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Benzodiazepine Information Coalition

Ashton Manual

Free Ashton Manual

PDF
Kindle
Nook

Table of Contents

Contents
Introduction
Chapter 1: The benzodiazepines: what they do in the body
Chapter 2: How to withdraw from benzodiazepines after long-term use
Chapter 2: Slow withdrawal schedules
Chapter 3: Benzodiazepine withdrawal symptoms, acute & protracted
Supplement

THE ASHTON MANUAL SUPPLEMENT, APRIL 2011

IMPORTANT MESSAGE FROM PROFESSOR ASHTON, JANUARY 2007

FOREWORD TO REVISED EDITION, AUGUST 2002

FOREWORD 2001

ABOUT PROFESSOR C HEATHER ASHTON, DM, FRCP

SUMMARY OF CONTENTS

MEDICAL DISCLAIMER

CHAPTER 1. THE BENZODIAZEPINES: WHAT THEY DO IN THE BODY

Background

About this chapter

The benzodiazepines
Potency
Speed of elimination
Duration of effects
Therapeutic actions of benzodiazepines
Mechanisms of action

Adverse effects of benzodiazepines
Oversedation
Drug interactions
Memory impairment
Paradoxical stimulant effects
Depression, emotional blunting
Adverse effects in the elderly
Adverse effects in pregnancy
Tolerance
Dependence
    Therapeutic dose dependence
    Prescribed high dose dependence
    Recreational benzodiazepine abuse

Socioeconomic costs of long-term benzodiazepine use

Further reading

Table 1. Benzodiazepines and similar drugs
Table 2. Therapeutic actions of benzodiazepines
Table 3. Some socioeconomic costs of long-term benzodiazepine use
Fig. 1. Diagram of mechanism of action of the natural neurotransmitter GABA (gamma aminobutyric acid) and benzodiazepine on nerve cells (neurons) in the brain

CHAPTER 2. HOW TO WITHDRAW FROM BENZODIAZEPINES AFTER LONG-TERM USE

Background

Why should you come off benzodiazepines?

Before starting benzodiazepine withdrawal
    Consult your doctor and pharmacist
    Make sure you have adequate psychological support
    Get into the right frame of mind
        Be confident
        Be patient
        Choose your own way

The withdrawal
    Dosage tapering
    Switching to a long-acting benzodiazepine
    Designing and following the withdrawal schedule
    Withdrawal in older people
    Withdrawal of antidepressants

Further reading

Slow withdrawal schedules

  • 1. Withdrawal from high dose (6mg) alprazolam (Xanax) daily with diazepam (Valium) substitution
  • 2. Simple withdrawal from diazepam (Valium) 40mg daily
  • 3. Withdrawal from lorazepam (Ativan) 6mg daily with diazepam (Valium) substitution
  • 4. Withdrawal from nitrazepam (Mogadon) 10mg at night with diazepam (Valium) substitution
  • 5. Withdrawal from clonazepam (Klonopin) 1.5mg daily with substitution of diazepam (Valium)
  • 6. Withdrawal from clonazepam (Klonopin) 3mg daily with substitution of diazepam (Valium)
  • 7. Withdrawal from alprazolam (Xanax) 4mg daily with diazepam (Valium) substitution
  • 8. Withdrawal from lorazepam (Ativan) 3mg daily with diazepam (Valium) substitution
  • 9. Withdrawal from temazepam (Restoril) 30mg nightly with diazepam (Valium) substitution
  • 10. Withdrawal from oxazepam (Serax) 20mg three times daily (60mg) with diazepam (Valium) substitution
  • 11. Withdrawal from chlordiazepoxide (Librium) 25mg three times daily (75mg)
  • 12. Withdrawal from zopiclone (Zimovane) 15mg with diazepam (Valium) substitution
  • 13. Antidepressant Withdrawal Table

CHAPTER 3. BENZODIAZEPINE WITHDRAWAL SYMPTOMS, ACUTE AND PROTRACTED

Mechanisms of withdrawal reactions

Acute withdrawal symptoms

Individual symptoms, their causes and how to deal with them
    Insomnia, nightmares, sleep disturbance
    Intrusive memories
    Panic attacks
    Generalised anxiety, panics and phobias
    Psychological techniques
    Complementary medicine techniques
    Exercise and other techniques
    Sensory hypersensitivity
    Depersonalisation, derealisation
    Hallucinations, illusions, perceptual distortions
    Depression, aggression, obsessions
    Muscle symptoms
    Bodily sensations
    Heart and lungs
    Problems with balance
    Digestive problems
    Immune system
    Endocrine problems
    Fits, convulsions

Extra medication during benzodiazepine withdrawal
    Antidepressants
    Beta-blockers
    Hypnotics and sedatives
    Other drugs

Benzodiazepine use during and after withdrawal

Diet, fluids and exercise
    Smoking

Course of withdrawal

Protracted withdrawal symptoms
    Anxiety
    Depression
    Insomnia
    Sensory and motor disturbances
    Possible mechanisms of persisting sensory and motor symptoms
    Poor memory and cognition
    Do benzodiazepines cause structural brain damage?
    Gastrointestinal symptoms
    Coping with protracted symptoms
    How long do benzodiazepines stay in the body after withdrawal?

Epilogue
    Education
    Research
    Treatment methods
    Provision of facilities

Further reading

Table 1. Benzodiazepine withdrawal symptoms
Table 2. Antidepressant withdrawal symptoms
Table 3. Some protracted benzodiazepine withdrawal symptoms
Table 4. Some possible causes of protracted benzodiazepine withdrawal symptoms

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Scroll to top
  • About Benzodiazepines
    • Benzo Basics
      • Ashton Manual
      • A Brief History Of Benzodiazepines
      • Class Actions and Lawsuits—and Reporting Harm 
      • FDA 2020 Benzodiazepine Boxed Warning
      • Medications and Supplements of Concern
      • Xanax Study Outcomes
    • Benzo Stories
    • Prescribing
      • Addiction vs Physical Dependence
      • Genetic Testing
      • Informed Consent
      • Low Dose Benzodiazepines
      • Mechanism of Action
      • Prescribing Statistics
      • Steps to Reduce Benzodiazepine Overprescribing
      • Therapeutic Actions
    • Prescribing Risks
      • Akathisia
      • Fluoroquinolones
      • Functional Brain Changes
      • Interdose Withdrawal
      • Paradoxical Reactions
      • Physical Dependence
      • Risks of Remaining on Benzodiazepines
      • Red Flags
      • Short-Term Risks
      • Side Effects
      • Suicide
      • Tolerance
    • Deprescribing
      • Ashton Manual
      • Tapering Strategies and Solutions
      • Detox, Cold Turkey, Abrupt Cessation
      • Estimates of Withdrawal
      • How To Find Tapering Help
      • Dosages Prevent Safe Withdrawal
      • Why Patients Shouldn’t Go To Detox or Rehab
    • Desprescribing Risks
      • Akathisia
      • Benzodiazepine Withdrawal Syndrome (BWS)
      • Forced Switching or Stopping
      • Functional Brain Changes
      • Kindling
      • Protracted Withdrawal Syndrome (PWS)
      • Suicide
      • Withdrawal & Post Withdrawal Symptoms
    • Special Populations
      • Benzodiazepines and PTSD
      • Celebrities
      • COVID-19
      • Elderly
      • Women
      • Incarcerated Population
      • Substance Use Disorders
  • About Us
    • Our Mission
    • Board Members and Advisors
    • Press Room
    • Receive Our Newsletter
    • FAQs
    • Volunteer
      • Informed Consent Policy
      • FDA Reporting Program
      • Share Your Story!
      • Media Interview List Registration
    • Contact Us
  • Our Impact
    • Media Outreach
    • Podcasts
    • Programs and Projects
    • Research and Publications
    • Speaking and Events
    • Quarterly Updates
    • Upcoming Events
  • Resources
    • Ashton Manual
    • Benzodiazepine Tapering Strategies and Solutions
    • Financial and Disability Information
    • How To Find Tapering Help
    • Support
    • Information
    • Benzodiazepine Cooperative Providers
  • Blog
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