Benzodiazepines: Time to Say Goodbye?

Benzodiazepines: the good news and bad news, right? I mean, if you’re being knocked around by anxiety, they can bring quick relief. But, of course, there’s that multifaceted downside. Is it time to say goodbye?

I’ve wrestled with anxiety since I was a kid. A dozen or so years ago I left a psychiatrist’s office with a script for .25 mg clonazepam (Klonopin).

Naturally, I drove right to the pharmacy and waited for the fill.

How well I remember the euphoria not long after wolfing-down the first tablet. Absolutely, I felt an overwhelming sense of ease, as though a hundred pounds had been lifted from my shoulders. And I said to myself, “So this is what living is supposed to feel like.” Really, it was akin to the buzz I’d get from drinking those first couple of beers – in the old days.

Well, I did just one .25’er daily for two years and decided I no longer wanted to head for my briefcase first thing every morning. So I quit, and was fortunate not to have experienced withdrawal symptoms.

But it isn’t always quite that easy, is it?

Benzodiazepines: Popular Stuff

Visiting drugs.com, I put together a list of anxiety meds that includes brand name, generics, and OTCs. Of the twelve most popular, seven were benzodiazepines (benzos). You’ll see both the brand and generic name for a drug made the list three times.

Here they are in order of popularity: Xanax, clonazepam (Klonopin), alprazolam (Xanax), lorazepam (Ativan), Ativan, buspirone (Buspar), hydroxyzine (Vistaril), Lexapro, Buspar, Valium, diazepam (Valium), escitalopram (Lexapro).

Do you use any of them?

Benzodiazepine Information Coalition

If you’re ready to say goodbye to benzos, or know someone who is, I came upon a great resource: Benzodiazepine Information Coalition (BIC).

BICs mission is to provide education regarding the potential adverse effects of prescribed benzos. Their work includes prevention of patient injury through medical recognition, informed consent, and education.

Benzodiazepine Tapering Strategies and Solutions

Among the many valuable goodies on the BIC site is a blog with some great articles. I’d like to feature one of the pieces, “Benzodiazepine Tapering Strategies and Solutions.”

Now, the article, and my highlighting, provide some very detailed info regarding benzo tapering. Please understand, I’m presenting it for resource purposes, not direction or recommendation. I am not a physician. But be sure to chat with yours, okay?

So here are 10 highlights…

1. Benzos are schedule IV controlled substances, not recommended for use beyond two to four weeks. That said, prescribing them comes with the responsibility of providing an exit strategy.
2. Patients who aren’t able to successfully withdraw from a benzo in a few weeks may forfeit years of their life to an unsuccessful taper. So it’s imperative that docs and patients are educated about available methods of tapering.
3. A common taper method is to instruct the patient to cut a pill by 1/4 weekly. This leads to a completed taper in some four weeks. But many researchers, docs, and patients would consider a four week taper too rapid. Indeed, it’s been found to be ineffective for 32-42% of long-term benzo users.
4. Although there are other options available to patients and docs, the general guideline is not to exceed a 5-10% reduction in current dose every two to four weeks. But keep in mind, some benzos aren’t designed for gradual reduction.
5. When considering switching to a longer-acting benzo, conversion can be tricky. Professor Heather Ashton’s Benzodiazepine Equivalence Table offers a guide of average conversions. Of note, this guide, as well as assorted charts and doc opinions, can significantly vary.
6. Regarding meds to assist with a benzo taper, BICs experience from thousands of online support groups indicates many patients withdrawing from benzos develop multiple sensitivities to other medications, which seem to aggravate withdrawal symptoms. That means with a sufficiently slow, patient-led taper, additional meds are typically not necessary.
7. Those who dose at regular intervals are more likely to successfully complete a benzo taper because they don’t experience severe “drops” throughout the day between doses that make discontinuation intolerable. These symptoms are commonly referred to as “interdose” withdrawal.
8. The Ashton Manual is likely the best known “cut-and-hold” method in the benzo community. It has a 90% reported success rate, but still may be too fast for many patients to taper comfortably. Also, many patients can’t tolerate Valium, which the Ashton Manual requires. The Valium recommendation is based upon it coming in a much smaller dose and having a longer half-life than other benzos.
9. Dry-tapering is a popular method because of convenience and feelings of intimidation regarding other methods. It involves using a pill-cutter or scale and shaving-off a pill in compliance with a taper plan. Tapering Strips, a newcomer to the cessation market, is worth a look-see.
10. Liquid titration is a method known in the online support community. Simply, the patient makes a homemade suspension in water or milk. A pill is either crushed or allowed to disintegrate in, say, 300 mls of liquid. One ml is removed from the suspension and discarded, the rest ingested. More and more mls are reduced and discarded each day until nothing’s left.

So there you have 10 article highlights, but there’s so much more. You’ll find a link to the piece at the end.