Transcription
Hi, I'm Dr. Joseph. During the purpose of this video is what I consider to be best practices for tapering for someone who's been on benzodiazepines and they want to come off and they want to do it safe.
So, um, the first thing that you want to think about is, uh, which risk category are you in? Because depending on the risk category, it'll influence whether you go more aggressive with your taper or if you go a little slower. So let me define what a lower risk category person is. So this would be someone that is younger, I'm going to say less than 40. It's someone that is on benzodiazepines, I would say for maybe less than two years or something like that. They haven't been on it for a really substantial amount of time. They may be on a lower dose of it. You know, they may be on say like a milligram of Xanax or or equivalent to that. Um, and and yes, so so that that would be what I would consider like a low-risk person and someone that at least I would think would have a fairly straightforward taper.
The other person, let's say they are 65. They have been on Klonopin for maybe 30, 40 years or something like that. And maybe they're on, you know, reasonably high doses of that. Maybe they're taking maybe two milligrams in the morning, two two milligrams in the evening. That's more of a high-risk person. And the things that go into that is your brain is less plastic as you age. It's going to take a longer time, um, to to make changes. As you go down, you're on a higher dose, there's been more compensatory adaptations over time, so you're going to be more, um, better served by going a little slow.
So, okay, so we have, so what's the overall strategy? Where should we start? So I think the best way for a lot of people to start is simply just doing dry cuts with the scale. So if you have a tablet, you would just get a razor, you would measure the tablet on the scale, you'd see how much it weighs, and then you would get a razor and then you'd start shaving some of the pill off. Typically, I recommend doing, uh, between five to ten percent cuts. And, um, and that is again, you know, you might want to do a 10% cut if you're a low-risk person. No, sorry. Yeah, yeah. And you want to do a five percent cut if you if you're higher risk.
And, um, the other thing, and and so you, so you do that, you do a cut, and then you want to wait around two to four weeks, just to kind of see how you settle. You may have symptoms which kind of die down towards the end of two weeks, and you say, okay, I'm, I'm now ready for for another cut. And at which time you would do so. So there's another thing that you need to think about. I think it's best practice to try and slow down right when you get to the end of your taper. And so what is the end of my taper? I like to consider it when you're going at doses below, I would have commonly recommend recognizes the the lowest kind of effective dose. And so what I consider that to be, you know, is, you know, what is the dose of Xanax, like the lowest dose that that people use therapeutically for anxiety? And that's probably about like a half a milligram. Um, Klonopin, it might be a half a milligram as well. For diazepam, this is 20 milligrams. For Temazepam, that's that's around 15 milligrams. So once you get to that dose, you want to slow your rate of taper down.
So you might, um, okay, so let me say it like, so let's say you were taking, you know, 60 milligrams of Valium, that that was your level. You might be okay doing 10% cuts with 60 being the base, you know, all the way down to 20. So you might just go, you know, each each two-week period, you just taken off six, um, you're taking off, um, uh, six, uh, six milligrams and you go all the way down. Once you got to 20, I would reset it there. So I would say, okay, 20 is my new set point, and now I'm going to go down in, um, in two milligram increments and kind of slow it way down. When you get to the end, what typically happens during the course of withdrawal is it is at that last dose when you're kind of going below that minimum therapeutic dose that things start to get a little bit more difficult. So we always recommend slowing down, and you may need adjustments. You may find that when you're kind of going down right at the end, that it's becoming more difficult. You can reset and then you can do smaller cuts, and overall that seems to help most people.
Um, there are other kind of tweaks and nuances to this. You know, some people will do a like a like a like a liquid micro taper where they'll take down a dose every single day. Those people tend to like doing that if they have a lot of symptoms after they have drops, even five percent drops. They may do something like that, and that works. It's a lot more complicated and time-consuming rather than just doing a drop and waiting a few weeks, but that works for some people. And, um, and yes, I mean, there's some other, there's some other nuances in there about, uh, interdose withdrawal. And that's that, and that's when say you start having a lot of anxiety right before you take your next dose, where, um, there may be, um, something to gain by crossing over to Valium before you begin your taper, or even spacing out your doses. So for instance, if you're taking, you know, Xanax XR, you might want to break that up into the Xanax immediate release, uh, normal formulation and break it into maybe three, uh, increments throughout the day or four increments, and that's another option. But I have other videos specifically on that, so you can look at that for further details.
And, um, yeah, I hope this was helpful. I think that is this is kind of like the way to go, uh, for most people who are starting a benzodiazepine taper. You can go and look at the Ashton manual as well. The advice is pretty similar and a lot more comprehensive. Um, have you done a taper like this? You know, did this work for you? You know, what did you think about the advice? Please let me know in the comments below. And thanks.