Plan Next Steps
“Consider sequential tapers for patients who are on chronic benzodiazepines and opioids. Coordinate care with other prescribers (e.g., psychiatrist) as necessary. In general, taper off opioids first, then the benzodiazepines” [wa.gov]
Reference
Decide if the ultimate goal for the taper is dose reduction or medication discontinuation. If dose reduction, decide what the final dose goal will be.
Consider starting with: 25% reduction every 1-2 weeks
- Can switch to 12.5% reduction near end (+/- drug-free holidays)
- If dose does not allow for 25% reduction, consider using 50% reduction with drug-free days
Resources
- Benzodiazepine Tapering Strategies (UNC resource) [recommended resource]
- Benzodiazepine & Z-Drug (BZRA) Deprescribing Algorithm (deprescribing.org provider resource)
- EMPOWER Trial Brochure (patient education resource)
- Benzodiazepine Information Sheet (UNC resource)
- Planning to Stop Taking Benzodiazepine: Care Instructions (Epic patient education resource)
Having a patient and their provider sign a benzodiazepine taper agreement ensures that both the patient and the provider know what goal they are working towards and the responsibilities of each party involved.
Resources
- Benzodiazepine Taper Agreement (UNC resource)
Taper can also be paused or slowed if withdrawal symptoms persist or are severe.
- Refer patient to a mental health provider (psychiatrist, psychologist, counselor) or help in the management of anxiety and/or insomnia
- Encourage the use of cognitive behavioral therapy (CBT) for increased success in tapering plan
Resources
- Benzodiazepine Information Sheet (UNC resource) [recommended resource]
- Is a Benzodiazepine or Z-Drug Still Needed for Sleep? (deprescribing.org patient resource)
- Benzodiazepine & Z-Drug (BZRA) Deprescribing Algorithm (deprescribing.org provider resource)
Having a follow-up plan in place will facilitate tapering success.
*A consultant pharmacist will provide recommendations for these items prior to patient’s clinic visit