Common side effects include slurred speech, memory loss, confusion, sleepiness, and increased fall risk. If people become tolerant, and as the dose is increased to get more therapeutic benefit, the side effects get worse, too. Some people even start to crave these medications and use more than prescribed or develop an addiction to them. Benzodiazepines are some of the more commonly prescribed medications in the world.
- In 2016, estimates suggest that about half a million people in the United States misused sedative drugs.
- However, that doesn’t necessarily mean you will require inpatient care.
- As of February 2024, the Maudsley Deprescribing Guidelines have been released.
- If the doctor says something you don’t like, listen and state your objection firmly but nicely.
Over 92 million prescriptions for benzodiazepines are dispensed in the UnitedStates annually, yet little is known about the experiences of those takingand discontinuing them. Depending on your situation, your doctor may think it best to prescribe very small amounts of medication at a time. This will prevent you from altering the taper, but it might mean frequent trips to the pharmacy. Anyone taking them on a daily basis can develop a tolerance and dependence. One disadvantage to this method is that most medications are not water-soluble (meaning they are not fully dissolved in water), so the resulting liquid suspension must be shaken to distribute the medication fully.
Multiple protocols also exist for tapering benzodiazepines in older adults [16]. Reducing the drug by 25 percent every one to two weeks until the individual is drug free is a safe and accepted method of tapering the drugs. For those individuals who have difficulties with tapering the medication, supportive measures including cognitive-behavioral therapy (CBT) and taper with medication substitution may improve outcomes. Stopping benzodiazepines all at once can be dangerous, so your doctor will likely guide you through a tapering regimen that involves gradually reducing your dose over time. If you experience severe withdrawal symptoms during tapering, tell your doctor so they can adjust your care plan as needed.
Tapering options were limited
There are fewer problems with the longer acting chlordiazepoxide and diazepam than with the shorter acting alprazolam and lorazepam. Based on the experience of missed doses, people on benzodiazepines how family can play an important role in addiction recovery 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.
What makes benzodiazepine withdrawal so dangerous?
In my experience, the only exception to the general rule of slow reduction is triazolam (Halcion). This benzodiazepine is eliminated so quickly (half-life 2 hours) that you are practically withdrawn each day, after a dose the night before. For this reason, triazolam can be stopped abruptly without substitution of a long-acting benzodiazepine. If withdrawal symptoms occur, you could take a short course of diazepam starting at about 10mg, decreasing the dosage as shown on Schedule 2. The same approach applies to the non-benzodiazepines zolpidem and zaleplon which both have half-lives of 2 hours.
While some prescribers may view this as a gradual reduction, most experienced researchers, physicians, patients, and prescribing guidelines consider these tapers too rapid. This rapid tapering method was found in one study to be ineffective for at least 32% to 42% of patients who were prescribed benzodiazepines long-term (that is, they failed to achieve a drug-free state). Protracted withdrawalsymptoms are more common than previously appreciated.8 Further research is needed to better understand how to stratify whichpatients might be at particular risk for either acute or protracted benzodiazepinewithdrawal. Although some patients may prefer a quicker taper, this must be balanced with the severity of potential withdrawal symptoms. Even benzodiazepine tapers lasting one to two years can be successful. Some people can stop benzodiazepines after several years’ exposure with little difficulty.
In some rare cases, a rapid withdrawal might be considered a lesser evil—for example, if the drug produces a paradoxical response, which happens very infrequently. While many patients who want to get off benzodiazepines have an understandable desire to withdraw from the medication as quickly as possible, rapid withdrawal is often the riskiest and most dangerous once signs of physical dependence are present. Whether patients are working closely with a prescriber or withdrawing with limited assistance, they should taper at the most comfortable rate. No patient should ever be made to taper or forced off benzodiazepines against their will. As the methods here indicate, once a patient chooses to withdraw, there are many ways to accomplish that goal without relying on rapid tapers, oversized reductions, or cold turkeys. Online support communities have developed different systems of “micro-tapering” to help reduce medication evenly throughout a taper to lessen the chance of withdrawal symptoms.
Some patients on alprazolam require five or six daily doses to maintain steady serum levels. A new study wanted to find out whether supportive therapies, on the whole, would improve the success rates of stopping long-standing (more than four weeks), daily benzodiazepine or Z-drug use—something that hadn’t yet been measured. To do so, researchers pooled results from several published clinical trials and performed a metanalysis.
People tapering off the same original dosage of medication can have drastically different tapering experiences. Experiencing rebound symptoms means the symptoms you had before taking benzodiazepines come back even stronger than before. The survey link was posted for a month three different times (October 2018, November2018, and January 2019).
Can you prevent withdrawal?
(Valium has a much longer half-life than most other benzodiazepines, allowing for a ‘smoother’ taper AND is delivered in 2mg, 5mg, and 10 mg doses, as well as manufacturer liquid formulations, making it possible to make smaller reductions). You will also need to be familiar with the crossover equivalents, etc., which can be found in the Ashton Manual. An Ashton based online conversion tool can be found here.If you wish to taper directly off of the benzodiazepine you are currently taking, as opposed to crossing to Valium you can cite the British National Formulary guidelines. While they can quickly relieve symptoms of anxiety and panic, these drugs pose a high risk of dependence. In other words, your body may rely on benzodiazepines to function if you take them frequently and for more than a short period of time.
New medical conditions not previously experienced
In fact, the write-in comments providedprofound insights into benzodiazepine-related adverse effects and how patients dealwith them. Several particularly relevant comments have been selected and are offeredhere. The authors identifiednine how long does acid last broad themes and selected relevant comments to represent each. During your taper, you may still experience some of the symptoms of withdrawal. Withdrawing from benzodiazepines can be a difficult, even dangerous process.