Frequently Asked Questions

About Benzodiazepines

Commonly prescribed benzodiazepines include Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam) and Xanax (alprazolam). A complete list can be found here.

Informed consent is the process by which doctors empower patients with sufficient information to accept or decline treatment based on a full understanding of the relevant risks, benefits, and uncertainties related to the proposed intervention, as well as alternatives. For more information, see here.

While exact numbers are difficult to come by, an industry study conducted in 2012 found that 94 million prescriptions for benzodiazepines were filled annually in the United States.

Non-benzodiazepines (“Z-drugs”) are a class of psychoactive drugs that are benzodiazepine-like in nature. Non-benzodiazepine pharmacodynamics offer very similar benefits, side-effects, and risks as benzodiazepines. However, non-benzodiazepines have different chemical structures, and therefore differ from benzodiazepines on a molecular level.

Common side effects include memory and cognitive impairment, increased or new sleep impairments, increased or new anxiety, neuropathy, pins and needles sensations, unexplained new health or psychiatric problems, increased risk of Alzheimer’s disease, lack of balance with an increased risk of falling and related physical injuries, digestion issues, sleep apnea, and tremors. For a more complete list of side effects, see here.

Tolerance occurs when a higher dose of the drug is needed to achieve the same response achieved initially. Tolerance can be likened to a mini withdrawal for someone dependent on benzodiazepines, because the body demands the drug, and is technically receiving the drug but is too acclimated to the dose to respond in the intended manner.

Interdose withdrawal refers to the withdrawal effect experienced when the drug wears off prior to the next scheduled dose.

No. Patients, especially those still on the drug, tend to experience multiple “unexplained” issues and receive multiple incorrect diagnoses.

Yes. They impede the ability to retain information and form memories, which are essential for the most highly effective anxiety therapies, CBT and exposure therapy. They can also interfere with EMDR and first-line PTSD trauma processing therapies.

About BIC

Benzodiazepine-injured patients, who grew tired of suffering in silence, decided to take action and spread awareness and advocacy for patients about the benzodiazepine epidemic.

BIC provides resources on their website, instigates media coverage and research, and networks with medical professionals to break the silence around this epidemic and to bring benzodiazepine injury to the forefront of medical discussion.

We provide resources and recommended providers and support groups. We can not help individuals with specific cessation questions or support, and do not answer these questions. For more on specific providers and support groups, see here.

Absolutely not. BIC exists to educate on the dangers of benzodiazepines only.

No. Due to the complicated and potentially disabling nature of benzodiazepine cessation, we firmly believe each patient has the right to a fully informed consent in choosing if and when to take benzodiazepines, and to choose a taper rate of their own when they decide to stop taking them.

We hope to prevent further patient injury by providing accurate information on the risks of benzodiazepine use. We understand that the most complicated and dangerous aspect of benzodiazepine use is cessation; the last thing we want to see is an outright ban on benzodiazepines that would result in thousands of unnecessary deaths.

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About Benzodiazepine Cessation

Sudden cessation of benzodiazepines is highly dangerous, with the possibility of seizures, severe and/or protracted withdrawal syndrome, and even death. A sensible taper plan can avoid the risk of seizures and mitigate, although not eliminate, withdrawal symptoms.

A taper is a gradual reduction in benzodiazepine dosage. Depending on your individual situation, a taper may last weeks, months, or even years.

There are numerous ways of tapering, including cut-and-hold, microtaper (via scale or liquid titration), compounding and taper strips. You may choose to taper from your original drug or “crossover” to a longer acting benzodiazepine. For more information go here.

“Half-life” is the amount of time for the concentration of drug in the blood to fall by 50 percent. This time-period will vary between individuals. Commonly used “short” half-life benzodiazepines include Ativan and Xanax, while “long” half-life benzodiazepines include Klonopin, Valium, and Librium. Of note, Valium and Librium are further transformed into “active” metabolites, each with their own elimination half-lives. This means that they accumulate gradually and are cleared more slowly from the body, which can provide an advantage in tapering, as it can help prevent withdrawal between doses. Elimination half-lives are often doubled or tripled in the elderly, due to less efficient metabolism in the liver.

There is not yet adequate awareness in the U.S for the FDA to require this of manufacturers.

Kindling refers to the neurological condition resulting from repeated withdrawal episodes from sedative–hypnotic drugs such as alcohol and benzodiazepines. Each withdrawal leads to more severe withdrawal symptoms than the previous withdrawal syndrome. Individuals who have had multiple withdrawal episodes are at an increased risk of severe withdrawal symptoms.

Many patients are told they are doing a slow taper, when they are actually doing a fast taper. The rule of thumb is not more than 5-10% of the current dose every 2-4 weeks. Most tapers take 10 months or much longer.

All benzodiazepines have an estimated dose that is equivalent to doses of other benzodiazepines. Unlike opiates, equivalence conversions between different benzodiazepines are not defined or required by the FDA. Evidence-based information on benzodiazepine equivalents is limited and many different sources report dissenting information. For this reason, some equivalence rates are listed in a range, as they are estimates and mostly based on clinical observation and judgement. People who take prescribed benzodiazepines are unique and will not all have identical experiences. An equivalent dose that works for one person may be too low or too high for another person taking the exact same drug and dose.

Crossovers are not required, but some patients who are taking a shorter acting benzodiazepine may prefer to follow the Ashton Manual and switch to a longer-acting benzodiazepine, such as Valium. A patient who prefers to taper directly from their own drug can look into compounding, liquid compounding, tapering strips, a 0.001 gram scale, or liquid titration.