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CHAPTER II



SLOW WITHDRAWAL SCHEDULES

A variety of withdrawal schedules from several benzodiazepines are illustrated below. Schedules such as these have worked on real people, but you may need to adapt them for your own needs. Reference to Table 1, Chapter I, which shows the equivalent strengths of different benzodiazepines, should enable you to work out your own programme and to devise an appropriate schedule for benzodiazepines such as prazepam (Centrax) and quazepam (Doral) and others which are not illustrated.

In my experience, the only exception to the general rule of slow reduction is triazolam (Halcion). This benzodiazepine is eliminated so quickly (half-life 2 hours) that you are practically withdrawn each day, after a dose the night before. For this reason, triazolam can be stopped abruptly without substitution of a long-acting benzodiazepine. If withdrawal symptoms occur, you could take a short course of diazepam starting at about 10mg, decreasing the dosage as shown on Schedule 2. The same approach applies to the non-benzodiazepines zolpidem and zaleplon which both have half-lives of 2 hours.

Schedule 1. Withdrawal from high dose (6mg) alprazolam (Xanax

daily with diazepam (Valium) substitution. (6mg alprazolam

is approximately equivalent to 120mg diazepam)

Morning Midday/Afternoon Evening/Night Daily Diazepam

Equivalent Starting dosage alprazolam 2mg alprazolam 2mg alprazolam 2mg 120mg Stage 1

(one week) alprazolam 2mg alprazolam 2mg alprazolam 1.5mg

diazepam 10mg 120mg Stage 2

(one week) alprazolam 2mg alprazolam 2mg alprazolam 1mg

diazepam 20mg 120mg Stage 3

(one week) alprazolam 1.5mg

diazepam 10mg alprazolam 2mg alprazolam 1mg

diazepam 20mg 120mg Stage 4

(one week) alprazolam 1mg

diazepam 20mg alprazolam 2mg alprazolam 1mg

diazepam 20mg 120mg Stage 5

(1-2 weeks) alprazolam 1mg

diazepam 20mg alprazolam 1mg

diazepam 10mg alprazolam 1mg

diazepam 20mg 110mg Stage 6

(1-2 weeks) alprazolam 1mg

diazepam 20mg alprazolam 1mg

diazepam 10mg alprazolam 0.5mg

diazepam 20mg 100mg Stage 7

(1-2 weeks) alprazolam 1mg

diazepam 20mg alprazolam 1mg

diazepam 10mg Stop alprazolam

diazepam 20mg 90mg Stage 8

(1-2 weeks) alprazolam 0.5mg

diazepam 20mg alprazolam 1mg

diazepam 10mg diazepam 20mg 80mg Stage 9

(1-2 weeks) alprazolam 0.5mg

diazepam 20mg alprazolam 0.5mg

diazepam 10mg diazepam 20mg 80mg Stage 10

(1-2 weeks) alprazolam 0.5mg

diazepam 20mg Stop alprazolam

diazepam 10mg diazepam 20mg 60mg Stage 11

(1-2 weeks) Stop alprazolam

diazepam 20mg diazepam 10mg diazepam 20mg 50mg Stage 12

(1-2 weeks) diazepam 25mg Stop midday dose;

divert 5mg each

to morning and

night doses diazepam 25mg 50mg Stage 13

(1-2 weeks) diazepam 20mg -- diazepam 25mg 45mg Stage 14

(1-2 weeks) diazepam 20mg -- diazepam 20mg 40mg

Continue as on Schedule 2, reducing from diazepam 40mg

Schedule 1 Notes:

There is no actual withdrawal (only diazepam substitution) in Stages 1-4, so these could be undertaken at weekly intervals (but you could take 2 weeks for each stage if preferred). The evening dose of diazepam could be taken at bed-time, rather than with the alprazolam if that is usually taken earlier. (Do not take any other sleeping tablet). Some dosage reduction occurs in later stages of the diazepam switchover (Stages 5-11), so these stages could be undertaken at two week intervals. Even at reducing doses, the diazepam should cover withdrawal from alprazolam, because by this time it has had time to work through the body and will be acting smoothly both day and night. The aim is to obtain a dose of diazepam which avoids withdrawal symptoms but is not so great as to make you sleepy. At Stage 12 it would be sensible to move to twice daily dosage. Diazepam is long-acting and there is no need to take it more than twice a day. There is no reduction in dosage while you make this change (Stages 11 and 12).

Schedule 2. Simple withdrawal from diazepam (Valium) 40mg daily

(follow this schedule to complete Schedule 1)

Morning Night Total

Daily Dosage Starting dosage diazepam 20mg diazepam 20mg 40mg Stage 1 (1-2 weeks) diazepam 18mg diazepam 20mg 38mg Stage 2 (1-2 weeks) diazepam 18mg diazepam 18mg 36mg Stage 3 (1-2 weeks) diazepam 16mg diazepam 18mg 34mg Stage 4 (1-2 weeks) diazepam 16mg diazepam 16mg 32mg Stage 5 (1-2 weeks) diazepam 14mg diazepam 16mg 30mg Stage 6 (1-2 weeks) diazepam 14mg diazepam 14mg 28mg Stage 7 (1-2 weeks) diazepam 12mg diazepam 14mg 26mg Stage 8 (1-2 weeks) diazepam 12mg diazepam 12mg 24mg Stage 9 (1-2 weeks) diazepam 10mg diazepam 12mg 22mg Stage 10 (1-2 weeks) diazepam 10mg diazepam 10mg 20mg Stage 11 (1-2 weeks) diazepam 8mg diazepam 10mg 18mg Stage 12 (1-2 weeks) diazepam 8mg diazepam 8mg 16mg Stage 13 (1-2 weeks) diazepam 6mg diazepam 8mg 14mg Stage 14 (1-2 weeks) diazepam 5mg diazepam 8mg 13mg Stage 15 (1-2 weeks) diazepam 4mg diazepam 8mg 12mg Stage 16 (1-2 weeks) diazepam 3mg diazepam 8mg 11mg Stage 17 (1-2 weeks) diazepam 2mg diazepam 8mg 10mg Stage 18 (1-2 weeks) diazepam 1mg diazepam 8mg 9mg Stage 19 (1-2 weeks) -- diazepam 8mg 8mg Stage 20 (1-2 weeks) -- diazepam 7mg 7mg Stage 21 (1-2 weeks) -- diazepam 6mg 6mg Stage 22 (1-2 weeks) -- diazepam 5mg 5mg Stage 23 (1-2 weeks) -- diazepam 4mg 4mg Stage 24 (1-2 weeks) -- diazepam 3mg 3mg Stage 25 (1-2 weeks) -- diazepam 2mg 2mg Stage 26 (1-2 weeks) -- diazepam 1mg 1mg

Schedule 2 Notes:

You could probably manage Stages 1-5 (or even Stages 1-10) in weekly intervals (but take 2 weeks between stages if you prefer). The later stages are probably better taken in 2 week intervals. When you get down to a dose of 5mg daily, you could begin to decrease in 0.5mg doses, but most people manage with 1mg reductions. You will need to utilise a mixture of 10mg, 5mg, and 2mg diazepam tablets to obtain the required dosages. Halve the (scored) 2mg tablet to obtain 1mg doses. If your starting dose is 20mg diazepam daily, you could begin at Stage 10, but in this case you could reduce by 1mg every 2 weeks. If starting from Schedule 1 (alprazolam 6mg daily) continue your reduction using this schedule.

Schedule 3. Withdrawal from lorazepam (Ativan) 6mg daily

with diazepam (Valium) substitution. (6mg lorazepam is

approximately equivalent to 60mg diazepam)

Morning Midday/Afternoon Evening/Night Daily Diazepam

Equivalent Starting dosage lorazepam 2mg lorazepam 2mg lorazepam 2mg 60mg Stage 1

(one week) lorazepam 2mg lorazepam 2mg lorazepam 1mg

diazepam 10mg 60mg Stage 2

(one week) lorazepam 1.5mg

diazepam 5mg lorazepam 2mg lorazepam 1mg

diazepam 10mg 60mg Stage 3

(one week) lorazepam 1.5mg

diazepam 5mg lorazepam 2mg lorazepam 0.5mg

diazepam 15mg 60mg Stage 4

(one week) lorazepam 1.5mg

diazepam 5mg lorazepam 1.5mg

diazepam 5mg lorazepam 0.5mg

diazepam 15mg 60mg Stage 5

(1-2 weeks) lorazepam 1.5mg

diazepam 5mg lorazepam 1.5mg

diazepam 5mg Stop lorazepam

diazepam 20mg 60mg Stage 6

(1-2 weeks) lorazepam 1mg

diazepam 5mg lorazepam 1.5mg

diazepam 5mg diazepam 20mg 55mg Stage 7

(1-2 weeks) lorazepam 1mg

diazepam 5mg lorazepam 1mg

diazepam 5mg diazepam 20mg 50mg Stage 8

(1-2 weeks) lorazepam 0.5mg

diazepam 5mg lorazepam 1mg

diazepam 5mg diazepam 20mg 45mg Stage 9

(1-2 weeks) lorazepam 0.5mg

diazepam 5mg lorazepam 0.5mg

diazepam 5mg diazepam 20mg 40mg Stage 10

(1-2 weeks) Stop lorazepam

diazepam 5mg lorazepam 0.5mg

diazepam 5mg diazepam 20mg 35mg Stage 11

(1-2 weeks) diazepam 5mg Stop lorazepam

diazepam 5mg diazepam 20mg 30mg Stage 12

(1-2 weeks) diazepam 5mg diazepam 5mg diazepam 18mg 28mg Stage 13

(1-2 weeks) diazepam 5mg diazepam 5mg diazepam 16mg 26mg Stage 14

(1-2 weeks) diazepam 5mg diazepam 5mg diazepam 14mg 24mg Stage 15

(1-2 weeks) diazepam 5mg diazepam 5mg diazepam 12mg 22mg Stage 16

(1-2 weeks) diazepam 5mg diazepam 5mg diazepam 10mg 20mg Stage 17

(1-2 weeks) diazepam 5mg diazepam 4mg diazepam 10mg 19mg Stage 18

(1-2 weeks) diazepam 4mg diazepam 4mg diazepam 10mg 18mg Stage 19

(1-2 weeks) diazepam 4mg diazepam 3mg diazepam 10mg 17mg Stage 20

(1-2 weeks) diazepam 3mg diazepam 3mg diazepam 10mg 16mg Stage 21

(1-2 weeks) diazepam 3mg diazepam 2mg diazepam 10mg 15mg Stage 22

(1-2 weeks) diazepam 2mg diazepam 2mg diazepam 10mg 14mg Stage 23

(1-2 weeks) diazepam 2mg diazepam 1mg diazepam 10mg 13mg Stage 24

(1-2 weeks) diazepam 1mg diazepam 1mg diazepam 10mg 12mg Stage 25

(1-2 weeks) diazepam 1mg Stop diazepam diazepam 10mg 11mg Stage 26

(1-2 weeks) Stop diazepam -- diazepam 10mg 10mg Stage 27

(1-2 weeks) -- -- diazepam 9mg 9mg Stage 28

(1-2 weeks) -- -- diazepam 8mg 8mg Stage 29

(1-2 weeks) -- -- diazepam 7mg 7mg Stage 30

(1-2 weeks) -- -- diazepam 6mg 6mg Stage 31

(1-2 weeks) -- -- diazepam 5mg 5mg Stage 32

(1-2 weeks) -- -- diazepam 4mg 4mg Stage 33

(1-2 weeks) -- -- diazepam 3mg 3mg Stage 34

(1-2 weeks) -- -- diazepam 2mg 2mg Stage 35

(1-2 weeks) -- -- diazepam 1mg 1mg Stage 36 -- -- Stop diazepam --

Schedule 3 Notes:

There is no actual withdrawal (only diazepam substitution) in Stages 1-5, so these could be undertaken at weekly intervals (but you could take 2 weeks if preferred). The evening dose of diazepam could be taken at bed-time, rather than with the lorazepam if that is usually taken earlier. (Do not take any other sleeping tablet). Some dosage reduction occurs during the later stages of the diazepam switchover (Stages 6-11), so these stages could be undertaken at two week intervals. Even at reducing doses, the diazepam should cover withdrawal from lorazepam, because by this time it has had time to work through the body and will be acting smoothly both day and night. The aim is to obtain a dose of diazepam which avoids withdrawal symptoms but is not so great as to make you sleepy. Day-time doses of diazepam are gradually phased out (Stages 17-25); in succeeding stages you only need to phase out the night-time dose by 1mg every week or two. A mixture of 10mg, 5mg and 2mg diazepam tablets will be needed to obtain the required doses. Halve the (scored) 2mg tablets to obtain 1mg doses.

Schedule 4. Withdrawal from nitrazepam (Mogadon) 10mg at

night with diazepam (Valium) substitution. (Nitrazepam

is approximately the same strength as diazepam)

Bed-time dose Starting dosage nitrazepam 10mg Stage 1 (1 week) nitrazepam 5mg

diazepam 5mg Stage 2 (1 week) Stop nitrazepam

diazepam 10mg Stage 3 (1-2 weeks) diazepam 9mg Stage 4 (1-2 weeks) diazepam 8mg Stage 5 (1-2 weeks) diazepam 7mg Stage 6 (1-2 weeks) diazepam 6mg Stage 7 (1-2 weeks) diazepam 5mg Stage 8 (1-2 weeks) diazepam 4mg Stage 9 (1-2 weeks) diazepam 3mg Stage 10 (1-2 weeks) diazepam 2mg Stage 11 (1-2 weeks) diazepam 1mg Stage 12 Stop diazepam

Schedule 4 Notes:

If you are taking more than 10mg nitrazepam, replace each 5mg nitrazepam, one at a time, with 5mg diazepam, then reduce the diazepam in 1mg or 2mg stages.

Schedule 5. Withdrawal from clonazepam (Klonopin) 1.5mg daily with

substitution of diazepam (Valium). (0.5mg clonazepam

is approximately equivalent to 10mg diazepam)

Morning Midday/Afternoon Evening/Night Daily Diazepam

Equivalent Starting dosage clonazepam 0.5mg clonazepam 0.5mg clonazepam 0.5mg 30mg Stage 1

(1 week) clonazepam 0.5mg clonazepam 0.5mg clonazepam 0.25mg

diazepam 5mg 30mg Stage 2

(1 week) clonazepam 0.5mg clonazepam 0.5mg Stop clonazepam

diazepam 10mg 30mg Stage 3

(1 week) clonazepam 0.25mg

diazepam 5mg clonazepam 0.5mg diazepam 10mg 30mg Stage 4

(1 week) clonazepam 0.25mg

diazepam 5mg clonazepam 0.25mg

diazepam 5mg diazepam 10mg 30mg Stage 5

(1 week) Stop clonazepam

diazepam 10mg clonazepam 0.25mg

diazepam 5mg diazepam 10mg 30mg Stage 6

(1-2 weeks) diazepam 10mg Stop clonazepam

diazepam 8mg diazepam 10mg 28mg Stage 7

(1-2 weeks) diazepam 10mg diazepam 6mg diazepam 10mg 26mg Stage 8

(1-2 weeks) diazepam 10mg diazepam 4mg diazepam 10mg 24mg Stage 9

(1-2 weeks) diazepam 10mg diazepam 2mg diazepam 10mg 22mg Stage 10

(1-2 weeks) diazepam 10mg Stop diazepam diazepam 10mg 20mg Stage 11

(1-2 weeks) diazepam 8mg -- diazepam 10mg 18mg Stage 12

(1-2 weeks) diazepam 6mg -- diazepam 10mg 16mg Stage 13

(1-2 weeks) diazepam 4mg -- diazepam 10mg 14mg Stage 14

(1-2 weeks) diazepam 2mg -- diazepam 10mg 12mg Stage 15

(1-2 weeks) Stop diazepam -- diazepam 10mg 10mg Continue reducing remaining diazepam by 1 mg every 2 weeks (see Schedule 3 Stage 26)

Schedule 6. Withdrawal from clonazepam (Klonopin) 3mg

daily with substitution of diazepam (Valium).

(1 mg clonazepam is equivalent to 20mg diazepam)

Morning Midday/Afternoon Evening/Night Daily Diazepam

Equivalent Starting dosage clonazepam 1mg clonazepam 1mg clonazepam 1mg 60mg Stage 1

(1-2 weeks) clonazepam 1mg clonazepam 1mg clonazepam 0.5mg

diazepam 10mg 60mg Stage 2

(1-2 weeks) clonazepam 0.5mg

diazepam 10mg clonazepam 1mg clonazepam 0.5mg

diazepam 10mg 60mg Stage 3

(1-2 weeks) clonazepam 0.5mg

diazepam 10mg clonazepam 0.5mg

diazepam 5mg clonazepam 0.5mg

diazepam 10mg 55mg Stage 4

(1-2 weeks) clonazepam 0.5mg

diazepam 10mg clonazepam 0.5mg

diazepam 5mg Stop clonazepam

diazepam 15mg 50mg Stage 5

(1-2 weeks) clonazepam 0.25mg

diazepam 10mg clonazepam 0.5mg

diazepam 5mg diazepam 15mg 45mg Stage 6

(1-2 weeks) clonazepam 0.25mg

diazepam 10mg clonazepam 0.25mg

diazepam 5mg diazepam 15mg 40mg Stage 7

(1-2 weeks) Stop clonazepam

diazepam 10mg clonazepam 0.25mg

diazepam 5mg diazepam 15mg 35mg Stage 8

(1-2 weeks) diazepam 10mg Stop clonazepam

diazepam 5mg diazepam 15mg 30mg Stage 9

(1-2 weeks) diazepam 10mg diazepam 2.5mg diazepam 15mg 27.5mg Stage 10

(1-2 weeks) diazepam 12mg Stop diazepam diazepam 15mg 27mg Stage 11

(1-2 weeks) diazepam 10mg -- diazepam 15mg 25mg Stage 12

(1-2 weeks) diazepam 10mg -- diazepam 14mg 24mg Stage 13

(1-2 weeks) diazepam 10mg -- diazepam 12mg 22mg Stage 14

(1-2 weeks) diazepam 10mg -- diazepam 10mg 20mg Continue from Schedule 5, Stage 10

Schedule 6 Notes:

The small reduction (27.5mg to 27mg) between Stages 9 and 10 is to allow you to adjust to twice daily dose.

Schedule 7. Withdrawal from alprazolam (Xanax) 4mg daily with

diazepam (Valium) substitution (4mg alprazolam is

approximately equivalent to 80mg diazepam)

Morning Midday Afternoon Evening Daily Diazepam

Equivalent Starting dosage alprazolam 1mg alprazolam 1mg alprazolam 1mg alprazolam 1mg 80mg Stage 1

(1 week) alprazolam 1mg alprazolam 1mg alprazolam 1mg alprazolam 0.5mg

diazepam 10mg 80mg Stage 2

(1 week) alprazolam 1mg alprazolam 0.5mg

diazepam 10mg alprazolam 1mg alprazolam 0.5mg

diazepam 10mg 80mg Stage 3

(1 week) alprazolam 0.5mg

diazepam 10mg alprazolam 0.5mg

diazepam 10mg alprazolam 1mg alprazolam 0.5mg

diazepam 10mg 80mg Stage 4

(1 week) alprazolam 0.5mg

diazepam 10mg alprazolam 0.5mg

diazepam 10mg alprazolam 0.5mg

diazepam 10mg alprazolam 0.5mg

diazepam 10mg 80mg Stage 5

(1 week) alprazolam 0.5mg

diazepam 10mg alprazolam 0.5mg

diazepam 10mg alprazolam 0.5mg

diazepam 10mg alprazolam 0.5mg

diazepam 10mg 80mg Stage 6

(1-2 weeks) alprazolam 0.5mg

diazepam 10mg alprazolam 0.25mg

diazepam 10mg alprazolam 0.5mg

diazepam 10mg diazepam 20mg 75mg Stage 7

(1-2 weeks) alprazolam 0.25mg

diazepam 10mg alprazolam 0.25mg

diazepam 10mg alprazolam 0.5mg

diazepam 10mg diazepam 20mg 70mg Stage 8

(1-2 weeks) alprazolam 0.25mg

diazepam 10mg alprazolam 0.25mg

diazepam 10mg alprazolam 0.25mg

diazepam 10mg diazepam 20mg 65mg Stage 9

(1-2 weeks) alprazolam 0.25mg

diazepam 10mg Stop alprazolam

diazepam 10mg alprazolam 0.25mg

diazepam 10mg diazepam 20mg 60mg Stage 10

(1-2 weeks) Stop alprazolam

diazepam 10mg diazepam 10mg alprazolam 0.25mg

diazepam 10mg diazepam 20mg 55mg Stage 11

(1-2 weeks)

diazepam 10mg diazepam 10mg Stop alprazolam

diazepam 10mg diazepam 20mg 50mg Stage 12

(1-2 weeks)

diazepam 10mg diazepam 5mg diazepam 10mg diazepam 20mg 45mg Stage 13

(1-2 weeks)

diazepam 5mg diazepam 5mg diazepam 10mg diazepam 20mg 40mg Stage 14

(1-2 weeks)

diazepam 5mg diazepam 5mg diazepam 5mg diazepam 20mg 35mg Stage 15

(1-2 weeks)

diazepam 5mg diazepam 5mg diazepam 5mg diazepam 15mg 30mg Stage 16

(1-2 weeks)

diazepam 5mg diazepam 5mg diazepam 5mg diazepam 12.5mg 27.5mg Stage 17

(1-2 weeks)

diazepam 5mg diazepam 5mg diazepam 5mg diazepam 10mg 25mg Stage 18

(1-2 weeks)

diazepam 5mg diazepam 2.5mg diazepam 5mg diazepam 10mg 22.5mg Stage 19

(1-2 weeks)

diazepam 5mg Stop diazepam diazepam 5mg diazepam 10mg 20mg Stage 20

(1-2 weeks)

diazepam 4mg -- diazepam 5mg diazepam 10mg 19mg Stage 21

(1-2 weeks)

diazepam 4mg -- diazepam 4mg diazepam 10mg 18mg Stage 22

(1-2 weeks)

diazepam 4mg -- diazepam 3mg diazepam 10mg 17mg Stage 23

(1-2 weeks)

diazepam 3mg -- diazepam 3mg diazepam 10mg 16mg Stage 24

(1-2 weeks)

diazepam 3mg -- diazepam 2mg diazepam 10mg 15mg Stage 25

(1-2 weeks)

diazepam 2mg -- diazepam 2mg diazepam 10mg 14mg Stage 26

(1-2 weeks)

diazepam 2mg -- Stop diazepam diazepam 10mg 12mg Stage 27

(1-2 weeks) Stop diazepam -- -- diazepam 10mg 10mg Continue reducing diazepam by 1mg every 2 weeks (see Schedule 3, Stage 26)

Schedule 7 Notes:

The evening diazepam dose can be taken at bed-time, rather than with alprazolam if that is usually taken earlier.

Schedule 8. Withdrawal from lorazepam (Ativan) 3mg daily with

diazepam (Valium) substitution. (3mg lorazepam

is approximately equivalent to 30mg diazepam)

Morning Midday/Afternoon Evening/Night Daily Diazepam

Equivalent Starting dosage lorazepam 1 mg lorazepam 1 mg lorazepam 1 mg 30mg Stage 1

(1 week) lorazepam 1 mg lorazepam 1 mg lorazepam 0.5mg

diazepam 5mg 30mg Stage 2

(1 week) lorazepam 0.5mg

diazepam 5mg lorazepam 1 mg lorazepam 0.5mg

diazepam 5mg 30mg Stage 3

(1 week) lorazepam 0.5mg

diazepam 5mg lorazepam 0.5mg

diazepam 5mg lorazepam 0.5mg

diazepam 5mg 30mg Stage 4

(1 week) lorazepam 0.5mg

diazepam 5mg lorazepam 0.5mg

diazepam 5mg Stop lorazepam

diazepam 10mg 30mg Stage 5

(1 week) Stop lorazepam

diazepam 10mg lorazepam 0.5mg

diazepam 5mg diazepam 10mg 30mg Stage 6

(1 week) diazepam 10mg Stop lorazepam

diazepam 10mg diazepam 10mg 30mg Stage 7

(1-2 weeks) diazepam 10mg diazepam 8mg diazepam 10mg 28mg Stage 8

(1-2 weeks) diazepam 8mg diazepam 8mg diazepam 10mg 26mg Stage 9

(1-2 weeks) diazepam 8mg diazepam 6mg diazepam 10mg 24mg Stage 10

(1-2 weeks) diazepam 6mg diazepam 6mg diazepam 10mg 22mg Stage 11

(1-2 weeks) diazepam 6mg diazepam 4mg diazepam 10mg 20mg Stage 12

(1-2 weeks) diazepam 6mg diazepam 2mg diazepam 10mg 18mg Stage 13

(1-2 weeks) diazepam 6mg Stop diazepam diazepam 10mg 16mg Stage 14

(1-2 weeks) diazepam 5mg -- diazepam 10mg 15mg Stage 15

(1-2 weeks) diazepam 4mg -- diazepam 10mg 14mg Stage 16

(1-2 weeks) diazepam 3mg -- diazepam 10mg 13mg Stage 17

(1-2 weeks) diazepam 2mg -- diazepam 10mg 12mg Stage 18

(1-2 weeks) diazepam 1mg -- diazepam 10mg 11mg Stage 19

(1-2 weeks) Stop diazepam -- diazepam 10mg 10mg Continue reducing night time diazepam by 1 mg every 1-2 weeks (See Schedule 3, Stage 26)

Schedule 9. Withdrawal from temazepam (Restoril) 30mg

nightly with diazepam substitution. (30mg temazepam is

approximately equivalent to 15mg diazepam)

Night time Equivalent diazepam dosage Starting dosage temazepam 30mg 15mg Stage 1 (1-2 weeks) temazepam 15mg

diazepam 7.5mg 15mg Stage 2 (1-2 weeks) temazepam 7.5mg

diazepam 12mg 15.75mg Stage 3 (1-2 weeks) Stop temazepam

diazepam 15mg 15mg Stage 4 (1-2 weeks) diazepam 14mg 14mg Stage 5 (1-2 weeks) diazepam 13mg 13mg Stage 6 (1-2 weeks) diazepam 12mg 12mg Stage 7 (1-2 weeks) diazepam 11mg 11mg Stage 8 (1-2 weeks) diazepam 10mg 10mg Stage 9 (1-2 weeks) diazepam 9mg 9mg Stage 10 (1-2 weeks) diazepam 8mg 8mg Stage 11 (1-2 weeks) diazepam 7mg 7mg Stage 12 (1-2 weeks) diazepam 6mg 6mg Stage 13 (1-2 weeks) diazepam 5mg 5mg Stage 14 (1-2 weeks) diazepam 4mg 4mg Stage 15 (1-2 weeks) diazepam 3mg 3mg Stage 16 (1-2 weeks) diazepam 2mg 2mg Stage 17 (1-2 weeks) diazepam 1mg 1mg Stage 18 Stop diazepam --

Schedule 10. Withdrawal from oxazepam (Serax) 20mg three times

daily (60mg) with diazepam (Valium) substitution (20mg

oxazepam is approximately equivalent to 10mg diazepam)

Morning Midday Evening/Night Daily Diazepam

Equivalent Starting dosage oxazepam 20mg oxazepam 20mg oxazepam 20mg 30mg Stage 1

(1 week) oxazepam 20mg oxazepam 20mg oxazepam 10mg

diazepam 5mg 30mg Stage 2

(1 week) oxazepam 10mg

diazepam 5mg oxazepam 20mg oxazepam 10mg

diazepam 5mg 30mg Stage 3

(1 week) oxazepam 10mg

diazepam 5mg oxazepam 10mg

diazepam 5mg oxazepam 10mg

diazepam 5mg 30mg Stage 4

(1-2 weeks) oxazepam 10mg

diazepam 5mg oxazepam 10mg

diazepam 5mg Stop oxazepam

diazepam 8mg 28mg Stage 5

(1-2 weeks) Stop oxazepam

diazepam 8mg oxazepam 10mg

diazepam 5mg diazepam 8mg 26mg Stage 6

(1-2 weeks) diazepam 8mg Stop oxazepam

diazepam 8mg diazepam 8mg 24mg Stage 7

(1-2 weeks) diazepam 10mg diazepam 2mg diazepam 10mg 22mg Stage 8

(1-2 weeks) diazepam 10mg Stop diazepam diazepam 10mg 20mg Stage 9

(1-2 weeks) diazepam 8mg -- diazepam 10mg 18mg Continue as on Schedule 2 from Stage 12

Schedule 10 Notes:

Oxazepam is short-acting (half-life 4-15 hrs) so substitution to diazepam (long-acting) is recommended. Diazepam need only be taken twice a day. A change from 5mg to 2mg diazepam tablets is necessary from Stage 4 onwards.

Schedule 11. Withdrawal from chlordiazepoxide (Librium) 25mg

three times daily (75mg). (25mg chlordiazepoxide

is approximately equivalent to 10mg diazepam)

Morning Midday Evening/Night Starting dosage chlordiazepoxide 25mg chlordiazepoxide 25mg chlordiazepoxide 25mg Stage 1

(1-2 weeks) chlordiazepoxide 25mg chlordiazepoxide 20mg chlordiazepoxide 25mg Stage 2

(1-2 weeks) chlordiazepoxide 20mg chlordiazepoxide 20mg chlordiazepoxide 25mg Stage 3

(1-2 weeks) chlordiazepoxide 20mg chlordiazepoxide 20mg chlordiazepoxide 20mg Stage 4

(1-2 weeks) chlordiazepoxide 25mg chlordiazepoxide 5mg chlordiazepoxide 25mg Stage 5

(1-2 weeks) chlordiazepoxide 25mg Stop chlordiazepoxide chlordiazepoxide 25mg Stage 6

(1-2 weeks) chlordiazepoxide 20mg -- chlordiazepoxide 25mg Stage 7

(1-2 weeks) chlordiazepoxide 20mg -- chlordiazepoxide 20mg Stage 8

(1-2 weeks) chlordiazepoxide 15mg -- chlordiazepoxide 20mg Stage 9

(1-2 weeks) chlordiazepoxide 15mg -- chlordiazepoxide 15mg Stage 10

(1-2 weeks) chlordiazepoxide 10mg -- chlordiazepoxide 15mg Stage 11

(1-2 weeks) chlordiazepoxide 10mg -- chlordiazepoxide 10mg Stage 12

(1-2 weeks) chlordiazepoxide 5mg -- chlordiazepoxide 10mg Stage 13

(1-2 weeks) chlordiazepoxide 5mg -- chlordiazepoxide 5mg Stage 14

(1-2 weeks) chlordiazepoxide

2.5mg (½ tablet) -- chlordiazepoxide 5mg Stage 15

(1-2 weeks) chlordiazepoxide

2.5mg (½ tablet) -- chlordiazepoxide

2.5mg (½ tablet) Stage 16

(1-2 weeks) Stop chlordiazepoxide -- chlordiazepoxide

2.5mg (½ tablet) Stage 17 -- -- Stop chlordiazepoxide

Schedule 11 Notes:

Chlordiazepoxide is long-acting so there is no need to take it more frequently than twice a day (hence Stages 4 and 5). Because chlordiazepoxide is long-acting, there is no need for diazepam substitution. If you are taking chlordiazepoxide capsules, change to tablets which can be halved for stages 14 onwards.

Schedule 12. Withdrawal from zopiclone (Zimovane) 15mg

with diazepam (Valium) substitution. (15mg zopiclone

is approximately equivalent to 10mg diazepam)

Night time Daily Diazepam

Equivalent Starting dosage zopiclone 15mg 10mg Stage 1

(1 week) zopiclone 7.5mg

diazepam 5mg 10mg Stage 2

(1 week) Stop zopiclone

diazepam 10mg 10mg Stage 3 (1-2 weeks) diazepam 9mg 9mg Stage 4 (1-2 weeks) diazepam 8mg 8mg Then continue reducing diazepam by 1mg every 1-2 weeks as on Schedule 2

Schedule 12 Notes:

It is possible to withdraw directly from zopiclone using the smallest available tablets (3.75mg), but this dose of zopiclone is equivalent to 2.5mg diazepam making for rather abrupt dosage reductions. This method can also be used for withdrawing from loprazolam and lormetazepam. 1mg of each of these is approximately equivalent to 10mg diazepam; their half-lives are 6-12 and 10-12 hrs respectively.

Schedule 13. Antidepressant Withdrawal Table

Drugs Dosage strengths and formulations* Tricyclics amitriptyline (Tryptizol, Elavil) tabs 10, 25, 50mg; liquid 25mg/5ml amoxapine (Asendis) tabs 25, 50, 100mg clomipramine (Anafranil) caps 10, 25, 50mg; syrup 25mg/5ml dothiepin (Prothiaden) tabs 25, 75mg doxepin (Sinequan) caps 10, 25, 50, 75mg imipramine (Tofranil) tabs 10, 25mg syrup 25mg/5ml lofepramine (Gamanil) tabs 70mg; liquid 70mg/5ml nortriptyline (Allegron, Pamelor) tabs 10, 25mg protriptyline (Concordin, Vivactil) tabs 5, 10mg trimipramine (Surmontil) tabs 10, 25mg Related antidepressants maprotiline (Ludiomil) tabs 10, 25, 50, 75mg mianserin (Bolvidon, Norval) tabs 10, 30mg trazodone (Molipaxin, Desyrel) caps 50, 100mg; tabs 150mg; liquid 50mg/5ml viloxazine (Vivalan) tabs 50mg MAOIs (monoamine oxidase inhibitors) phenelzine (Nardil) tabs 15mg moclobemide (Mannerix) tabs 150mg tranylcypromine (Parnate) tabs 10mg SSRIs (selective serotonin reuptake inhibitors) citalopram (Cipramil, Celexa) tabs 10, 20, 40mg; liquid 40mg/ml (drops) fluoxetine (Prozac) caps 20, 60mg; liquid 20mg/5ml fluvoxamine (Faverin, Luvox) tabs(s) 50, 100mg paroxetine (Seroxat, Paxil) tabs(s) 20, 30mg; liquid 20mg/5ml sertraline (Lustral, Zoloft) tabs 50, 100mg escitalopram (Cipralex, Lexapro) tabs 5, 10(s), 20mg(s) Others mirtazapine (Zispin, Remeron) tabs(s) 30mg nefazodone (Dutonin, Serzone) tabs(s) 100, 200mg reboxetine (Edronax, Vestra) tabs(s) 4mg venlafaxine (Efexor, Effexor) tabs 37.5, 75mg * tabs: tablets, (s) scored; caps: capsules; 5ml = 1 teaspoon

Schedule 13 Notes:

Guidelines for benzodiazepine users who are also taking an antidepressant and wish to withdraw from both drugs Complete the benzodiazepine withdrawal before starting to taper the antidepressant. Allow at least 4 weeks after stopping benzodiazepines before starting on antidepressant withdrawal. Consult your doctor before starting to withdraw the antidepressant and agree on a tapering schedule. Antidepressant withdrawal must be gradual to avoid withdrawal effects. Make each dose reduction as small as possible, e.g. by halving the tablets or using a liquid preparation. If smaller doses are not available, reduce by taking a tablet every other day, then every third day, etc. Allow 1-2 weeks between each dosage reduction. If withdrawal symptoms are severe (Chapter 3, Table 2) increase the dosage slightly (e.g. to the dose at your last reduction). When symptoms have settled, resume withdrawal at a slower rate. With slow tapering, as outlined above, withdrawal symptoms from antidepressants are usually absent, or if they occur, are mild and short-lived.