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Which Tapering method is best?

The only medically researched method of tapering off benzodiazepines that we are aware of was done by Dr. Heather Ashton.  Her work in the field of benzodiazepine withdrawal syndrome resulted in what we've come to know as the Ashton Manual.  

Dr. Ashton recommends changing faster-acting benzos like Xanax, Ativan and Klonopin for an equivalent dose of Valium and using the Valium to get a smoother, more controlled taper.  This is all explained in her manual.  

In the last few years we've had a number of people use a method called "Water Titration" to get off their benzo.  It was developed by a list member who learned the method from a former list member.  Many who were unable to get their doctors to prescribe Valium or simply didn't want to do the Ashton crossover have used the water titration to get off the faster-acting benzos.

In recent times some people have decided to use Milk Titration to taper their benzos. Milk titration is exactly the same as water titration except using whole milk. Those using this method like it because they believe the benzo dissolves in milk rather than just suspends like it does in water. We have seen no evidence to date that suggests that this is correct. However as the principle is the same as water titration either are good ways to consider.

We also have a version called "Lee's Simple Water Titration."  This is not true titrating but is a very simple version of just using water to dilute the drug so smaller cuts can be made. 

Still others have simply been able to dry cut their pills and have got off that way.

Some people have used compounding pharmacies to get the smaller doses they needed to taper off their benzo

So the biggest question is which method is right for you?  Well, of course, that depends.  Can you get your doctor to prescribe Valium?   Do you want to taper Valium?  Would you rather try just cutting your pills in tiny pieces and making cuts and see how it goes? Would you like to try water titration?   Do you just want to dilute your pill in water, take out a dropper full and taper that way? 

No one needs to tell you that your way is wrong or that if you don't do it this way or that way, you will be sorry.  If the way you choose to get off these drugs is working for you, that is what counts.  If you are having a hellacious time and want to think about something else then there may be other methods to consider.

There are as many ways to do this, as there are people.  And there are many factors in deciding how to do YOUR taper.  There is no one-way and there is absolutely no specific way that can guarantee a symptom-free withdrawal

Some of the principles of a good taper, for those who have been on benzos long term and find themselves to be tolerant to or dependent on them, might be

- donít cold turkey

- before you start a taper  take the same amount of drug each day at the same time each day, in other words make sure that blood levels are as consistent as possible

- consider crossing short acting benzos to Valium as suggested in the Ashton Manual

- when it comes time to make a first cut, opt for a cut  that is 10% or less of your current dose (Dr Breggin and David Cohen in their book "Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Drugs" suggest this might be an appropriate level), if you think 10% is going to be too hard to do, then cut less - you know your body best. If a person is trying water titration, the sum of the cuts over the first two weeks should be less than 10%.

-  wait 2 - 4 weeks before making another cut and evaluate the first cut to determine what you do next, most will want to cut the same or less. If using water titration evaluate the cut rate as you go and adjust if needed.

-  then follow your body, adjusting the amount cut downward as you need to

-  it is OK to hold at any time for up to a month if things get difficult (some have held longer than that when they needed to). It is Ok to reduce the cut rates when needed.

Any method that follows these principles is worth considering.

So research all the information on this site and at http://www.benzo.org.uk. Decide how you want to taper your benzodiazepine and then get together with a doctor who is knowledgeable in this field and develop a plan that is right for you.

 

 

 

Disclaimer:  The information contained in this website was not compiled by a doctor or anyone with medical training. The advice contained herein should not be substituted for the advice of a physician who is well-informed in the subject matter discussed. Before making any decisions about your health or treatment you should always confer with your physician and it is always assumed that you will do so.

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Last updated 23 May 2013