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Benzodiazepine Taper

Heidi James, MD and Andrew Buelt, DO
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Benzodiazepines are commonly used to treat anxiety. While a recent Cochrane review showed that maybe they are not as harmful as we’ve traditionally believed, many patients would be better served by not being on these medications.  The article reviewed in this peice reviews a taper approach that begins with converting patients to an equivalent dose of diazepam and tapering that medication over 8-12 weeks.


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Ian L., Dr -

The length of time a patient was on benzodiazepines is important eg one year vs twenty years in deciding the taper regime.
Don't think you can do it in twelve weeks if the patient has been on benzodiazepines for twenty years especially if they still have some residual anxiety panic agitation .
I believe people on benzodiazepines would be helped by being abstinent from Alchohol as the Alchohol Withdrawal is more intense on benzodiazepines .
A comprehensive manual for benzodiazepine withdrawal is the Ashton Manuel by Professor Heather Ashton DM FRCP August 2002 .Can find
Comprehensive about Benzodiazepine withdrawal with equivelancy tables and Tables for withdrawal from all the named benzodiazepines .

Heidi J., MD -

Great points, Ian! Thanks for sharing.

Jennifer L. -

I have also found the Ashton Manual helpful for benzo tapers in the past. I wonder if the authors have any comments on that protocol?

Heidi J., MD -

Hi Jennifer - ah, yes, the Ashton Manual. Thanks for the reminder. Andrew and I will be talking a bit more about benzo tapers in the June Mailbag as this NEJM piece came out just after the episode was release. Stay tuned!

Shannon W., FNP-C -

Can you provide the reference for LFT monitoring on oral Terbinafine? I cannot seem to find a reference that indicates follow up LFTs no longer indicated in an asymtomatic, otherwise healthy individual. I appreciate your help and I love your Podcast!

Heidi J., MD -

Hi Shannon -
Sorry the reference wasn't easy to find: here it is! The Family Practice Notebook also included the updated recommendations:

Thanks for listening :)

Rose W., DMSc, PAC -

There was discussion of switching Ativan to Valium as a model of taper but what about others ie Klonopin and/or Xanax?

Heidi J., MD -

Hi Rose - I asked Andrew about this. He said that all the high quality studies used Valium as the benzo of choice for tapering. As far as converting benzos other than lorazepam to Valium, Andrew uses Micromedix as his go to resource, and I like this calculator -

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The Benzos & Fungus Among Us Full episode audio for MD edition 169:10 min - 79 MB - M4AHippo Primary Care RAP March 2017 Summary 563 KB - PDF