Deprescribing and Tapering Benzodiazepines

Last edited on December 26, 2021

Deprescribing (or tapering) benzodiazepines is an important clinical skill. While there may be some indication for long-term use of benzodiazepines for certain individuals, most individuals on benzodiazepines do not need to be on it long-term! Studies showing the long-term efficacy of benzodiazepines are lacking. When tapering benzodiazepines, consider the duration of treatment, the dose, and the half-life of the benzodiazepine. If the patient has been on the benzodiazepine for more than 12 weeks, one may want to taper at a rate of 10 to 25% per week. Towards the later part of the taper, the taper should be slowed down more.

See main article: Sedative-, Hypnotic-, or Anxiolytic-Related Disorders

Some individuals on benzodiazepines for prolonged periods of time may meet criteria for a benzodiazepine use disorder. It is thus important to ask about other benzodiazepine or sedative hypnotic use (prescribed, non-prescribed, recreational), and other substance use.

Several jurisdictions and organizations have published recommendations on how to switch/taper benzodiazepines.

Guidelines

	Deprescribing.org^[1]	World Health Organization	San Francisco Health Plan
Jurisdiction	Canada	WHO	US
Link	Download	WHO Clinical Guidelines (2009)	Download

See also: Guina, J., & Merrill, B. (2018). Benzodiazepines II: waking up on sedatives: providing optimal care when inheriting benzodiazepine prescriptions in transfer patients. Journal of clinical medicine, 7(2), 20.

The length of time between each dose reduction should be based on the presence and severity of withdrawal symptoms.
The longer the interval between reductions, the more comfortable and safer the withdrawal (there should be at least 1 week between dose reductions).
- Abrupt cessation of benzodiazepines after chronic use (i.e. - more than several months) can cause seizures so the dose should always be gradually reduced.
Benzodiazepine withdrawal symptoms can fluctuate and intensity of the symptoms do not always decrease in a steady fashion.
If withdrawal symptoms worsen, stay with the current dose until symptoms resolve. Symptomatic treatment with adjunctive non-benzodiazepine medications can be used in cases where residual withdrawal symptoms are severe or are persistent.^[2]

Withdrawal management alone is unlikely to lead to sustained abstinence from benzodiazepines. Psychosocial treatment is just as important! If patients were on a benzodiazepine for an underlying psychiatric disorder, these psychiatric disorders must also be treated, or the risk of benzodiazepine use will be extremely high again.