From the Guidelines
The recommended rate for a benzodiazepine taper is a gradual reduction over many weeks, with a suggested withdrawal of 25% of the daily benzodiazepine dose each week, but often more gradual, considering the desirable end point. When considering benzodiazepine tapering, it's essential to prioritize a gradual approach to minimize the risk of rebound or withdrawal symptoms. According to the EMPOWER trial 1, a gradual reduction over many weeks can lead to success in tapering benzodiazepines, with 27% of patients stopping benzodiazepines compared to 5% in the control group.
Some key points to consider when tapering benzodiazepines include:
- Gradual reduction of the dose to minimize withdrawal symptoms
- Conversion to long-acting benzodiazepines, such as diazepam, to facilitate a smoother taper
- Individualization of the taper schedule based on the patient's symptoms and response to the taper
- Regular monitoring and psychological support throughout the tapering process to improve success rates
- Consideration of adjunctive medications, such as hydroxyzine or trazodone, to manage withdrawal symptoms without using additional benzodiazepines
It's also important to note that the taper schedule may need to be adjusted based on the patient's response, and a more gradual approach may be necessary for some patients. As suggested by Mugunthan and colleagues, withdrawing 25% of the daily benzodiazepine dose each week may be a reasonable starting point, but the taper should be tailored to the individual patient's needs 1. Additionally, the WHO recommendations suggest a gradual tapering dose over 8–12 weeks for benzodiazepine withdrawal 1.
Overall, a gradual and individualized approach to benzodiazepine tapering is crucial to minimize the risk of withdrawal symptoms and improve success rates. A slow and gradual taper, often over several months, is typically necessary to allow the GABA receptors in the brain to readapt to functioning without the benzodiazepine.
From the FDA Drug Label
In all patients, dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage. Although there are no systematically collected data to support a specific discontinuation schedule, it is suggested that the daily dosage be decreased by no more than 0.5 mg every 3 days. Some patients may require an even slower dosage reduction.
It is suggested that the dose be reduced by no more than 0.5 mg every 3 days, with the understanding that some patients may benefit from an even more gradual discontinuation.
The recommended rate for a benzodiazepine (BZD) taper is to decrease the daily dosage by no more than 0.5 mg every 3 days. However, some patients may require an even slower dosage reduction. The taper should be undertaken under close supervision and must be gradual 2.
From the Research
Benzodiazepine Taper Rates
The recommended rate for a benzodiazepine (BZD) taper can vary depending on several factors, including the dose and duration of benzodiazepine use.
- A study published in 1991 suggested a gradual taper of 25% per week reduction in benzodiazepine therapy 3.
- Another study from 1991 recommended a gradual tapering of the BZD over 4 weeks on an outpatient basis for low-dose withdrawal, and a taper of 10% per day for high-dose withdrawal as inpatients 4.
- A 2003 study compared fixed and symptom-triggered taper methods during in-patient benzodiazepine withdrawal treatment, and found that both methods were effective, with a reduction in benzodiazepine dosage of 86% over the first 8 days 5.
- A 2024 study described the implementation and short-term outcomes of an outpatient benzodiazepine taper protocol, which used a 4- to 6-week intensive outpatient taper protocol using diazepam 6.
Taper Protocols
Different taper protocols have been used in various studies, including:
- A fixed-dose phenobarbital taper protocol, which was found to be safe and effective for inpatient benzodiazepine detoxification 7.
- A symptom-triggered taper method, which was found to be as effective as a fixed dose taper method for in-patient benzodiazepine withdrawal treatment 5.
- An intensive outpatient taper protocol, which was used to treat benzodiazepine withdrawal in a substance use disorder bridge clinic 6.
Considerations
When considering a benzodiazepine taper, it is essential to take into account the individual's specific situation, including their dose and duration of benzodiazepine use, as well as any other substance use disorders they may have 4, 6.