Benzodiazepine Tapering Guidelines
Benzodiazepine tapers should be carefully scheduled with regular check-ins with patients
Benzodiazepines should never be stopped abruptly. Withdrawal symptoms can be life-threatening, including inducing seizures; tapering is always the best method.
Tapering is recommended when a patient has been taking benzodiazepines for more than 4 weeks and more than 3 days per week.
Generally, taper 5 to 10% every 2–4 weeks
Tapering looks different for every patient. It’s important to check in frequently with your patient to determine how they are feeling and adjust the dose as needed.
ASAM GuidelinesTapering should be supported with ongoing management of the primary disorder and use of available non-pharmacological approaches (e.g. CBT).
- A reasonable starting rate is a 5% to 10% dose reduction every 2 to 4 weeks
- Patients on lower doses for shorter durations may tolerate a faster taper.
- After assessing response and tolerability of the 5% to 10% dose decrease, faster tapers should not exceed a 25% reduction every 2 weeks, as they are associated with high discontinuation rates. This maximum rate is not recommended unless continued use poses imminent safety concerns.
- Those with greater physical dependence may need a slower approach, such as 5% to 10% every 6 to 8 weeks.
EXAMPLE: A patient on long-term benzodiazepines (Diazepam) will take many months to gradually reduce the dose they take – this slow approach is generally better tolerated.
| Week | Dose 1 | Dose 2 |
|---|---|---|
| 0 | 30mg | 30mg |
| 1-2 | 30mg | 25mg |
| 3-4 | 25mg | 25mg |
| 5-6 | 25mg | 20mg |
| 7-8 | 20mg | 20mg |
| 9-10 | 20mg | 15mg |
| 11-12 | 15mg | 15mg |
| 13-14 | 15mg | 10mg |
| 15-16 | 10mg | 10mg |
| 17-18 | 10mg | 5mg |
| 19-20 | 5mg | 5mg |
| 21-22 | 5mg | 2.5mg |
| 23-24 | 2.5mg | 2.5mg |
| 25 | 25.mg | – |
| 26 | – | – |
| 27 | – | – |
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Oregon Health Authority: How To Approach A Benzodiazepine Taper
Updated in 2022, this resource includes a step by step guide to tapering, how to convert the patient to diazepam, detailed schedules, and how to manage withdrawal symptoms.
Benzodiazopine Toolkit-Tapering/Deprescribing
Oregon Health Authority: Talking With Your Patient About Deprescribing Benzodiazepines
A 2 page document to help providers discuss the dangers of benzodiazepine prescriptions and how to taper.
Benzodiazopine Toolkit-Tapering/Deprescribing
Deprescribing.org
This website shares information about deprescribing approaches and deprescribing research with the public, health care providers and researchers. Lots of great resources including: evidence based guidelines, an online learning module & case reports, a deprescribing app for Apple and Android devices, patient-facing one-pagers regarding deprescribing.
Benzodiazopine Toolkit-Tapering/Deprescribing
The Canadian Medication Appropriateness and Deprescribing Network
This website shares great resources and information about deprescribing approaches.
Benzodiazopine Toolkit-Tapering/Deprescribing
Reconsidering Benzodiazepines And Z-Drug Prescriptions: Responsible Prescribing And Deprescribing.
This review aims to increase understanding among NPs working in primary care settings of the history and hazards of hypnotic drugs and, therefore, empower them to influence policy on safe prescribing of hypnotics and to implement deprescribing guidelines in clinical practice.
Benzodiazopine Toolkit-Tapering/Deprescribing
Deprescribing Benzodiazepine Receptor Agonists
This systematic review provides an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists (BZRAs). It also focuses on the highest level of evidence available and seeks input from primary care professionals in the guideline development, review, and endorsement processes.
Benzodiazopine Toolkit-Tapering/Deprescribing
Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey
This article observes the experiences of those who have used, tapered, or discontinued using benzodiazepines via online survey, looking at information such as long-term use, tapering, discontinuation, and withdrawal symptoms.
Benzodiazopine Toolkit-Tapering/Deprescribing
Veterans Affairs: Benzodiazepine Risks
A 2 page guide to help providers discuss the dangers of benzodiazepine prescriptions; there are scripted prompts to start the conversation and a tapering guide for a short (3 month) and long (6 month) taper regimen.
Benzodiazopine Toolkit-Tapering/Deprescribing
Deprescribing: Reducing Medications Safely to Meet Life’s Changes Focus On Benzodiazepine Receptor Agonists & Z-Drugs (BZRAs)
One pager that can be given to a patient as part of a deprescribing conversation.
Benzodiazopine Toolkit-Tapering/Deprescribing
The Canadian Medication Appropriateness and Deprescribing Network: Resources for patients and the general public.
A variety of resources for patients and the general public on best prescribing and deprescribing practices, along with medication-related injury prevention.
Benzodiazopine Toolkit-Tapering/Deprescribing
Oregon Health Authority: Patient Guide to Benzodiazepines & Tapering
This resource provides information to patients on what benzodiazepines are, side effects, dependence, alternate treatments methods, and tapering best practices.
Benzodiazopine Toolkit-Tapering/Deprescribing