From the Guidelines
For a patient who has been taking lorazepam 0.5 mg daily for 10 days, tapering is generally not necessary to discontinue the medication. The medication can typically be stopped directly after such a short duration of use at this low dose. Lorazepam is a benzodiazepine that can cause physical dependence, but this usually develops with higher doses or longer periods of use (typically several weeks to months) 1. After only 10 days at a low dose, the risk of withdrawal symptoms is minimal. However, if the patient has a history of sensitivity to medication changes or anxiety disorders, a conservative approach would be a brief taper over 2-3 days (such as 0.25 mg for 1-2 days before stopping). This approach is supported by the guideline that suggests tapering benzodiazepines gradually if discontinued because abrupt withdrawal can be associated with rebound anxiety, hallucinations, seizures, delirium tremens, and, in rare cases, death 1.
Key Considerations
- The patient should be advised that mild rebound symptoms like temporary increased anxiety or sleep disturbance might occur but should resolve quickly.
- If the patient was taking lorazepam for anxiety, it's also important to ensure they have alternative strategies for managing their anxiety symptoms after discontinuation, such as evidence-based psychotherapies (e.g., CBT) or specific anti-depressants or other nonbenzodiazepine medications approved for anxiety 1.
- Clinicians should communicate with mental health professionals managing the patient to discuss the patient’s needs, prioritize patient goals, weigh risks of concurrent benzodiazepine exposure, and coordinate care 1.
From the FDA Drug Label
To reduce the risk of withdrawal reactions, use a gradual taper to discontinue lorazepam or reduce the dosage Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages (i.e., higher and/or more frequent doses) and those who have had longer durations of use Acute withdrawal signs and symptoms associated with benzodiazepines have included abnormal involuntary movements, anxiety, blurred vision, depersonalization, depression, derealization, dizziness, fatigue, gastrointestinal adverse reactions (e.g., nausea, vomiting, diarrhea, weight loss, decreased appetite), headache, hyperacusis, hypertension, irritability, insomnia, memory impairment, muscle pain and stiffness, panic attacks, photophobia, restlessness, tachycardia, and tremor
The patient has been taking lorazepam 0.5 mg daily for 10 days, which is a relatively short duration. However, to minimize the risk of withdrawal reactions, it is recommended to taper down the dosage gradually before stopping the medication, as indicated in the drug label 2 and 2.
- Tapering is recommended to reduce the risk of withdrawal adverse reactions, even for patients who have been taking the medication for a short duration.
- The tapering plan should be patient-specific, taking into account the individual's dosage and duration of use.
- Monitoring for signs and symptoms of withdrawal is crucial during the tapering process.