Reduction schedules | Right Decisions

When reducing B-Z do not prescribe other psychotropics to compensate unless a specific condition or disorder is being treated.

There are multiple tapering schedules, due to variations in drugs, doses and dose frequency, see The Ashton Manual for examples. There is also a need to tailor reductions to individual needs and preferences, such as stopping a morning dose rather than a lunch time dose. While the following reduction steps are considered appropriate, for some individuals smaller reductions may be necessary.^69,84

Reduction dose varies with starting dose. Reduce by:

10mg/day every two to four weeks, down to a total daily dose of 50mg
5mg/day every two to four weeks, down to a total daily dose of 30mg
2mg/day every two to four weeks, down to a total daily dose of 20mg
1mg/day every two to four weeks, until stopped.

Example reduction regimes

Diazepam 5mg three times a day

Step	Morning (mg)	Lunch (mg)	Night (mg)	Total daily dose (mg)
Starting dose	Diazepam 5	Diazepam 5	Diazepam 5	15
Step 1	5	4	5	14
Step 2	5	3	5	13
Step 3	5	2	5	12
Step 4	5	1	5	11
Step 5	5	Stop	5	10
Step 6	4	-	5	9
Step 7	3	-	5	8
Step 8	2	-	5	7
Step 9	1	-	5	6
Step 10	Stop	-	5	5
Step 11	-	-	4	4
Step 12	-	-	3	3
Step 13	-	-	2	2
Step 14	-	-	1	1
Step 15	Stop	Stop	Stop	0

Diazepam 5mg twice daily and temazepam 20mg at night

Step	Morning (mg)	Teatime (mg)	Night (mg)	Total daily dose (diazepam mg)
Starting dose	Diazepam 5	Diazepam 5	Temazepam 20	20
Step 1	Diazepam 5	Diazepam 5	Diazepam 10	20
Step 2	5	4	10	19
Step 3	5	3	10	18
Step 4	5	2	10	17
Step 5	5	1	10	16
Step 6	5	Stop	10	15
Step 7	4	-	10	14
Step 8	3	-	10	13
Step 9	2	-	10	12
Step 10	1	-	10	11
Step 11	Stop	-	10	10
Step 12	-	-	9	9
Step 13	-	-	8	8
Step 14	-	-	7	7
Step 15	-	-	6	6
Step 16	-	-	5	5
Step 17	-	-	4	4
Step 18	-	-	3	3
Step 19	-	-	2	2
Step 20	-	-	1	1
Step 21	Stop	Stop	Stop	0

Lorazepam 1mg twice daily

Step	Morning (mg)	Night (mg)	Total daily dose (diazepam mg)
Starting dose	Lorezapam 1	Lorezapam 1	20
Step 1	Lorezapam 1	Diazepam 10	20
Step 2	Diazepam 10	Diazepam 10	20
Step 3	9	10	19
Step 4	8	10	18
Step 5	7	10	17
Step 6	6	10	16
Step 7	5	10	15
Step 8	4	10	14
Step 9	3	10	13
Step 10	2	10	12
Step 11	1	10	11
Step 12	Stop	10	10
Step 13	-	9	9
Step 14	-	8	8
Step 15	-	7	7
Step 16	-	6	6
Step 17	-	5	5
Step 18	-	4	4
Step 19	-	3	3
Step 20	-	2	2
Step 21	-	1	1
Step 22	-	Stop	Stop

Note: See approximate dose equivalents and switching considerations above. Lorazepam is more potent and has a shorter half-life than diazepam. Therefore, cross tapering may be appropriate as a first step to allow assessment of tolerance and adverse effects (e.g. sedation, withdrawal) prior to active reduction.

Diazepam 10mg three times daily and temazepam 20mg at night

Step	Morning (mg)	Lunch (mg)	Teatime (mg)	Night (mg)	Total daily dose (diazepam mg)
Starting dose	Diazepam 10	Diazepam 10	Diazepam 10	Temazepam 20	40
Step 1	Diazepam 10	Diazepam 10	Diazepam 10	Diazepam 10	40
Step 2	10	5	10	10	35
Step 3	10	5	5	10	30
Step 4	10	4	4	10	28
Step 5	8	4	4	10	26
Step 6	6	4	4	10	24
Step 7	4	4	4	10	22
Step 8	4	2	4	10	20
Step 9	4	1	4	10	19
Step 10	4	Stop	4	10	18
Step 11	4	-	3	10	17
Step 12	4	-	2	10	16
Step 13	4	-	1	10	15
Step 14	4	-	Stop	10	14
Step 15	4	-	-	9	13
Step 16	4	-	-	8	12
Step 17	4	-	-	7	11
Step 18	4	-	-	6	10
Step 19	3	-	-	6	9
Step 20	2	-	-	6	8
Step 21	1	-	-	6	7
Step 22	Stop	-	-	6	6
Step 23	-	-	-	5	5
Step 24	-	-	-	4	4
Step 25	-	-	-	3	3
Step 26	-	-	-	2	2
Step 27	-	-	-	1	1
Step 28	Stop	Stop	Stop	Stop	0