Benzodiazepine Tapering Guide

OffBenzos.com

Disclaimer: 

The information provided in this handout is for educational purposes only and is not intended as medical advice. It should not be used to diagnose or treat any health condition. Always consult with a qualified healthcare provider before making any changes to your medication or treatment plan.

Benzodiazepine Tapering Guide

You Set the Pace — We’re here to support you every step of the way.

We Believe in Patient EMPOWERED TAPERS: Eliminating Medications Through Patient Ownership of End Results. 

You Drive Dose Reductions Based on Self-Reported Symptom Severity

 Stage 1: Understand Why a Slow Taper Matters

Benzodiazepines can create a physical dependence, even when taken exactly as prescribed. If you stop suddenly, your nervous system can go into overdrive, which is why a gradual taper is the safest and most comfortable way to reduce or stop.

A slow taper lets your brain chemistry adapt gently and minimizes the risk of rebound symptoms

Stage 2: We Get a Baseline

Before starting a taper, your provider will:

• Review your medical and mental health history

• Review any other medications you’re taking

• Answer all your questions and concerns

• Identify the current dose and convert it (if needed) to an equivalent dose of diazepam (Valium®), which is long-acting and easier to taper.

• Use the CIWA-B scale (a screening instrument that evaluates benzodiazepine withdrawal severity) to get a baseline and track your withdrawal symptoms objectively over time. It’s a simple questionnaire that lets you and your provider measure things like anxiety, sleep, nausea, tremors, and more, so we can adjust as needed.

Stage 3: Switch to Diazepam (If Needed) slowly over one month

If you’re taking something like Xanax (alprazolam), Ativan (lorazepam), or Klonopin (clonazepam), we’ll likely switch you over to an equivalent dose of Valium. Why? Because Valium stays in your system longer and gives you a smoother, more stable taper.

Once we determine the correct Valium dose (typically over 1–4 weeks), we’ll maintain it until you feel stable before starting the reduction.

Stage 4: Start Your Taper – At Your Pace

Example: Higher than 10 mg of Valium: 5-10% of total dose every 2-4 weeks

From a 10 mg/day Valium baseline:

🟢 Most patients reduce by 0.5 to 1 mg every 2 to 4 weeks, but you can adjust the dosage and frequency more slowly if needed, to make it easier. We already have a low-dose, slow liquid taper plan below for you

🟡 If symptoms are strong, hold steady for another week or two

 🔴 If withdrawal is too intense, go back to the previous dose and stabilize

CIWA-B Benzodiazepine Withdrawal Severity Scores

• 🟢1-20: Mild withdrawal symptoms 🟢

•  🟡 21-40: Moderate withdrawal symptoms  🟡

•  🔴 41-60: Severe withdrawal symptoms  🔴

• We use the CIWA-B to help you monitor symptoms, so you don’t have to guess

• You can visit OffBenzos.com, test yourself, and view your score, or we can email it to you automatically. 

 This process continues slowly. The lower your dose gets, the slower we may go.

Stage 5: Easing the Bumps

Tapering isn’t always smooth — and that’s okay.

To help, your provider may suggest:

• Acamprosate (Campral®) – (non-addictive) Can help ease anxiety, restlessness, and sleep disruption by gently modulating your brain’s GABA system
  
  

• Sleep support –supplements like magnesium, CBT-I techniques
  
  

• Anxiety tools – Breathwork, Exercise, and guided meditations

Stage 6: Taper Holidays Are Okay

Feeling overwhelmed? You can pause your taper for a week, a month, or even two months. You don’t have to “power through.” This is your body, your healing, your call.

“Taper Holiday” = hold at your current dose, let your nervous system catch up, then continue when ready.

 Takeaways

• You’re in charge. We’re just your guide, cheerleader, and safety officer.

• Go slow. Go steady. 0.5–1 mg every 2–4 weeks is a safe and effective dose.

• You can also go lower and slower if you need to

• CIWA-B helps us monitor symptoms — so you don’t have to guess.

• There’s no shame in pausing. This is not a race. 

Read These Resources To Become A Taper Expert

How to Approach a Benzodiazepine Taper: Oregon Board of Pharmacy: A Great Resource

Ashton Manual

Joint Clinical Practice Guideline on Benzodiazepine Tapering: Tapering Benzodiazepine Medications: A Guide for Patients