Diazepam Tapering Schedule for 7.5 mg Daily
For a patient taking diazepam 7.5 mg daily (2.5 mg during the day and 5 mg at night), reduce the total daily dose by 25% every 1-2 weeks until complete discontinuation, which translates to approximately 2 mg reductions every 1-2 weeks. 1
Specific Tapering Schedule
Week 1-2: Reduce to 5.5 mg daily (2 mg morning, 3.5 mg evening) - this represents a 27% reduction 1
Week 3-4: Reduce to 4 mg daily (1.5 mg morning, 2.5 mg evening) - continuing the 25% reduction pattern 1
Week 5-6: Reduce to 2.5 mg daily (0 mg morning, 2.5 mg evening OR 1.25 mg twice daily) 1
Week 7-8: Reduce to 1.25 mg daily (single evening dose) 1
Week 9-10: Reduce to 0.625 mg daily (may require tablet splitting or liquid formulation) 1, 2
Week 11: Discontinue completely 1
This schedule achieves complete discontinuation in approximately 10-11 weeks. However, if the patient has been taking diazepam for years, consider a slower taper of 10% of the previous dose every 2-4 weeks instead, which would extend the taper to approximately 6 months. 1
Critical Monitoring and Adjustment Points
Monitor closely for withdrawal symptoms including anxiety, insomnia, irritability, tremor, and in severe cases, seizures. 1 If withdrawal symptoms become severe at any point, pause the taper and return to the previous well-tolerated dose, then resume tapering more slowly when the patient stabilizes. 1, 2, 3
The FDA label specifically states that if a patient develops withdrawal reactions during tapering, consider pausing the taper or increasing the dosage to the previous tapered dosage level, then subsequently decrease the dosage more slowly. 3
Alternative Approach for Final Doses
Once reaching the smallest available dose (typically 2 mg tablets that can be split to 1 mg), consider extending the interval between doses rather than further reducing the dose. For example, take 1 mg every other day for 1-2 weeks before complete discontinuation. 1
Special Considerations and Pitfalls
Abrupt discontinuation must be avoided as it can lead to rebound anxiety, hallucinations, seizures, delirium tremens, and in rare cases, death. 1 This is particularly critical given that diazepam has a long elimination half-life (20-100 hours for diazepam and its active metabolite desmethyldiazepam), which provides some self-tapering effect but does not eliminate withdrawal risk. 4
Do not use a rigid "one-size-fits-all" approach. 2 Some patients may require a much slower taper, particularly if they experience significant withdrawal symptoms. A taper of 10% per month may be more appropriate for patients who have been on benzodiazepines for extended periods. 1, 2
Consider adding cognitive behavioral therapy (CBT) during the tapering process, as this increases tapering success rates and helps manage anxiety that may emerge during dose reduction. 1
For elderly patients or those with debilitating disease, an even more gradual tapering schedule may be necessary due to increased sensitivity to benzodiazepine effects. 1 The FDA label recommends starting doses of only 2-2.5 mg once or twice daily in geriatric patients, suggesting they may require proportionally slower tapers. 3
Documentation and Patient Education
Educate the patient that withdrawal symptoms are expected and manageable, and that the taper can be slowed or paused at any time if symptoms become problematic. 1, 2 Set realistic expectations that the process may take 2-6 months depending on individual tolerance.
Avoid concurrent use with opioids whenever possible during the taper, as this combination significantly increases the risk of fatal overdose. 1 If both medications are present, it may be safer to taper opioids first due to greater risks associated with benzodiazepine withdrawal. 1