1. Calculate the total daily dose. Switch from short-acting agent (Alprazolam, Lorazepam) to longer-acting agent (Diazepam, Clonazepam, Chlordiazepoxide or Phenobarital). Upon initiation of taper, reduce the calculated dose by 25-50% to adjust for possible metabolic variance.

1. Pre-medicate two weeks prior to taper with Valproate 500mg BID or Carbamazepine 200mg every AM and 400mg every HS. Continue this medication for four weeks post-BZPs. Follow the usual safeguards (lab testing and blood levels) when prescribing these medications.

2. Schedule first follow-up visit two to four days after initiating taper to determine if adjustment in initial calculated dose is needed.

2. Utilize concomitant behavioral supports.

3. Reduce total daily dose by 5-10% per week in divided doses.

3. Discontinue current Benzodiazepine treatment and switch to Diazepam 2mg BID for two days, followed by 2mg every day for two days, then stop. For high doses, begin with 5mg BID for two days and then continue as described.

4. After ¼ to ½ of the dose is reached, you can slow the taper with cooperative patient.

4. Use adjuvant medications as mentioned above for rebound anxiety and other symptoms.

5. With cooperative patients who are having difficulty with this taper regimen, you can extend the total time of reduction to as much as six months.

6. Consider adjunctive agents to help with symptoms: Trazodone, Hydroxyzine, neuroleptics, anti-depressants, Clonidine and alpha-blocking agents.

Chlorodiazepoxide (Librium)

5-30 h

25mg

Diazepam (Valium)

20-50 h

10mg

Alprazolam (Xanax)

6-20 h

0.5mg

Clonazepam (Klonopin)

18-39 h

0.5mg

Lorazepam (Ativan)

10-20 h

1mg

Oxazepam (Serax)

3-21 h

15 mg

Triazolam (Halcion)

1.6-5.5 h

0.5mg

Phenobarbital (barbiturate)

53-118 h

30 mg