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Benzodiazepine and z-drug withdrawal - Management
Additional information

These schedules are adapted from the Ashton Manual [Ashton, 2002c].

  • Diazepam is available in a variety of strengths (2 mg, 5 mg, and 10 mg) and formulations (scored tablets or liquid) to facilitate dose reduction, particularly at lower doses.

Suggested withdrawal schedule for diazepam

  • From diazepam 40 mg per day or less:
    • Reduce dose by 2–4 mg every 1–2 weeks until reaching 20 mg per day, then
    • Reduce dose by 1–2 mg every 1–2 weeks until reaching 10 mg per day, then
    • Reduce dose by 1 mg every 1–2 weeks until reaching 5 mg per day, then
    • Reduce dose by 0.5–1 mg every 1–2 weeks until completely stopped.
  • Estimated total withdrawal time:
    • From diazepam 40 mg per day: 30–60 weeks.
    • From diazepam 20 mg per day: 20–40 weeks.

Suggested withdrawal schedules for temazepam, nitrazepam, and zopiclone without diazepam conversion

  • From temazepam 20 mg daily or less:
    • Reduce daily dose by a quarter of a 10 mg tablet (2.5 mg) every 2 weeks.
    • The target dose for when to stop is when the person is taking only a quarter of a 10 mg tablet as a daily dose.
    • If stopping is not possible at the target dose, offer temazepam liquid (10 mg/5 mL) and an oral syringe to achieve further reductions.
    • Estimated total withdrawal time: 16–20 weeks or longer.
  • From nitrazepam 10 mg daily or less:
    • Reduce the daily daily dose by a quarter of a 5 mg tablet (1.25 mg) every 2 weeks.
    • The target dose for when to stop is when the person is taking only a quarter of a 5 mg tablet as a daily dose.
    • If stopping is not possible at the target dose, offer nitrazepam (2.5 mg/5 mL) liquid and an oral syringe to achieve further reductions.
    • Estimated total withdrawal time: 16–20 weeks or longer.
  • From zopiclone 7.5 mg per day or less:
    • Reduce the daily dose by half of a 3.75 mg tablet (1.875 mg) every 2 weeks.
    • The target dose for when to stop is when the person is taking only half of a 3.75 mg tablet.
    • If stopping is not possible at the target dose, one option is to convert to diazepam to complete the withdrawal, although this is controversial.
    • Estimated total withdrawal time: 16–20 weeks or longer.

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