Benzodiazepine Tapering Guidelines

Introduction to Tapering Principles

A commonly used and safe tapering schedule for benzodiazepines is a reduction of 25% every 1-2 weeks, as recommended by the Centers for Disease Control and Prevention, based on MMWR Recommendations and Reports 1, 2
Tapering benzodiazepines gradually is essential as abrupt withdrawal can lead to rebound anxiety, hallucinations, seizures, delirium tremens, and in rare cases, death, according to the Centers for Disease Control and Prevention 1

Elderly patients or those with debilitating disease may require even more gradual tapering due to increased sensitivity to benzodiazepine effects, as suggested by the American Gastroenterological Association 3, 4
Patients with certain medical conditions, such as respiratory disease, should be monitored closely when taking benzodiazepines, as they can cause respiratory depression, particularly when combined with opioids, according to the American Gastroenterological Association 3, 4

Monitor for withdrawal symptoms including anxiety, insomnia, irritability, tremor, and in severe cases, seizures, as recommended by the Centers for Disease Control and Prevention 1
Cognitive behavioral therapy (CBT) increases tapering success rates and may be particularly helpful for patients struggling with benzodiazepine tapering, according to the Centers for Disease Control and Prevention 1
Avoid concurrent use of benzodiazepines with opioids whenever possible, as this combination significantly increases the risk of fatal overdose, as warned by the Centers for Disease Control and Prevention 1, 5
When patients are receiving both benzodiazepines and opioids and require tapering to reduce risk of respiratory depression, it might be safer to taper opioids first due to greater risks associated with benzodiazepine withdrawal, as suggested by the Centers for Disease Control and Prevention 1

If withdrawal symptoms become severe during benzodiazepine tapering, consider slowing the taper or temporarily returning to the previous dose, as recommended by the Centers for Disease Control and Prevention (CDC) 6, 7
Tapers may need to be paused and restarted when the patient is ready, especially when reaching lower doses, according to the CDC guidelines 6, 7

For patients who have been taking diazepam for years, consider a slower taper of 10% of the previous dose every 2-4 weeks, as suggested by the CDC 6, 7
Once the smallest available dose is reached, the interval between doses can be extended (e.g., every other day) before complete discontinuation, as recommended by the CDC 6, 7