Benzodiazepines come in many different dosages and strengths. One might assume there are enough dosages available to safely taper off of the drug but, for many patients, this is not true. Breaking a pill in half, or even quarters, while tapering can result in severe and debilitating withdrawal symptoms, failed cessation, patient injury, seizures, psychosis, suicide, and/or death. This could be easily prevented for many by making benzodiazepines available in smaller doses.
FDA Prescribing Information Is Insufficient
Xanax will be used to illustrate this problem, but the same concerns can be applied to all benzodiazepines. FDA Xanax prescribing literature states:
It is suggested that the dose be reduced by no more than 0.5 mg every three days, with the understanding that some patients may benefit from an even more gradual discontinuation. Some patients may prove resistant to all discontinuation regimens.
Not only are these suggestions incredibly fast anecdotally among people who have actually attempted benzodiazepine tapers, but they also contradict other guidelines on benzodiazepine withdrawal issued by bodies such as the New York City Department of Health and Mental Hygiene, the State of Pennsylvania, the United States Veterans Administration, Government of South Australia and the National Pain Centre of Canada. Also, the FDA’s Prescribing Information for Xanax does not quantify how many patients are resistant to all discontinuation regimens, what “resistant” entails, how many of those studied required an even more gradual discontinuation, or which alternative regimens were attempted before labeling a patient resistant. The FDA literature additionally states that studies beyond 4 months of patient usage have not yet been conducted, and many of the benzodiazepine-dependent patients in question fall into that category.
The FDA literature additionally states that studies beyond 4 months of patient usage have not yet been conducted, and many of the benzodiazepine-dependent patients in question fall into that category.
According to the American Psychiatric Association’s Benzodiazepine Task Force led by Dr. Carl Salzman, 40 to 80% of patients stopping benzodiazepines experience withdrawal. A review by Nassima et al concluded that the FDA’s Xanax cessation recommendations are too fast and recommend not exceeding 0.125 mg reductions weekly. 0.125 mg is half of the smallest available Xanax pill (0.25 mg), so that number may have been chosen out of convenience, not necessarily optimal patient outcomes. While Nassima et al’s conclusions may work for some, they have still proven far too fast for many patients, and this illustrates the absolute need for the drug to be made available in smaller doses. With 40 to 80% of patients experiencing withdrawal, and more than 90 million prescriptions written in the United States annually, it is critical that stopping a benzodiazepine be as safe and simple as possible.
With 40 to 80% of patients experiencing withdrawal, and more than 90 million prescriptions written in the United States annually, it is critical that stopping a benzodiazepine be as safe and simple as possible.
What Taper Rate Is Most Successful?
According to Schweizer et al, reductions implemented by many physicians of 25% per week have a 32-42% failure rate. Benzodiazepine Information Coalition recommends a reduction rate of around 5 to 10% or less every two to four weeks, A recommended safe taper with a reported patient success rate of over 90% is outlined in the Ashton Manual. Ashton does not recommend for anyone to end their taper of a benzodiazepine above an equivalence of 0.1 mg of Xanax which is less than a half of a 0.25 mg pill, and suggests ending as low as the equivalent of 0.025 mgs of Xanax, which is merely crumbs of the total pill. How does a patient reduce a tiny, but potent, Xanax tablet to 0 milligrams in 5-10% reductions or less? Not without great difficulty with the currently available options. Due to accuracy issues and other concerns with pill splitting, especially potent ones like Xanax, one can see how the currently available dosages for discontinuation are dangerously deficient. Breaking a pill in half is well out of optimal range for both taper speed and taper rate.
Other methods developed, namely by patients desperate to discontinue these drugs, suggest tapering to an even lower dose prior to stopping, finding that microtapering (reducing by tiny micrograms per day) to 0 mg is even more tolerable and successful for patients. Depending on the patient’s geographical location, some benzodiazepines, including Xanax, are available in a liquid formulation but the sole concentration (1mg/1mL) option available may not benefit the patient in their taper without additional patient burden as it may require further dilution to allow for concentration of drug that is conducive to microtapering at the rate required for that patient.
Redress is Urgently Needed to Help Patients
While many creative tapering solutions to this problem exist, mostly developed by patients or sometimes in cooperation with outside-the-box-thinking pharmacists, most of them still remain potentially inaccurate, unnecessarily complicated, and/or financially burdensome to the patient. One physician in the Netherlands, Dr. Peter Groot, faced with this issue during his own prescribed medication dependence, attempted to solve this problem by inventing his own tapering strips, making many drugs available in smaller doses for tapering, which are now available for direct order in Europe. Since patients already bear enough of the withdrawal burden, often unexpectedly and without having been warned of this risk, they shouldn’t have to alter dangerous medications to safely discontinue them. Further confounding the problem, many of the available taper methods (making your own at-home liquids, shaving pills to weigh on a scale, etc.) are confusing, require many steps, a steady hand, and math skills to be successful from patients who are already both physically and cognitively impaired from the drug and withdrawal itself. If the goal is to help patients succeed in benzodiazepine cessation, the resources to do so need to be readily available and affordable. Writing off a majority of benzodiazepine-dependent patients as “resistant” without further solutions is an unacceptable and lazy response to a problem with potentially devastating and painful outcomes.
The obvious and simple solution would be for the FDA to require the manufacturing of smaller doses of benzodiazepines.
The obvious and simple solution would be for the FDA to require the manufacturing of smaller doses of benzodiazepines. This would allow patients the ability to follow a safe and tolerable taper plan from their current dose to zero milligrams without the need to implement risky at-home methods or afford expensive (and often not covered by insurance) professional pharmaceutical compounding, facilitating accurate dosing and tolerable symptoms as they take on benzodiazepine cessation. This solution would aid all parties by broadening the prescriber’s toolkit while assisting patients who choose to withdraw in a less onerous manner.
I have been on xanax for @ 40 years, starting at o,25 and eventually graduated to o,50mg after, Anxiety disorder is genitic in my family. I have been taking @ 3 to 4 0.5mg daily for 4o years. Now I am an having tolerance withdrawals and going through severe hell. To many side effects to get into. I want desperately to get off all meds, if possible. I would like to be admitted in some place for help doing this so it will be easier to do so even if other meds are necessary to keep me side effect free and safe or lessoned asap. I am in desperate need for a place to be admitted to in order to do this. I need help desperately. I would like a place close to home as possible. I live near Boston, MA. I am 76 and live alone and have been on xanax for @ 40 years at a dose of.05mg. I would love to finally get off all meds, if possible with tolerable side effects. I have Medicare as a primary and Medx BC/BS as a secondary insurance. I need help desperately. Please get in touch with me asap please. You can e-mail me at pathyatt48@yahoo,com or call my cell to talk or text me at 508-733=4003. Taank you, Pat
I was on Alprazopam 0.5 once a day for 3 years ,yesterday I broke the pill in half …also today I did the same. Am I safe
Why do you feel so horrible tapering off benzos.
By chance, my pharmacist helped me find a very simple answer. I’m sure this would work with any of these drugs. Many of them do not dissolve in water so some of the common techniques don’t work. However, he was able to give me an oil suspension with basically any dose I wanted. You shake it up, draw a little out with a syringe, and fill up capsules. The trick to getting off these drugs is a very linear taper, very small amounts. Not steps 0.5, 0.25, etc. I was on 15 mg Valium and near the end, I was going down 0.05 mg (yes, five one-hundredths) every other day. The difference in amount is so slow your body doesn’t realize it. VERY simple! The key is very small increments, using this oil suspension method. If you need more info, please feel free to contact me at bill [at] insulators [dot] info.
I am struggling with the fact that Clonazepam does not come in smaller doses. I have been on it for 30 years (I am 49) and it has all but destroyed my life (as well as my young daughter’s last few years). I finally understand that this drug is the problem but I have a lot of trouble with thinking and understanding things and my brain just doesn’t work well enough to grasp what I have to do to get my dose smaller. I know the Ashton Manual is helpful for a lot of people but I just can’t process it. No support people in my life to help. Can’t believe I’ve been told this drug is good for me for so long when all it has done is make me sick.
I’m struggling with the same thing, and on this website I recently found a promising way to do a slow taper. In the second-from-the-last paragraph of the above article, click on “Dr. Peter Groot,” and it takes you to his company’s website, Taperingstrip.com. They sell clonazepam and other drugs in steadily decreasing levels. Click on “Prescribing and ordering,” then “Anti-epileptics,” then “Clonazepam.” I’d like to taper at a slower pace than the schedules they provide, and I found it’s possible because they also allow us to customize at the pace we prefer. All that’s required is for your doctor to fax them the downloaded form as a prescription. They say most insurance covers it. Good luck.
A life saving resource I’ve found is a FB support group called ‘Beating Benzos’. (also check out the website) It’s a more positive, stable support group.
The creators are a couple from the U.K. who have lived experience (she had huge issues for decades & her partner helped her w/taper plan)
He makes up SAFE, slow personalized tapers based on The Ashton Method. You have to be a member of the FB group, & read the ‘guides’ upon entry … my GP supports my taper, but I had to find any/all info on my own – & grateful b/c I can go at my own rate & comfort level.
We know benzos attach to & alter our GABA receptors as well, as the Central Nervous System .. so, no matter what a medical professional may say .. it’s critical to do a slow & stable taper (dry/cut/ weigh method or liquid/water taper.)
All the best !
It’s funny how so many sites on the web are soo compassionate to help you off benzos …..but only if you can pay or you see the check insurance plan tab here….then the compassion goes out the window and they will pass you on to another service …..this is a problem that needs addressing like any other disease one has…it’s has been a profit market for the pharmisutical places for years ….but no help from them it seems to help you off them….most dr.s will never tell you of the withdrawal problems of these benzos….mine did not…I was prescribed them to help out the anexiety and help relieve some tension for bph….has been six months on them and trying to self taper …been a roller coaster for past few weeks and can’t get affordable help to do it right….dr. wants me to make appointment ($$$) to talk about my issue with this drug(klonopin)….I read an article about a woman who called it “the hypochondriacs drug ” due to weird symptoms that couldn’t be explained …but showed no reason why they were happening ….I feel I fall in this thought also…never knew or heard of benzo withdrawals till a few weeks ago ….and pretty much covered every symptom I was having …..now looking for help to ween off this poison safely but everyone wants to make money of you for help it seems….I , like most now don’t have money to do this ….lost our butt in our business due to covid 19 ….no insurance ….and bearly surviving to pay our bills ….so what does one do ….I want to be normal again and have a life without issues like before…I have read many different taper procedures and all seem to kinda contradict each other at times….is there a set in stone taper formula to do this …and if so ? Where can it be found ? Thanks for any information I can get to help off this ….Paul
I found I had to be my own health advocate and do as much research as you can on benzodiazepines and withdrawal. I found reviews from those taking these drugs more helpful than the medical profession. I fell off my bicycle in June and got a concussion and developed anxiety 24/7. I was prescribed 1mg lorazepam a day. I took it for a week before I researched it. Once I knew it was highly addictive I sought an alternative. My doc prescribed hydroxyzine which is an antihistamine. This drug made my head very foggy that I struggled to function. I was then prescribed sertraline, a SSRI (antidepressant)drug that works well with anxiety. I started on 25mg for 6 weeks (many side effects). I increased to 37.5mg after 6 weeks. My decision to increase slowly following psychiatrist advice to increase to 50mg. Slowly increase is the key. I’ve been on 50mg for a week now and have been able to stop taking lorazepam. I tapered my lorazepam usage whilst taking sertraline. I went from 1mg sertraline to 0.75mg, to 0.5mg, to 0.125mg then stop. I’ve done this over 6weeks. I may have to increase my sertraline to 75mg but I’m giving the 50mg dose at least a month to give me a more therapeutic response. I’ve been told I need to be on sertraline (not addictive) for at least 12 months before trying to taper off to give my brain time to heal from the traumatic brain injury
My advice is listen to your body and do your own research!!!
I’ve been on both Xanax and sertraline and tapered off of Xanax much more easily than the sertraline. Sertraline is a bad drug. I, and others I know, had very bad withdrawal from sertraline. It causes “brain zaps” which you can research, not fun. My first taper was too fast and didn’t work, unbearable withdrawal – and I can take a lot. My next one I approached much more slowly and was able to effectively do it in 6 months. These things are extraordinarily over-prescribed and not much less dangerous then benzo’s in my experience. If you or anyone is seeing this please think twice before taking an ssri. A lot of doctors are either unaware or don’t believe this happens so they don’t want you, but it’s actually well documented. Good luck!!
I was titrated off phenobarbital (3) 64.8 mg nightly over a three month period. I am 76 and have taken this med for epilepsy since I was five. Following this titration I could not sleep, and had increased seizure activity. So the doctor put me on clonazepam 2 mg at night. That did help some; but yesterday I saw a neurologist who said I was still withdrawing from phenobarb. He is putting me back on 30 mg of phenobarb, nightly; but wants me to stop the clonazepam that I have been taking for a month and a half. He wants my referring doc -who titrated the phenobarb To do this. After his handling of the phenobarb titration, I am concerned. How can I do this safely?
I’m trying so hard to come off 10mg each night and the withdrawal symptoms are just awful. I’m spending half my life on the sofa. I’m 70 years old and have been on these since the age of 24. I’m just about to drop from 2mgs tonight to 1.5mgs. My Dr has made me come off this very quickly, has no patience and even though I’ve cut it now by 90%, I’m frightened of the drop from 2mgs to 1.5mgs tonight. Am I near the end of this nightmare? I’ve even thought I had appendicitis, my abdomen hurts that much and now I have a permanent lump in my throat and putting it down to this reduction but frightened that it might be something more sinister. Thank you for listening.
How are you doing? Did this work for you?
I read your comment. It worried me a doctor would do this to you. They can put you on but they don’t know how to take you off.
Rachael I am in a very similar situation. I was prescribed clonazepam I don’t even remember how many years ago probably 13 years ago or more. I was prescribed 1 mg twice daily. Thank God I was conservative and only took one. I really don’t know why I was already taking citalopram an antidepressant. Anyway all these years later and for quite some time I have had symptoms but thought my age was to blame. I am 78 now and my short term memory is not good. I have been try to taper on my own but am alarmed by being constipated and gassy to an extreme degree. Maybe I have a bowel obstruction.
Hope you find the help you need. I am looking into a micro taper but like you I don’t really have the mental ability to do it on my own and don’t trust doctors. I am furious with my doc who prescribed these as I was not aware of the dependence issues involved and trusted her. Sorry for the rambling. God bless. Patty
I am 75 years old female and have taken Xanax for severe spontaneous panic attacks that began at age 19. I used to take 1.50 mg per day for several years over the last year I have tapered down 0.75 mg, as this can’t be particularly accurate due to breaking pills in half and even biting little pieces off. The problem is just medication is particularly successful in maintaining not having these severe panic attacks, up to 12 of them a day, although I would like to stop taking the medication and I don’t see that there is any real urgency in it after 38 years. I really am interested in learning if my gradual tapering off which is working is in my best interest. There’s not any dramatically Noticeable effect with this very slow tapering. Eager to learn opinions.
WOW..you seem to be EXTREMELY lucky!!!
I took 1MG of Ativan for 2 weeks…and had almost 3 years of life altering, HELL ON EARTH, withdrawals when I tapered down.
The information on your website is very good . Pleases sign me up for your newsletter. I am trying to get off Zanax. I hate this withdrawal Physciatrists has prescribed this to me for 25 years. I am 87 years old.
I have great success tapering of a moderate Zanax addiction down to .25mg daily and using liquid melatonin and CBD oil. As you continue to taper .125mg increase your dose of CBD oil. It can take awhile to nail down what dose of melatonin and CBD oil works best for your metabolism but this taper program and regimented routine totally worked with barely noticeable withdrawal symptoms.
Sam, which liquid melatonin and cbd oil are you referring to..I’d be willing to try this. Thank you
Did you hear back from Sam?
Ruby, see my post dated December 30, 2023
I’ve been on 1mg of Ativan a day for 5 months. I also take 100mg Pritisq.
Realizing I should not be on the Ativan for this long, I am beginning to taper.
Would you say the 10% every few weeks (go slow, assess as I go) would be best and safest? As we know the cutting of these pills is very difficult, and I’ve seen the water titration methods. I don’t think there is a liquid Ativan. Looking for advice on how to achieve that 10% cuts effectively.
I have .50 pills that are scored but that only gets it down to .25
Looking for encouragement and advice on how to succeed.
Thanks in advance
I just take .5 mg very rarely maybe twice a week. Do I have to be concerned about withdrawal symptoms?
Twice a week isn’t really very rarely. Some people do experience side effects, dependency and withdrawal dosing multiple times per week. Klonopin has a long enough half life it can last 2+ days. One example of someone being harmed prescribed this way is documented here in the Boston Globe.
I had no idea I was on a harmful drug. I had been taking attivan for about 20 yrs. I saw a show on tv about benzos and that’s when and how I found out how bad they were. I then found out how difficult it was to get off. I was 79 and dr after dr told me not to even try to get off. I tapered down and was off in 6 months with no adverse reactions.
Carol
Congrats!!! Yeah you! How did you do that?? I have been having various symptoms but attributed it to getting older. I am 78. I am now feeling physical and psychological symptoms that I had misinterpreted. I thought it was life circumstances like falling and nearly breaking my back. And I spent most of my time in bed. No other interests. It has truly affected my life. How did you taper??
Presently titrating off 30 years taking Ativan as prescribed. First attempt failed(relapse)when doctor insisted on a too-rapid taper. I live in constant physical pain – pelvic pain, especially bladder pain. I had severe nerve pain on my skin, mostly my legs. Extremely temperature sensitive. First failed titration led to an inability to maintain “normal” body temperature-I could not stay warm unless in a warm bath or in bed! Presently tapering with Valium crossover. Terrified! Terrified of the extreme insomnia which went untreated during too-rapid taper by this doctor who would not listen to my symptoms. I went nights upon nights with no sleep at all! It was hell on wheels!
I have not picked up for a year this june. Didn’t really understand how fuckin toxic xanax is. Started taking the drug 22 years ago. Aha moment was when in psychosis last march.
Tapering off 0.125mg per day. Doing great. Ive been on it for about 1 1/2 years.
I should be off completely by this weekend. No withdrawal symptoms.
What Benzo were you taking? I am down to .125mg of Clonazepam. Unfortunately the Valium equivalent is 2.5mg. Cant go any smaller without a titration or jumping off. What was your next move???
I need the same info. I’m just taparing my clonazepam to 0.125 mg from 0.5 mg.. I took 0.5 mg for long 6 months.. Then i slowly started to do my taparing. At first i tapar it down to 0.25 for 2 months. Now I’m on 0.125. But after starting with 0.125 I’m now with withdrawal symptoms.. I want to know how many months i should be on this 0.125 before totally stop. Please help me..
I’m on 0.25 at night and wonder how you got on and how to get down from Thais dose thanks?
Im on lorazepam for
8 months now and im trying to stop taking it I started with .50mg
And last month I started tapping to
.25mg
And last nignt
I starded with .125mg its hard i get more anxiety,headache and nose in my ear, withdrawal is suck
Are you on clonazapam? I’m on 0.25 at night and wonder how to get off thanks
I’m in the midst of withdrawing from 2 mg of xanax after being prescribed for 6 years. I want to die and can find no relief from “addition” specialists. I kept getting prescribed gabapentin, trazadone, etc. for my symptoms. My biggest problems are with balance and tinnitus. Any suggestions?
Have you tried to slow your taper and use clonidine?
Starting Valium withdrawal regimen. Thirty years of using Xanax and imiprimine for severe anxiety/panic. Lifesaver for twenty years, then problems. Any advice on Valium withdrawal? On my second day & feel hopeful.
I take .25 mg 3 times aday for bout 8 months will that be hard to get off of it an can I take something else while getting off zanix
Can you please tell me how are your balance and tinnitus issues now? Are you still having symptoms?
I have been on .5mg of Xanax for about 5 months. I want to come off of this med! What is a safe titration and will I need to worry about withdrawing!? Please help! Doctors just want to put me on other meds for anxiety and I do not want to do that! It’s redundant!
I am on xanax 1mg for 5yrs and i want to get off of it, but i know it will be horrible, because i was weaned off of ativan and i wanted to die!
Lisa,
How did you wean off Ativan? I’m currently wanting to do this
“If the goal is to help patients succeed in benzodiazepine cessation, the resources to do so need to be readily available and affordable.” <~~ Yes; 100%.
"Writing off a majority of benzodiazepine-dependent patients as “resistant” without further solutions is an unacceptable and lazy response to a problem with potentially devastating and painful outcomes." <~~ "Lazy" = Corrupt ; "Problem" = Intentionally Profitable Consequence
Ativan should be banned.
I’m still tapering a water based titration. Nerves in feet and legs very painful. I have suffered and aged. The drug co gives you a 1 way ticket to hell.
I agree, 100%!!
Professor C. Heather Ashton, University of Newcastle in the UK asked the manufacturers of Ativan many years ago if they would consider producing 0.5 mg and 0.25 mg tablets. They refused her request.
Drug companies just want money. They should have lower dosage to withdrawal from. But then they would loose money. How sad. Gov should step in and help
I agree. I am currently tapering off of clonazapam. I was taking 0.5 mg twice a day , now I take 0.125 in the morning and 0.187 at night. Since there aren’t any lower doses the pharmacy cuts my pills. I have been reducing my dosage by 1/8 the every 4 weeks.
Hi, I was doing the same i believe. 1/8 a day but became ill. Glad its working out for you
Lorazepam (Ativan generic) is available in the US in 0.5mg tablets. Better yet, Lorazepam is available in a liquid solution (Lorazepam Intensol) with 1ml of liquid equal to 2mg of Lorazepam. This makes it very easy to measure small dosages using small syringes (1ml and .1ml) which are cheap to purchase from Amazon. I have been using this to taper off Ativan with great success (so far).
How do you do it successfully? I do water taper. I started with 1 ml per day at 300 ml. I am down to 170 ml. It is he’ll. I feel horrible. Back pain, stomach pain, headaches, nausea, anxiety, cannot sleep, depression, cry a lot and on and on….. I am desperate. Right now I am at around 0.9 mg of Ativan and I started 1.5 mg which is 0.75 ml of liquid form. Your feed back will be greatly appreciated.
Ativan (Lorazepam) DOES come in 1/2 mg. tablets, .
At least in the United States it does. That tablet can be broken in half to get a 1/4mg. Tablet.
That’s still too high for a safe taper. 0.25 mg of lorazepam is equivalent to 5 mg of diazepam. A safer taper from 0.5 mg would begin with a reduction of 0.025 mg or less (5% of the current dose).