The information below is intended as a reference only, and should not be taken as medical advice. If you have questions about your medications, consult your pharmacist, doctor, nurse, or other healthcare professional.
If used daily for more than 1-2 months
- Reduce dose by a maximum of 25% every week initially (i.e., week 1 75%-50%-25%) and this can be extended if needed
- If intolerable withdrawal symptoms occur (usually 1-3 days after a dose change), go back to the previously tolerated dose until symptoms resolve and plan for a more gradual taper with the patient
- Dose reduction may need to slow down as one gets to smaller doses (i.e., 25% of the original dose)
- Overall, the rate of discontinuation needs to be controlled by the person taking the medication
- No taper required unless one has experienced withdrawal symptoms when slowly tapering shorter acting agents from the same class
Withdrawal Symptoms and Monitoring Guidance
- Acute: rebound insomnia, electrical zaps, tremor, anxiety, depression, nausea, vomiting, dizziness, seizures.
- Protracted: Depression, anxiety, stress intolerance, food intolerance, pain syndrome, dysgeusia, parosmia
Some people can stop benzodiazepines after several years’ exposure with little difficulty. There are fewer problems with the longer acting chlordiazepoxide and diazepam than with the shorter acting alprazolam and lorazepam. Others can have problems after a relatively brief exposure. Based on the experience of missed doses, people on benzodiazepines will often know whether they are likely to have a problem. There is an acute withdrawal syndrome that is managed by tapering and a protracted withdrawal syndrome that at present has no treatment.
Bruyère Research Institute Deprescribing Algorithm Guidelines
The Deprescribing Guidelines for the Elderly project has developed an evidence-based guideline to support clinicians in safely reducing or stopping benzodiazepine receptor agonists. The team of pharmacists, family physicians, specialists, and medical researchers behind the guideline has also developed a de-prescribing algorithm to help clinicians decide when and how to reduce benzodiazepines safely and how to monitor effect:
- Benzodiazepine Receptor Agonist deprescribing guideline (published in Canadian Family Physician)
- Benzodiazepine Receptor Agonist deprescribing algorithm [PDF]
- Whiteboard video on using the Benzodiazepine Receptor Agonist deprescribing algorithm (YouTube)
- Patient handout on Benzodiazepine receptor agonists [PDF]
- A guide to deprescribing benzodiazepines [PDF]
- Patient Handout Sedative-hypnotic medications [PDF]