Suggested manner of tapering benzodiazepines (alprazolam, etizolam, lorazepam, diazepam, clonazepam, etc)

Many persons who have been taking benzodiazepines or other tranquilizing prescription medicines will experience withdrawal symptoms if they try to stop the medicine abruptly.

Tapering-off, i.e. reducing the doses gradually is recommended. But specific details on how to taper-off are usually unavailable or inadequate.

Tapering-off can be done by changing two variables, i.e, dose quantity or amount(like 2 mg, 1.5 mg, 1 mg, etc) and interval between subsequent doses(like once in a day, or twice a day).

For example:

A person has been taking "2 mg clonazepam a day"(Clonazepam 2 mg at once, every 24 hours) may taper as follow:

• He can increase the interval between doses from 24 hours to 30 hours for the first 10 doses, while maintaining the same dose, i.e. 2 mg.
• Reduce the dose to 1.5 mg, while keeping the interval the same, i.e. 30 hours, for the next 10 doses.
• Increase the interval from 30 to 36 hours while keeping dose the same, for the next 10 doses.
• Reduce the dose to 1 mg, while maintaining the interval of 36 hours, for the next 10 doses.
• Increase the interval to 42 hours, while maintaining the dose at 1 mg, for the next 10 doses.
• Reduce the dose to 0.5 mg, while maintaining the interval at 42 hours, for the next 10 doses.
• Increase the interval to 48 hours, maintaining dose of 0.5 mg for the next 10 doses.
• Reduce dose to 0.25 mg, maintaining the interval of 48 hours for the next 10 doses.
• Since finding tablets of doses 0.125 mg is not possible, only the interval can be here onwards. Increase the interval by 6 hours after every 10 doses. Once you reach the interval of 72 hours, you can stop the drug.

In the above example, we have reduced the dose and increased the interval alternatively. Change only one thing at a time, keeping the other thing constant. Next change the 'other thing' while keeping the 'first thing' constant.

Above steps of intervals(i.e. 6 hours) and doses(0.5 mg) are completely arbitrary. One may choose an interval of 8 hours or even 12 hours, but longer than 12 hours is not advisable especially in the first few steps.

Persons taking 'fast and short-acting' medicines such as alprazolam, lorazepam, etc. will have to go slower. After the first few steps, they may need to be provided a cover of 'slower yet longer acting' medicine such as clonazepam or chlordiazepoxide. Clonazepam and chlordiazepoxide will also need to be tapered-off.

The longer you have been taking the medicine, the slower the tapering should be. Somebody who has been taking the medicines for (say) 3 years needs to taper slowly than somebody who has been taking it for (say) 3 weeks.

Tapering-off 'fast and short-acting' medicines requires to be done more slowly and is often not as successful. Persons will need atleast one dose of it in a day, and may need to be 'covered' with a 'slower yet longer acting' clonazepam or chlordiazepoxide.

Diazepam(valium, calmpose) should not be used as an alternative to clonazepam or chlordiazepoxide because even though it is long-acting, it has a quicker onset, which makes withdrawal symptoms more likely.

Use of 'substances of abuse' such as alcohol, stimulants(including nicotine), opioid(including medically unsupervised tramadol, codeine, noscapine, etc), etc. should be avoided during this period.