Diazepam Tapering Schedule for 10 mg Daily Dose
For patients taking 10 mg of diazepam daily, the recommended tapering schedule is a gradual reduction of 0.5-1 mg every 4 weeks, with a total tapering period of approximately 20-40 weeks to minimize withdrawal symptoms and maximize successful discontinuation. 1
Detailed Tapering Protocol
Initial Phase (Months 1-3)
- Start with a reduction of 10% of the original dose (1 mg) every 4 weeks
- Weeks 1-4: Reduce from 10 mg to 9 mg daily
- Weeks 5-8: Reduce from 9 mg to 8 mg daily
- Weeks 9-12: Reduce from 8 mg to 7 mg daily
Middle Phase (Months 4-6)
- Continue with 1 mg reductions every 4 weeks
- Weeks 13-16: Reduce from 7 mg to 6 mg daily
- Weeks 17-20: Reduce from 6 mg to 5 mg daily
- Weeks 21-24: Reduce from 5 mg to 4 mg daily
Final Phase (Months 7-10)
- Slow the taper to 0.5 mg reductions every 4 weeks as lower doses are reached
- Weeks 25-28: Reduce from 4 mg to 3.5 mg daily
- Weeks 29-32: Reduce from 3.5 mg to 3 mg daily
- Weeks 33-36: Reduce from 3 mg to 2.5 mg daily
- Weeks 37-40: Reduce from 2.5 mg to 2 mg daily
Terminal Phase (Months 11-12)
- Further slow the taper for the final doses
- Weeks 41-44: Reduce from 2 mg to 1.5 mg daily
- Weeks 45-48: Reduce from 1.5 mg to 1 mg daily
- Weeks 49-52: Reduce from 1 mg to 0.5 mg daily
- Weeks 53-56: Discontinue completely
Monitoring and Adjustment Considerations
Follow up with patients at least monthly during tapering to monitor for withdrawal symptoms 1
If withdrawal symptoms become intolerable:
- Pause the taper
- Maintain the current dose for 1-2 months
- Resume tapering at a slower rate when symptoms subside 1
Common withdrawal symptoms to monitor for:
- Anxiety
- Tremors
- Insomnia/nightmares
- Excessive sweating
- Tachycardia/palpitations
- Headache
- Muscle aches 2
Special Considerations
- For elderly patients or those with debilitating disease, start with a lower dose (2-2.5 mg) and taper even more gradually 3
- If the patient is also taking opioids, coordinate tapering plans carefully as concurrent use increases risk of overdose 4, 3
- Never abruptly discontinue diazepam due to risk of withdrawal seizures 5
- For patients who have been on diazepam for many years, consider an even slower taper of 5% reduction every 2-4 weeks 1
Managing Withdrawal Symptoms
- Consider non-pharmacologic treatments for underlying conditions to help manage withdrawal symptoms 1
- For severe withdrawal symptoms:
- α2-adrenergic agonists (clonidine, tizanidine) may help with sympathetic hyperactivity
- Acetaminophen or NSAIDs for muscle aches
- Trazodone or mirtazapine may be considered for insomnia 1
Patient Education Points
- Explain that withdrawal symptoms may occur but can be managed with proper tapering
- Discuss that many patients actually feel and function better following benzodiazepine tapering 1
- Advise about increased risk for overdose if returning to previously prescribed higher doses 1
- Cognitive behavioral therapy can be helpful during the tapering process 1
This tapering schedule balances the need to minimize withdrawal symptoms while achieving successful discontinuation within a reasonable timeframe. The slower taper at lower doses recognizes the non-linear relationship between dose reduction and receptor occupancy, which helps reduce withdrawal intensity.