you feel tired and kind of bombed and druggy.  It helps you sleep and a lot of people like benzos for this effect. 

2) Tolerance to the anti-anxiety effects.

Studies are demonstrating that tolerance to (1) builds up MUCH faster than tolerance to (2) - in fact, its quite possible that you may build up tolerance to (1) in a few weeks, but tolerance to (2) can take years.

This is the benzo trap.  When you start feeling like you take the pill and it doesnt give you the former effect, you up the dose to get it, ending up in a spiral of increased tolerance and increased dosage, when in reality, the anti-anxiety effects are still in place.

So my advice is, where possible stick with the dose that started working out for you fairly early on.  Increasing it significantly as a result of (1) will lead to increased dependence and complexity.

Note that this information applies to all benzos other than xanax, which is indeed different, and applied more consistently to longer acting benzos like diazepam and clonozepam.

[StrungOutOnLife]

I just realized this wasn't pinned.

Idiotic, I know, but I just noticed. It was at the bottom, too. Good thing we only have one page at this point.

[HaloGirl66]

I just realized this wasn't pinned.

Idiotic, I know, but I just noticed. It was at the bottom, too. Good thing we only have one page at this point.

<{POST_SNAPBACK}>

It's pinned now, thanks for pointing that out!

[StrungOutOnLife]

I just realized this wasn't pinned.

Idiotic, I know, but I just noticed. It was at the bottom, too. Good thing we only have one page at this point.

<{POST_SNAPBACK}>

It's pinned now, thanks for pointing that out!

<{POST_SNAPBACK}>

You're welcome.

[pricklefoot]

Noticed that, in their infinite wisdom, the federal gov't won't allow any benzo-class meds to be part of the upcoming Medicare part D prescription drug benefit:

This AP story explains the sad details.

Which means that this thread may see an uptick in hits as people look for safe tapering. Having done clonazepam taper in both safe and sudden modes, it's not a pretty picture.

Basically, the wise docs (not) in Congress decided that benzos were addictive, and addiction is bad, and Medicaid may pay for benzos, so the legislators can look all "War on Drugs" by banning them from Medicare part D.

[dixie]

I was CT off a 5 year benzo use 3 years ago and I still suffer so much and not able to function. My liver still hurts and all the tests come back normal but not able to do much of anything and still cannot leave the house or talk to anyone.

I have thought about taking something anything but the hair falling out and skin coming off after I was CT off was enough to make me not touch another poison to help this.

at 42 my life is over as I knew it. my hair is still coming out in hand fulls and the rashes all over and the itch is horrific to say the least.

Help me anyone.....I am so alone and not one friggen doc believes this can be this prolonged.

[midnightman]

I think it may be important to just add that tapers should be viewed as a longer-term solution to getting off of benzo's or to lower the daily dose needed / taken. I've tapered back a couple times not with the point being to get off of them completely, but to lower my tolerance temporarily so the dose I was used to could be more effective.

Sometimes people will try to taper way too quickly due to issues like not being able to get another prescription, etc, and I think those who are in that situation need to be much more wary. Tapers are not meant to take you from a maintenance benzo dose to nothing in a short period of time, so if anybody is reading this thread in an effort to do something along those lines, please don't!!!! Even if you've been taking the medication at a higher dose than prescribed, it's not worth the pain & possible complications to try to taper too rapidly on your own. Please be very cautious if you've been on any benzo for an extended period of time & are trying to lower the dose!!!!