CHAPTER II (Part 2)
SLOW WITHDRAWAL SCHEDULES
CHAPTER TWO (PART 2) CONTENTS
Schedule 02: Simple withdrawal from diazepam (Valium) 40mg daily
Schedule 03: Withdrawal from lorazepam (Ativan) 6mg daily with diazepam (Valium) substitution
Schedule 04: Withdrawal from nitrazepam (Mogadon) 10mg at night with diazepam (Valium) substitution
Schedule 06: Withdrawal from clonazepam (Klonopin) 3mg daily with substitution of diazepam (Valium)
Schedule 07: Withdrawal from alprazolam (Xanax) 4mg daily with diazepam (Valium) substitution
Schedule 08: Withdrawal from lorazepam (Ativan) 3mg daily with diazepam (Valium) substitution
Schedule 09: Withdrawal from temazepam (Restoril) 30mg nightly with diazepam (Valium) substitution
Schedule 11: Withdrawal from chlordiazepoxide (Librium) 25mg three times daily (75mg)
Schedule 12: Withdrawal from zopiclone (Zimovane) 15mg with diazepam (Valium) substitution
Schedule 13: Antidepressant Withdrawal Table
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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 This benzodiazepine is eliminated so quickly (half-life 2 hours) that you are practically withdrawn each day, after a dose the night before.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.
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SCHEDULE 1
Withdrawal from high dose (6mg) alprazolam (Xanax daily with diazepam (Valium) substitution
(6mg alprazolam is approximately equivalent to 120mg diazepam)
|
|
|
Equivalent |
|
Starting dosage | alprazolam 2mg | alprazolam 2mg | alprazolam 2mg |
|
Stage 1 (one week) |
alprazolam 2mg | alprazolam 2mg |
alprazolam 1.5mg diazepam 10mg |
|
Stage 2 (one week) |
alprazolam 2mg | alprazolam 2mg |
alprazolam 1mg diazepam 20mg |
|
Stage 3 (one week) |
alprazolam 1.5mg diazepam 10mg |
alprazolam 2mg |
alprazolam 1mg diazepam 20mg |
|
Stage 4 (one week) |
alprazolam 1mg diazepam 20mg |
alprazolam 2mg |
alprazolam 1mg diazepam 20mg |
|
Stage 5 (1-2 weeks) |
alprazolam 1mg diazepam 20mg |
alprazolam 1mg diazepam 10mg |
alprazolam 1mg diazepam 20mg |
|
Stage 6 (1-2 weeks) |
alprazolam 1mg diazepam 20mg |
alprazolam 1mg diazepam 10mg |
alprazolam 0.5mg diazepam 20mg |
|
Stage 7 (1-2 weeks) |
alprazolam 1mg diazepam 20mg |
alprazolam 1mg diazepam 10mg |
Stop alprazolam diazepam 20mg |
|
Stage 8 (1-2 weeks) |
alprazolam 0.5mg diazepam 20mg |
alprazolam 1mg diazepam 10mg |
diazepam 20mg |
|
Stage 9 (1-2 weeks) |
alprazolam 0.5mg diazepam 20mg |
alprazolam 0.5mg diazepam 10mg |
diazepam 20mg |
|
Stage 10 (1-2 weeks) |
alprazolam 0.5mg diazepam 20mg |
Stop alprazolam diazepam 10mg |
diazepam 20mg |
|
Stage 11 (1-2 weeks) |
Stop alprazolam diazepam 20mg |
diazepam 10mg | diazepam 20mg |
|
Stage 12 (1-2 weeks) |
diazepam 25mg |
Stop midday dose; divert 5mg each to morning and night doses |
diazepam 25mg |
|
Stage 13 (1-2 weeks) |
diazepam 20mg |
|
diazepam 25mg |
|
Stage 14 (1-2 weeks) |
diazepam 20mg |
|
diazepam 20mg |
|
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).
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SCHEDULE 2
Simple withdrawal from diazepam (Valium) 40mg daily
(follow this schedule to complete Schedule 1)
|
|
Daily Dosage |
|
Starting dosage | diazepam 20mg | diazepam 20mg |
|
Stage 1 (1-2 weeks) | diazepam 18mg | diazepam 20mg |
|
Stage 2 (1-2 weeks) | diazepam 18mg | diazepam 18mg |
|
Stage 3 (1-2 weeks) | diazepam 16mg | diazepam 18mg |
|
Stage 4 (1-2 weeks) | diazepam 16mg | diazepam 16mg |
|
Stage 5 (1-2 weeks) | diazepam 14mg | diazepam 16mg |
|
Stage 6 (1-2 weeks) | diazepam 14mg | diazepam 14mg |
|
Stage 7 (1-2 weeks) | diazepam 12mg | diazepam 14mg |
|
Stage 8 (1-2 weeks) | diazepam 12mg | diazepam 12mg |
|
Stage 9 (1-2 weeks) | diazepam 10mg | diazepam 12mg |
|
Stage 10 (1-2 weeks) | diazepam 10mg | diazepam 10mg |
|
Stage 11 (1-2 weeks) | diazepam 8mg | diazepam 10mg |
|
Stage 12 (1-2 weeks) | diazepam 8mg | diazepam 8mg |
|
Stage 13 (1-2 weeks) | diazepam 6mg | diazepam 8mg |
|
Stage 14 (1-2 weeks) | diazepam 5mg | diazepam 8mg |
|
Stage 15 (1-2 weeks) | diazepam 4mg | diazepam 8mg |
|
Stage 16 (1-2 weeks) | diazepam 3mg | diazepam 8mg |
|
Stage 17 (1-2 weeks) | diazepam 2mg | diazepam 8mg |
|
Stage 18 (1-2 weeks) | diazepam 1mg | diazepam 8mg |
|
Stage 19 (1-2 weeks) |
|
diazepam 8mg |
|
Stage 20 (1-2 weeks) |
|
diazepam 7mg |
|
Stage 21 (1-2 weeks) |
|
diazepam 6mg |
|
Stage 22 (1-2 weeks) |
|
diazepam 5mg |
|
Stage 23 (1-2 weeks) |
|
diazepam 4mg |
|
Stage 24 (1-2 weeks) |
|
diazepam 3mg |
|
Stage 25 (1-2 weeks) |
|
diazepam 2mg |
|
Stage 26 (1-2 weeks) |
|
diazepam 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.
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SCHEDULE 3
Withdrawal from lorazepam (Ativan) 6mg daily with diazepam (Valium) substitution
(6mg lorazepam is approximately equivalent to 60mg diazepam)
|
|
|
Equivalent |
|
Starting dosage | lorazepam 2mg | lorazepam 2mg | lorazepam 2mg |
|
Stage 1 (one week) |
lorazepam 2mg | lorazepam 2mg |
lorazepam 1mg diazepam 10mg |
|
Stage 2 (one week) |
lorazepam 1.5mg diazepam 5mg |
lorazepam 2mg |
lorazepam 1mg diazepam 10mg |
|
Stage 3 (one week) |
lorazepam 1.5mg diazepam 5mg |
lorazepam 2mg |
lorazepam 0.5mg diazepam 15mg |
|
Stage 4 (one week) |
lorazepam 1.5mg diazepam 5mg |
lorazepam 1.5mg diazepam 5mg |
lorazepam 0.5mg diazepam 15mg |
|
Stage 5 (1-2 weeks) |
lorazepam 1.5mg diazepam 5mg |
lorazepam 1.5mg diazepam 5mg |
Stop lorazepam diazepam 20mg |
|
Stage 6 (1-2 weeks) |
lorazepam 1mg diazepam 5mg |
lorazepam 1.5mg diazepam 5mg |
diazepam 20mg |
|
Stage 7 (1-2 weeks) |
lorazepam 1mg diazepam 5mg |
lorazepam 1mg diazepam 5mg |
diazepam 20mg |
|
Stage 8 (1-2 weeks) |
lorazepam 0.5mg diazepam 5mg |
lorazepam 1mg diazepam 5mg |
diazepam 20mg |
|
Stage 9 (1-2 weeks) |
lorazepam 0.5mg diazepam 5mg |
lorazepam 0.5mg diazepam 5mg |
diazepam 20mg |
|
Stage 10 (1-2 weeks) |
Stop lorazepam diazepam 5mg |
lorazepam 0.5mg diazepam 5mg |
diazepam 20mg |
|
Stage 11 (1-2 weeks) |
diazepam 5mg |
Stop lorazepam diazepam 5mg |
diazepam 20mg |
|
Stage 12 (1-2 weeks) |
diazepam 5mg | diazepam 5mg | diazepam 18mg |
|
Stage 13 (1-2 weeks) |
diazepam 5mg | diazepam 5mg | diazepam 16mg |
|
Stage 14 (1-2 weeks) |
diazepam 5mg | diazepam 5mg | diazepam 14mg |
|
Stage 15 (1-2 weeks) |
diazepam 5mg | diazepam 5mg | diazepam 12mg |
|
Stage 16 (1-2 weeks) |
diazepam 5mg | diazepam 5mg | diazepam 10mg |
|
Stage 17 (1-2 weeks) |
diazepam 5mg | diazepam 4mg | diazepam 10mg |
|
Stage 18 (1-2 weeks) |
diazepam 4mg | diazepam 4mg | diazepam 10mg |
|
Stage 19 (1-2 weeks) |
diazepam 4mg | diazepam 3mg | diazepam 10mg |
|
Stage 20 (1-2 weeks) |
diazepam 3mg | diazepam 3mg | diazepam 10mg |
|
Stage 21 (1-2 weeks) |
diazepam 3mg | diazepam 2mg | diazepam 10mg |
|
Stage 22 (1-2 weeks) |
diazepam 2mg | diazepam 2mg | diazepam 10mg |
|
Stage 23 (1-2 weeks) |
diazepam 2mg | diazepam 1mg | diazepam 10mg |
|
Stage 24 (1-2 weeks) |
diazepam 1mg | diazepam 1mg | diazepam 10mg |
|
Stage 25 (1-2 weeks) |
diazepam 1mg | Stop diazepam | diazepam 10mg |
|
Stage 26 (1-2 weeks) |
Stop diazepam |
|
diazepam 10mg |
|
Stage 27 (1-2 weeks) |
|
|
diazepam 9mg |
|
Stage 28 (1-2 weeks) |
|
|
diazepam 8mg |
|
Stage 29 (1-2 weeks) |
|
|
diazepam 7mg |
|
Stage 30 (1-2 weeks) |
|
|
diazepam 6mg |
|
Stage 31 (1-2 weeks) |
|
|
diazepam 5mg |
|
Stage 32 (1-2 weeks) |
|
|
diazepam 4mg |
|
Stage 33 (1-2 weeks) |
|
|
diazepam 3mg |
|
Stage 34 (1-2 weeks) |
|
|
diazepam 2mg |
|
Stage 35 (1-2 weeks) |
|
|
diazepam 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.
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SCHEDULE 4
Withdrawal from nitrazepam (Mogadon) 10mg at night with diazepam (Valium) substitution
(Nitrazepam is approximately the same strength as diazepam)
|
|
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.
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SCHEDULE 5
Withdrawal from clonazepam (Klonopin) 1.5mg daily with substitution of diazepam (Valium)
(0.5mg clonazepam is approximately equivalent to 10mg diazepam)
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|
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Equivalent |
|
Starting dosage | clonazepam 0.5mg | clonazepam 0.5mg | clonazepam 0.5mg |
|
Stage 1 (1 week) |
clonazepam 0.5mg | clonazepam 0.5mg |
clonazepam 0.25mg diazepam 5mg |
|
Stage 2 (1 week) |
clonazepam 0.5mg | clonazepam 0.5mg |
Stop clonazepam diazepam 10mg |
|
Stage 3 (1 week) |
clonazepam 0.25mg diazepam 5mg |
clonazepam 0.5mg | diazepam 10mg |
|
Stage 4 (1 week) |
clonazepam 0.25mg diazepam 5mg |
clonazepam 0.25mg diazepam 5mg |
diazepam 10mg |
|
Stage 5 (1 week) |
Stop clonazepam diazepam 10mg |
clonazepam 0.25mg diazepam 5mg |
diazepam 10mg |
|
Stage 6 (1-2 weeks) |
diazepam 10mg |
Stop clonazepam diazepam 8mg |
diazepam 10mg |
|
Stage 7 (1-2 weeks) |
diazepam 10mg | diazepam 6mg | diazepam 10mg |
|
Stage 8 (1-2 weeks) |
diazepam 10mg | diazepam 4mg | diazepam 10mg |
|
Stage 9 (1-2 weeks) |
diazepam 10mg | diazepam 2mg | diazepam 10mg |
|
Stage 10 (1-2 weeks) |
diazepam 10mg | Stop diazepam | diazepam 10mg |
|
Stage 11 (1-2 weeks) |
diazepam 8mg |
|
diazepam 10mg |
|
Stage 12 (1-2 weeks) |
diazepam 6mg |
|
diazepam 10mg |
|
Stage 13 (1-2 weeks) |
diazepam 4mg |
|
diazepam 10mg |
|
Stage 14 (1-2 weeks) |
diazepam 2mg |
|
diazepam 10mg |
|
Stage 15 (1-2 weeks) |
Stop diazepam |
|
diazepam 10mg |
|
|
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SCHEDULE 6
Withdrawal from clonazepam (Klonopin) 3mg daily with substitution of diazepam (Valium)
(1 mg clonazepam is equivalent to 20mg diazepam)
|
|
|
Equivalent |
|
Starting dosage | clonazepam 1mg | clonazepam 1mg | clonazepam 1mg |
|
Stage 1 (1-2 weeks) |
clonazepam 1mg | clonazepam 1mg |
clonazepam 0.5mg diazepam 10mg |
|
Stage 2 (1-2 weeks) |
clonazepam 0.5mg diazepam 10mg |
clonazepam 1mg |
clonazepam 0.5mg diazepam 10mg |
|
Stage 3 (1-2 weeks) |
clonazepam 0.5mg diazepam 10mg |
clonazepam 0.5mg diazepam 5mg |
clonazepam 0.5mg diazepam 10mg |
|
Stage 4 (1-2 weeks) |
clonazepam 0.5mg diazepam 10mg |
clonazepam 0.5mg diazepam 5mg |
Stop clonazepam diazepam 15mg |
|
Stage 5 (1-2 weeks) |
clonazepam 0.25mg diazepam 10mg |
clonazepam 0.5mg diazepam 5mg |
diazepam 15mg |
|
Stage 6 (1-2 weeks) |
clonazepam 0.25mg diazepam 10mg |
clonazepam 0.25mg diazepam 5mg |
diazepam 15mg |
|
Stage 7 (1-2 weeks) |
Stop clonazepam diazepam 10mg |
clonazepam 0.25mg diazepam 5mg |
diazepam 15mg |
|
Stage 8 (1-2 weeks) |
diazepam 10mg |
Stop clonazepam diazepam 5mg |
diazepam 15mg |
|
Stage 9 (1-2 weeks) |
diazepam 10mg | diazepam 2.5mg | diazepam 15mg |
|
Stage 10 (1-2 weeks) |
diazepam 12mg | Stop diazepam | diazepam 15mg |
|
Stage 11 (1-2 weeks) |
diazepam 10mg |
|
diazepam 15mg |
|
Stage 12 (1-2 weeks) |
diazepam 10mg |
|
diazepam 14mg |
|
Stage 13 (1-2 weeks) |
diazepam 10mg |
|
diazepam 12mg |
|
Stage 14 (1-2 weeks) |
diazepam 10mg |
|
diazepam 10mg |
|
|
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.
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SCHEDULE 7
Withdrawal from alprazolam (Xanax) 4mg daily with diazepam (Valium) substitution
(4mg alprazolam is approximately equivalent to 80mg diazepam)
|
|
|
|
Equivalent |
|
Starting dosage | alprazolam 1mg | alprazolam 1mg | alprazolam 1mg | alprazolam 1mg |
|
Stage 1 (1 week) |
alprazolam 1mg | alprazolam 1mg | alprazolam 1mg |
alprazolam 0.5mg diazepam 10mg |
|
Stage 2 (1 week) |
alprazolam 1mg |
alprazolam 0.5mg diazepam 10mg |
alprazolam 1mg |
alprazolam 0.5mg diazepam 10mg |
|
Stage 3 (1 week) |
alprazolam 0.5mg diazepam 10mg |
alprazolam 0.5mg diazepam 10mg |
alprazolam 1mg |
alprazolam 0.5mg diazepam 10mg |
|
Stage 4 (1 week) |
alprazolam 0.5mg diazepam 10mg |
alprazolam 0.5mg diazepam 10mg |
alprazolam 0.5mg diazepam 10mg |
alprazolam 0.5mg diazepam 10mg |
|
Stage 5 (1 week) |
alprazolam 0.5mg diazepam 10mg |
alprazolam 0.5mg diazepam 10mg |
alprazolam 0.5mg diazepam 10mg |
alprazolam 0.5mg diazepam 10mg |
|
Stage 6 (1-2 weeks) |
alprazolam 0.5mg diazepam 10mg |
alprazolam 0.25mg diazepam 10mg |
alprazolam 0.5mg diazepam 10mg |
diazepam 20mg |
|
Stage 7 (1-2 weeks) |
alprazolam 0.25mg diazepam 10mg |
alprazolam 0.25mg diazepam 10mg |
alprazolam 0.5mg diazepam 10mg |
diazepam 20mg |
|
Stage 8 (1-2 weeks) |
alprazolam 0.25mg diazepam 10mg |
alprazolam 0.25mg diazepam 10mg |
alprazolam 0.25mg diazepam 10mg |
diazepam 20mg |
|
Stage 9 (1-2 weeks) |
alprazolam 0.25mg diazepam 10mg |
Stop alprazolam diazepam 10mg |
alprazolam 0.25mg diazepam 10mg |
diazepam 20mg |
|
Stage 10 (1-2 weeks) |
Stop alprazolam diazepam 10mg |
diazepam 10mg |
alprazolam 0.25mg diazepam 10mg |
diazepam 20mg |
|
Stage 11 (1-2 weeks) |
diazepam 10mg |
diazepam 10mg |
Stop alprazolam diazepam 10mg |
diazepam 20mg |
|
Stage 12 (1-2 weeks) |
diazepam 10mg |
diazepam 5mg | diazepam 10mg | diazepam 20mg |
|
Stage 13 (1-2 weeks) |
diazepam 5mg |
diazepam 5mg | diazepam 10mg | diazepam 20mg |
|
Stage 14 (1-2 weeks) |
diazepam 5mg |
diazepam 5mg | diazepam 5mg | diazepam 20mg |
|
Stage 15 (1-2 weeks) |
diazepam 5mg |
diazepam 5mg | diazepam 5mg | diazepam 15mg |
|
Stage 16 (1-2 weeks) |
diazepam 5mg |
diazepam 5mg | diazepam 5mg | diazepam 12.5mg |
|
Stage 17 (1-2 weeks) |
diazepam 5mg |
diazepam 5mg | diazepam 5mg | diazepam 10mg |
|
Stage 18 (1-2 weeks) |
diazepam 5mg |
diazepam 2.5mg | diazepam 5mg | diazepam 10mg |
|
Stage 19 (1-2 weeks) |
diazepam 5mg |
Stop diazepam | diazepam 5mg | diazepam 10mg |
|
Stage 20 (1-2 weeks) |
diazepam 4mg |
|
diazepam 5mg | diazepam 10mg |
|
Stage 21 (1-2 weeks) |
diazepam 4mg |
|
diazepam 4mg | diazepam 10mg |
|
Stage 22 (1-2 weeks) |
diazepam 4mg |
|
diazepam 3mg | diazepam 10mg |
|
Stage 23 (1-2 weeks) |
diazepam 3mg |
|
diazepam 3mg | diazepam 10mg |
|
Stage 24 (1-2 weeks) |
diazepam 3mg |
|
diazepam 2mg | diazepam 10mg |
|
Stage 25 (1-2 weeks) |
diazepam 2mg |
|
diazepam 2mg | diazepam 10mg |
|
Stage 26 (1-2 weeks) |
diazepam 2mg |
|
Stop diazepam | diazepam 10mg |
|
Stage 27 (1-2 weeks) |
Stop diazepam |
|
|
diazepam 10mg |
|
|
Schedule 7 Notes:
-
The evening diazepam dose can be taken at bed-time, rather than with alprazolam if that is usually taken earlier.
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SCHEDULE 8
Withdrawal from lorazepam (Ativan) 3mg daily with diazepam (Valium) substitution
(3mg lorazepam is approximately equivalent to 30mg diazepam)
|
|
|
Equivalent |
|
Starting dosage | lorazepam 1 mg | lorazepam 1 mg | lorazepam 1 mg |
|
Stage 1 (1 week) |
lorazepam 1 mg | lorazepam 1 mg |
lorazepam 0.5mg diazepam 5mg |
|
Stage 2 (1 week) |
lorazepam 0.5mg diazepam 5mg |
lorazepam 1 mg |
lorazepam 0.5mg diazepam 5mg |
|
Stage 3 (1 week) |
lorazepam 0.5mg diazepam 5mg |
lorazepam 0.5mg diazepam 5mg |
lorazepam 0.5mg diazepam 5mg |
|
Stage 4 (1 week) |
lorazepam 0.5mg diazepam 5mg |
lorazepam 0.5mg diazepam 5mg |
Stop lorazepam diazepam 10mg |
|
Stage 5 (1 week) |
Stop lorazepam diazepam 10mg |
lorazepam 0.5mg diazepam 5mg |
diazepam 10mg |
|
Stage 6 (1 week) |
diazepam 10mg |
Stop lorazepam diazepam 10mg |
diazepam 10mg |
|
Stage 7 (1-2 weeks) |
diazepam 10mg | diazepam 8mg | diazepam 10mg |
|
Stage 8 (1-2 weeks) |
diazepam 8mg | diazepam 8mg | diazepam 10mg |
|
Stage 9 (1-2 weeks) |
diazepam 8mg | diazepam 6mg | diazepam 10mg |
|
Stage 10 (1-2 weeks) |
diazepam 6mg | diazepam 6mg | diazepam 10mg |
|
Stage 11 (1-2 weeks) |
diazepam 6mg | diazepam 4mg | diazepam 10mg |
|
Stage 12 (1-2 weeks) |
diazepam 6mg | diazepam 2mg | diazepam 10mg |
|
Stage 13 (1-2 weeks) |
diazepam 6mg | Stop diazepam | diazepam 10mg |
|
Stage 14 (1-2 weeks) |
diazepam 5mg |
|
diazepam 10mg |
|
Stage 15 (1-2 weeks) |
diazepam 4mg |
|
diazepam 10mg |
|
Stage 16 (1-2 weeks) |
diazepam 3mg |
|
diazepam 10mg |
|
Stage 17 (1-2 weeks) |
diazepam 2mg |
|
diazepam 10mg |
|
Stage 18 (1-2 weeks) |
diazepam 1mg |
|
diazepam 10mg |
|
Stage 19 (1-2 weeks) |
Stop diazepam |
|
diazepam 10mg |
|
|
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SCHEDULE 9
Withdrawal from temazepam (Restoril) 30mg nightly with diazepam substitution
(30mg temazepam is approximately equivalent to 15mg diazepam)
|
|
|
Starting dosage | temazepam 30mg |
|
Stage 1 (1-2 weeks) |
temazepam 15mg diazepam 7.5mg |
|
Stage 2 (1-2 weeks) |
temazepam 7.5mg diazepam 12mg |
|
Stage 3 (1-2 weeks) |
Stop temazepam diazepam 15mg |
|
Stage 4 (1-2 weeks) | diazepam 14mg |
|
Stage 5 (1-2 weeks) | diazepam 13mg |
|
Stage 6 (1-2 weeks) | diazepam 12mg |
|
Stage 7 (1-2 weeks) | diazepam 11mg |
|
Stage 8 (1-2 weeks) | diazepam 10mg |
|
Stage 9 (1-2 weeks) | diazepam 9mg |
|
Stage 10 (1-2 weeks) | diazepam 8mg |
|
Stage 11 (1-2 weeks) | diazepam 7mg |
|
Stage 12 (1-2 weeks) | diazepam 6mg |
|
Stage 13 (1-2 weeks) | diazepam 5mg |
|
Stage 14 (1-2 weeks) | diazepam 4mg |
|
Stage 15 (1-2 weeks) | diazepam 3mg |
|
Stage 16 (1-2 weeks) | diazepam 2mg |
|
Stage 17 (1-2 weeks) | diazepam 1mg |
|
Stage 18 | Stop diazepam |
|
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Schedule 10
Withdrawal from oxazepam (Serax) 20mg three times daily (60mg) with diazepam (Valium) substitution
(20mg oxazepam is approximately equivalent to 10mg diazepam)
|
|
|
Equivalent |
|
Starting dosage | oxazepam 20mg | oxazepam 20mg | oxazepam 20mg |
|
Stage 1 (1 week) |
oxazepam 20mg | oxazepam 20mg |
oxazepam 10mg diazepam 5mg |
|
Stage 2 (1 week) |
oxazepam 10mg diazepam 5mg |
oxazepam 20mg |
oxazepam 10mg diazepam 5mg |
|
Stage 3 (1 week) |
oxazepam 10mg diazepam 5mg |
oxazepam 10mg diazepam 5mg |
oxazepam 10mg diazepam 5mg |
|
Stage 4 (1-2 weeks) |
oxazepam 10mg diazepam 5mg |
oxazepam 10mg diazepam 5mg |
Stop oxazepam diazepam 8mg |
|
Stage 5 (1-2 weeks) |
Stop oxazepam diazepam 8mg |
oxazepam 10mg diazepam 5mg |
diazepam 8mg |
|
Stage 6 (1-2 weeks) |
diazepam 8mg |
Stop oxazepam diazepam 8mg |
diazepam 8mg |
|
Stage 7 (1-2 weeks) |
diazepam 10mg | diazepam 2mg | diazepam 10mg |
|
Stage 8 (1-2 weeks) |
diazepam 10mg | Stop diazepam | diazepam 10mg |
|
Stage 9 (1-2 weeks) |
diazepam 8mg |
|
diazepam 10mg |
|
|
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.
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SCHEDULE 11
Withdrawal from chlordiazepoxide (Librium) 25mg three times daily (75mg)
(25mg chlordiazepoxide is approximately equivalent to 10mg diazepam)
|
|
|
|
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.
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SCHEDULE 12
Withdrawal from zopiclone (Zimovane) 15mg with diazepam (Valium) substitution
(15mg zopiclone is approximately equivalent to 10mg diazepam)
|
Equivalent |
|
Starting dosage | zopiclone 15mg |
|
Stage 1 (1 week) |
zopiclone 7.5mg diazepam 5mg |
|
Stage 2 (1 week) |
Stop zopiclone diazepam 10mg |
|
Stage 3 (1-2 weeks) | diazepam 9mg |
|
Stage 4 (1-2 weeks) | diazepam 8mg |
|
|
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.
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SCHEDULE 13
Antidepressant Withdrawal Table
|
|
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 |
|
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.
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