Lorazepam Taper Plan for Patient Taking 2mg Three Times Weekly
For a patient taking 2mg of lorazepam three times weekly, a 10% weekly reduction taper over approximately 10 weeks is recommended to minimize withdrawal symptoms while safely discontinuing the medication.
Taper Schedule
The patient is currently taking 2mg three times weekly (6mg total weekly dose). Following a 10% weekly reduction:
| Week | Dose | Schedule | Weekly Total |
|---|---|---|---|
| Current | 2mg × 3 days | Mon/Wed/Fri | 6mg |
| Week 1 | 1.8mg × 3 days | Mon/Wed/Fri | 5.4mg |
| Week 2 | 1.6mg × 3 days | Mon/Wed/Fri | 4.8mg |
| Week 3 | 1.4mg × 3 days | Mon/Wed/Fri | 4.2mg |
| Week 4 | 1.3mg × 3 days | Mon/Wed/Fri | 3.9mg |
| Week 5 | 1.2mg × 3 days | Mon/Wed/Fri | 3.6mg |
| Week 6 | 1.0mg × 3 days | Mon/Wed/Fri | 3.0mg |
| Week 7 | 0.8mg × 3 days | Mon/Wed/Fri | 2.4mg |
| Week 8 | 0.6mg × 3 days | Mon/Wed/Fri | 1.8mg |
| Week 9 | 0.5mg × 3 days | Mon/Wed/Fri | 1.5mg |
| Week 10 | 0.25mg × 3 days | Mon/Wed/Fri | 0.75mg |
| Week 11 | Discontinue | - | 0mg |
Rationale and Evidence
The 2022 CDC Clinical Practice Guideline recommends that "when patients have been taking opioids for longer durations (e.g., for ≥1 year), tapers of 10% per month or slower are likely to be better tolerated than more rapid tapers" 1. While this guideline specifically addresses opioids, the principle applies to benzodiazepines as well, which also cause physical dependence.
The FDA drug label for lorazepam specifically states: "To reduce the risk of withdrawal reactions, use a gradual taper to discontinue lorazepam or reduce the dosage" 2. The label further warns that abrupt discontinuation may precipitate withdrawal reactions which can be life-threatening.
The Mayo Clinic Proceedings consensus panel (2020) suggests "individualized tapering plans that range from 10% per month (or slower) to faster tapers of 10% per week until 30% of the original dose is reached, followed by 10% weekly reductions of the remaining dose" 1. For intermittent use as in this case, a 10% weekly reduction is appropriate.
Monitoring and Adjustments
- Monitor for withdrawal symptoms at each visit: anxiety, insomnia, tremor, sweating, gastrointestinal disturbances, and increased heart rate 1.
- If significant withdrawal symptoms occur, pause the taper temporarily and resume at a slower rate (5% reductions instead of 10%) 1.
- For patients struggling with the taper, consider extending the interval between dose reductions to biweekly or monthly 1.
Potential Adjunctive Therapies
If withdrawal symptoms become problematic during the taper, consider:
- Hydroxyzine 25-50mg as needed for anxiety symptoms 3
- Non-pharmacological interventions such as cognitive behavioral therapy, mindfulness, and relaxation techniques 1
- Avoid substituting with other benzodiazepines or z-drugs
Important Considerations
- Lorazepam has a shorter half-life compared to other benzodiazepines, which may make withdrawal symptoms appear more quickly but also resolve faster 4.
- Even intermittent use (three times weekly) can lead to physical dependence requiring a taper 2.
- Withdrawal symptoms may be mistaken for recurrence of the original condition for which lorazepam was prescribed 5.
- Patient agreement and interest in tapering is a key component of successful tapers 1.
Practical Implementation Tips
- Use a pill cutter for precise dose reductions
- For doses below 0.5mg, consider using the liquid formulation of lorazepam for more precise dosing
- Schedule follow-up appointments at least monthly during the taper 1
- Educate the patient about potential withdrawal symptoms and distinguish them from recurrence of underlying anxiety
This taper plan balances the need to minimize withdrawal symptoms while achieving complete discontinuation within a reasonable timeframe, prioritizing patient safety and comfort throughout the process.