These recommendations are in line with published reviews and guidelines on withdrawing benzodiazepines and are based on expert opinion [Mant and Walsh, 1997; Ashton, 2002b; Australian Government Department of Health and Ageing, 2004; Taylor et al, 2007; BNF 56, 2008; Lader et al, 2009].

Withdrawing z-drugs

• Although less well studied, given that they work similarly, the same approach for withdrawing benzodiazepines has been recommended as for withdrawing z-drugs [Ashton, 2002c].

Basis for gradual drug withdrawal

• Despite the lack of good quality evidence, gradual withdrawal of benzodiazepines is recommended to allow a smooth, gradual fall in blood-drug level, thus minimizing withdrawal symptoms. For further information, see Managing someone who wants to stop.

Time required for drug withdrawal

• Although some experts have recommended drug withdrawal over 8–12 weeks, or longer (such as 6 months) if the person has tried to stop before but failed [Lader et al, 2009], the time needed for drug withdrawal can vary from 4 weeks to a year or longer [Ashton, 2002b; Ashton, 2005; BNF 56, 2008].
• Consequently, no specified time frame has been recommended as drug withdrawal should be titrated according to the severity of withdrawal symptoms and individual preference. However, it is recommended that the person should not to be tempted to prolong the drug withdrawal to an extremely slow rate towards the end [Ashton, 2002b; Lader et al, 2009].

Examples of drug withdrawal schedules

• These are adapted from the Ashton Manual [Ashton, 2002c]. This widely published manual was developed on the basis of clinical experience of managing people withdrawing from benzodiazepines and z-drugs in an English specialist clinic over a 12-year period.
• The drug withdrawal schedules are comparable to that recommended by the British National Formulary which suggests withdrawing in steps of about one-eighth (range one-tenth to one-quarter) of the daily dose every fortnight [BNF 56, 2008].