How to Taper off Benzodiazepines: Weaning Methods & Treatment

Tapering weans the body off a benzodiazepine slowly to create a more manageable withdrawal process. This can make recovery more reachable.

Article at a Glance:

• Tapering is a strategy to stop substance use that involves slowly reducing the dose to prevent withdrawal symptoms.
• Benzo withdrawal symptoms can include nausea, vomiting, convulsions, agitation and headaches.
• Tapers are challenging to use without medical assistance, but addiction professionals can help a person develop a taper program.

What Is Benzodiazepine Tapering or Weaning off Benzodiazepines?

Benzodiazepine tapers include highly detailed schedules for daily and weekly benzo consumption to suppress or overcome withdrawal symptoms. There are two benzo tapering strategies:

• Direct tapers focus on reducing the benzodiazepine dosage slowly over time.
• Substitution tapers switch the patient to a more stable benzodiazepine before continuing. Short-acting benzos, such as Xanax and Ativan, only last in the system for a short time, which requires consistent dosages to prevent withdrawal. Valium, a long-acting benzo, sticks around much longer, allowing the body to wean at its own pace.

Who Can Benefit From Tapering Their Benzo Intake

Benzodiazepine tapers are designed to lessen the worries of detox. Many people can trace their hesitation to stop benzos to the withdrawal symptoms. Tapering benzodiazepines can ease these uncertainties. At its core, tapering is about slowly familiarizing the body to live without benzos while making withdrawal manageable.

Types of Benzodiazepines Tapering Methods

Strategies for benzodiazepine tapering can differ depending on how much and which type you take. Tapering aims to minimize withdrawal symptoms and maintain safety because stopping benzodiazepines cold turkey can result in seizures. The National Center for PTSD has issued guidance with several benzodiazepine tapering methods. While your healthcare provider will work with you to create a customized plan, these are some helpful examples of what you may expect. 

• For patients taking higher doses than typically recommended, you may expect to be admitted for 24-hour monitoring. During this time, your healthcare team may switch a short-acting benzo for a longer-acting one at a reduced dose. This dose reduction will continue over several weeks or months.
• If you only take a benzo to sleep, you can likely gradually reduce your dose weekly until your healthcare provider advises you it is safe to stop.
• For those taking their benzos throughout the day, the first step may be to reduce the number of times throughout the day that you take your medication. Then, you will likely slowly decrease the total amount you take during the day over weeks or months until it is safe to stop.

Direct Tapering

Direct tapering is when you continue to use the same medication you have become dependent on but at lower doses over time. Doing so allows your body time to gradually adjust to having less and less medication in your system throughout your taper. This can help minimize withdrawal symptoms and decrease the likelihood of relapsing. 

Substitute Tapering

Substitute tapering is similar to direct tapering, with one notable exception — with substitution, you start taking a different medication (like a long-acting benzodiazepine) instead of your original medication (in this example, a short-acting benzodiazepine). Over time, the medication you are substituting with is tapered down until you can safely stop it.

Titration Tapering

Titration tapering is not recommended. This is where doses are gradually diluted in water over time. However, this method poses several serious health risks and is not encouraged. 

Why Consider Tapering vs. Stopping Benzodiazepines Cold Turkey?

Stopping benzodiazepines cold turkey is very dangerous as it can lead to severe symptoms, including seizures and death. If you are considering stopping your benzodiazepine, always consult your pharmacist or healthcare provider first. By creating a plan to taper your benzodiazepine down, you can decrease the chance of severe withdrawal symptoms and the likelihood of relapse. 

Common Benzodiazepine Withdrawal Symptoms

Depending on the benzo, severe withdrawal symptoms can last for weeks or months, with residual effects for years. Symptoms of benzo withdrawal include:

• Headaches: Patients going through withdrawal will exhibit confusion, lethargy and headaches in the absence of benzos.
• Disrupted sleep patterns: Insomnia or excessive sleep habits may develop as withdrawal progresses.
• Agitation: Irritable and uncouth behavior is common, especially when cravings hit their hardest.
• Convulsions: Erratic actions and movements result from disrupted chemical signals to extremities.
• Nausea and vomiting: People with benzo withdrawal will be in a state of perpetual sickness throughout the process.
• Psychosocial episodes: During withdrawal, the central nervous system attempts to self-correct after months or years of substance interference. Mild to severe neurological incidents may result, such as severe panic attacks, psychosis, hallucinations and seizures.

Can Klonopin cause stomach problems?

Yes, Klonopin (clonazepam) can cause gastrointestinal (GI) distress, especially during withdrawal.

Does Xanax cause stomach pain?

Yes, like other benzos, Xanax (alprazolam) can cause stomach upset during withdrawal.

Is withdrawal from benzos a medical emergency?

For some people, yes, it can be an emergency, especially in people prone to seizures.

Side Effects of Benzodiazepine Tapering

Tapering benzodiazepines is an effective strategy for stopping and can help reduce symptoms of withdrawal. However, it is important to have a plan in place with significant support in the event that you experience symptoms. Symptoms of benzodiazepine tapering can include: 

• Rebound insomnia, especially if you have been taking this medication to help you sleep.
• Anxiety or panic attacks can return, so it is important to have strong psychosocial support during this time.
• Other symptoms can include irritability, trouble concentrating and headache. 

Benzodiazepines Withdrawal Timeline

Benzodiazepine withdrawal is typically grouped into three distinct phases. Although symptoms differ from person to person, many experience withdrawal. Another thing to consider includes whether you take a long- or short-acting benzodiazepine, as withdrawal symptoms seem worse for those on high doses or short-acting benzodiazepines. 

Medications Used When Tapering off Benzodiazepines

There are several options that can help when you are tapering off benzodiazepines. In general, these medications can help with feelings of anxiety or panic. Medications may include buspirone or the rescue medication flumazenil. 

Buspirone

Buspirone is a noncontrolled prescription medication used to treat anxiety disorders. During benzodiazepine withdrawal, rebound anxiety or panic attacks are common. Buspirone provides a non-benzodiazepine option for treating these instances, and its effects are considered similar to benzodiazepines but without the potential for physical dependence. 

Flumazenil

Flumazenil is a rescue medication for benzodiazepines. It is most often used after procedures to reverse the effects of benzodiazepines and help you to wake up. However, if you use benzodiazepines regularly, flumazenil can cause you to go into sudden and severe withdrawal — even causing seizures or death. For this reason, it is important to tell your healthcare providers that you take benzodiazepines and how much. 

Why Benzodiazepines Withdrawal Symptoms Occur

Benzodiazepines enhance the effects of the brain chemical gamma amino-butyric acid (GABA). Normally, GABA is responsible for dampening certain signals sent by the central nervous system (CNS).

Benzos enhance the effects of GABA, and to maintain normal functioning, the body develops a tolerance to excess GABA. When benzos are removed from the system, it leads to higher-than-normal GABA levels, which leads to overexcitement of the CNS. Symptoms can include nervousness, anxiety and seizures.

Can Tapering Your Benzodiazepines Intake Reduce Withdrawal Symptoms?

A benzo taper can sometimes rid someone recovering from withdrawal symptoms. This is because tapering allows the central nervous system to adjust to the drug’s removal slowly. It never gets the opportunity to enter a withdrawal phase.

On the other end of the spectrum, quitting cold turkey provides no such safeguard — withdrawals are at their worst, even deadly. For this reason, neither at-home detoxes nor stopping cold turkey are recommended by physicians. These outdated approaches lack support, guidance and safety measures.

Benzodiazepine Tapering Schedule

As a general rule of thumb, physicians and rehabilitation personnel suggest a reduction in benzo use by increments of 10% every week. A less conservative approach can push these numbers into the 25% range if necessary — this approach is usually for patients who’ve tried but did not succeed with a taper before.

Challenges of Cutting Down Your Benzodiazepine Intake

Weaning yourself off a benzodiazepine without medical supervision can be complex. If you accidentally taper too quickly, your doctor can adjust the schedule to ease breakthrough withdrawal symptoms. Also, make sure your doctor knows all other medications you are taking so they can prepare the best plan for you.

Relapse Prevention Strategies

Avoiding benzo withdrawal can help reduce your risk of relapse. By limiting withdrawal symptoms through a medically managed taper, you increase your chances of successfully staying off benzos long-term. However, it is not the only step. Recent studies have shown that combining therapy and other psychological care with tapering or medical detox is often more successful than tapering by itself.

Medically assisted detox and addiction treatment is your best bet if you are trying to taper your drug or alcohol use. The Recovery Village provides 24-hour medical detox care and addiction rehab at facilities nationwide, and each care plan can be customized to your exact needs. Don’t risk your life with addiction or recovering alone — call The Recovery Village today to learn more about medical detox.

How The Recovery Village Uses Benzodiazepines Tapering

Your doctor is an excellent resource for helping you wean off benzos. They can design a taper schedule to decrease your benzo dose gradually. This may involve prescribing lower doses of medication(s) so you do not need to cut up higher-dose pills. An addiction treatment facility or specialist can also help with this process if your doctor is not available or you’d like additional treatment or support.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Leila Khurshid

Leila Khurshid is a clinical pharmacist based in Denver, CO. After graduating from Regis University with her Doctor of Pharmacy, she completed a PGY1 Pharmacy Residency at St. Mark’s Hospital in Salt Lake City, UT where she continued to practice for a number of years. Read more