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Index · Contents · Introduction · Chapter I · Chapter II · Withdrawal Schedules · Chapter III
Medical Disclaimer · Order A Printed Copy · Professor Ashton's Main Page
The Ashton Manual in other languages · Supplement, April 2011

CHAPTER II: SLOW WITHDRAWAL SCHEDULES BENZODIAZEPINES: HOW THEY WORK AND HOW TO WITHDRAW (aka The Ashton Manual) • PROTOCOL FOR THE TREATMENT OF BENZODIAZEPINE WITHDRAWAL • Medical research information from a benzodiazepine withdrawal clinic Professor C Heather Ashton DM, FRCP Revised August 2002 • Ashton Manual Index Page • Contents Page • Introduction • Chapter I: The benzodiazepines: what they do in the body • Chapter II: How to withdraw from benzodiazepines after long-term use • Chapter II: Slow withdrawal schedules • Chapter III: Benzodiazepine withdrawal symptoms, acute & protracted

CHAPTER II

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 This benzodiazepine is eliminated so quickly (half-life 2 hours) that you are practically withdrawn each day, after a dose the night before.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.

1. Withdrawal from high dose (6mg) alprazolam (Xanax) daily with diazepam (Valium) substitution

2. Simple withdrawal from diazepam (Valium) 40mg daily

3. Withdrawal from lorazepam (Ativan) 6mg daily with diazepam (Valium) substitution

4. Withdrawal from nitrazepam (Mogadon) 10mg at night with diazepam (Valium) substitution

5. Withdrawal from clonazepam (Klonopin) 1.5mg daily with substitution of diazepam (Valium)

6. Withdrawal from clonazepam (Klonopin) 3mg daily with substitution of diazepam (Valium)

7. Withdrawal from alprazolam (Xanax) 4mg daily with diazepam (Valium) substitution

8. Withdrawal from lorazepam (Ativan) 3mg daily with diazepam (Valium) substitution

9. Withdrawal from temazepam (Restoril) 30mg nightly with diazepam (Valium) substitution

10. Withdrawal from oxazepam (Serax) 20mg three times daily (60mg) with diazepam (Valium) substitution

11. Withdrawal from chlordiazepoxide (Librium) 25mg three times daily (75mg)

12. Withdrawal from zopiclone (Zimovane) 15mg with diazepam (Valium) substitution

13. Antidepressant Withdrawal Table

Schedule 1. Withdrawal from high dose (6mg) alprazolam (Xanax
daily with diazepam (Valium) substitution. (6mg alprazolam
is approximately equivalent to 120mg diazepam)

	Morning	Midday/Afternoon	Evening/Night	Daily Diazepam Equivalent
Starting dosage	alprazolam 2mg	alprazolam 2mg	alprazolam 2mg	120mg
Stage 1 (one week)	alprazolam 2mg	alprazolam 2mg	alprazolam 1.5mg diazepam 10mg	120mg
Stage 2 (one week)	alprazolam 2mg	alprazolam 2mg	alprazolam 1mg diazepam 20mg	120mg
Stage 3 (one week)	alprazolam 1.5mg diazepam 10mg	alprazolam 2mg	alprazolam 1mg diazepam 20mg	120mg
Stage 4 (one week)	alprazolam 1mg diazepam 20mg	alprazolam 2mg	alprazolam 1mg diazepam 20mg	120mg
Stage 5 (1-2 weeks)	alprazolam 1mg diazepam 20mg	alprazolam 1mg diazepam 10mg	alprazolam 1mg diazepam 20mg	110mg
Stage 6 (1-2 weeks)	alprazolam 1mg diazepam 20mg	alprazolam 1mg diazepam 10mg	alprazolam 0.5mg diazepam 20mg	100mg
Stage 7 (1-2 weeks)	alprazolam 1mg diazepam 20mg	alprazolam 1mg diazepam 10mg	Stop alprazolam diazepam 20mg	90mg
Stage 8 (1-2 weeks)	alprazolam 0.5mg diazepam 20mg	alprazolam 1mg diazepam 10mg	diazepam 20mg	80mg
Stage 9 (1-2 weeks)	alprazolam 0.5mg diazepam 20mg	alprazolam 0.5mg diazepam 10mg	diazepam 20mg	80mg
Stage 10 (1-2 weeks)	alprazolam 0.5mg diazepam 20mg	Stop alprazolam diazepam 10mg	diazepam 20mg	60mg
Stage 11 (1-2 weeks)	Stop alprazolam diazepam 20mg	diazepam 10mg	diazepam 20mg	50mg
Stage 12 (1-2 weeks)	diazepam 25mg	Stop midday dose; divert 5mg each to morning and night doses	diazepam 25mg	50mg
Stage 13 (1-2 weeks)	diazepam 20mg	--	diazepam 25mg	45mg
Stage 14 (1-2 weeks)	diazepam 20mg	--	diazepam 20mg	40mg

Continue as on Schedule 2, reducing from diazepam 40mg

Schedule 1 Notes:


1. 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).

2. 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).

3. 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.

4. 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)

	Morning	Night	Total Daily Dosage
Starting dosage	diazepam 20mg	diazepam 20mg	40mg
Stage 1 (1-2 weeks)	diazepam 18mg	diazepam 20mg	38mg
Stage 2 (1-2 weeks)	diazepam 18mg	diazepam 18mg	36mg
Stage 3 (1-2 weeks)	diazepam 16mg	diazepam 18mg	34mg
Stage 4 (1-2 weeks)	diazepam 16mg	diazepam 16mg	32mg
Stage 5 (1-2 weeks)	diazepam 14mg	diazepam 16mg	30mg
Stage 6 (1-2 weeks)	diazepam 14mg	diazepam 14mg	28mg
Stage 7 (1-2 weeks)	diazepam 12mg	diazepam 14mg	26mg
Stage 8 (1-2 weeks)	diazepam 12mg	diazepam 12mg	24mg
Stage 9 (1-2 weeks)	diazepam 10mg	diazepam 12mg	22mg
Stage 10 (1-2 weeks)	diazepam 10mg	diazepam 10mg	20mg
Stage 11 (1-2 weeks)	diazepam 8mg	diazepam 10mg	18mg
Stage 12 (1-2 weeks)	diazepam 8mg	diazepam 8mg	16mg
Stage 13 (1-2 weeks)	diazepam 6mg	diazepam 8mg	14mg
Stage 14 (1-2 weeks)	diazepam 5mg	diazepam 8mg	13mg
Stage 15 (1-2 weeks)	diazepam 4mg	diazepam 8mg	12mg
Stage 16 (1-2 weeks)	diazepam 3mg	diazepam 8mg	11mg
Stage 17 (1-2 weeks)	diazepam 2mg	diazepam 8mg	10mg
Stage 18 (1-2 weeks)	diazepam 1mg	diazepam 8mg	9mg
Stage 19 (1-2 weeks)	--	diazepam 8mg	8mg
Stage 20 (1-2 weeks)	--	diazepam 7mg	7mg
Stage 21 (1-2 weeks)	--	diazepam 6mg	6mg
Stage 22 (1-2 weeks)	--	diazepam 5mg	5mg
Stage 23 (1-2 weeks)	--	diazepam 4mg	4mg
Stage 24 (1-2 weeks)	--	diazepam 3mg	3mg
Stage 25 (1-2 weeks)	--	diazepam 2mg	2mg
Stage 26 (1-2 weeks)	--	diazepam 1mg	1mg

Schedule 2 Notes:


1. You could probably manage Stages 1-5 (or even Stages 1-10) in weekly intervals (but take 2 weeks between stages if you prefer).

2. The later stages are probably better taken in 2 week intervals.

3. 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.

4. 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.

5. 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.

6. 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)

	Morning	Midday/Afternoon	Evening/Night	Daily Diazepam Equivalent
Starting dosage	lorazepam 2mg	lorazepam 2mg	lorazepam 2mg	60mg
Stage 1 (one week)	lorazepam 2mg	lorazepam 2mg	lorazepam 1mg diazepam 10mg	60mg
Stage 2 (one week)	lorazepam 1.5mg diazepam 5mg	lorazepam 2mg	lorazepam 1mg diazepam 10mg	60mg
Stage 3 (one week)	lorazepam 1.5mg diazepam 5mg	lorazepam 2mg	lorazepam 0.5mg diazepam 15mg	60mg
Stage 4 (one week)	lorazepam 1.5mg diazepam 5mg	lorazepam 1.5mg diazepam 5mg	lorazepam 0.5mg diazepam 15mg	60mg
Stage 5 (1-2 weeks)	lorazepam 1.5mg diazepam 5mg	lorazepam 1.5mg diazepam 5mg	Stop lorazepam diazepam 20mg	60mg
Stage 6 (1-2 weeks)	lorazepam 1mg diazepam 5mg	lorazepam 1.5mg diazepam 5mg	diazepam 20mg	55mg
Stage 7 (1-2 weeks)	lorazepam 1mg diazepam 5mg	lorazepam 1mg diazepam 5mg	diazepam 20mg	50mg
Stage 8 (1-2 weeks)	lorazepam 0.5mg diazepam 5mg	lorazepam 1mg diazepam 5mg	diazepam 20mg	45mg
Stage 9 (1-2 weeks)	lorazepam 0.5mg diazepam 5mg	lorazepam 0.5mg diazepam 5mg	diazepam 20mg	40mg
Stage 10 (1-2 weeks)	Stop lorazepam diazepam 5mg	lorazepam 0.5mg diazepam 5mg	diazepam 20mg	35mg
Stage 11 (1-2 weeks)	diazepam 5mg	Stop lorazepam diazepam 5mg	diazepam 20mg	30mg
Stage 12 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 18mg	28mg
Stage 13 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 16mg	26mg
Stage 14 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 14mg	24mg
Stage 15 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 12mg	22mg
Stage 16 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 10mg	20mg
Stage 17 (1-2 weeks)	diazepam 5mg	diazepam 4mg	diazepam 10mg	19mg
Stage 18 (1-2 weeks)	diazepam 4mg	diazepam 4mg	diazepam 10mg	18mg
Stage 19 (1-2 weeks)	diazepam 4mg	diazepam 3mg	diazepam 10mg	17mg
Stage 20 (1-2 weeks)	diazepam 3mg	diazepam 3mg	diazepam 10mg	16mg
Stage 21 (1-2 weeks)	diazepam 3mg	diazepam 2mg	diazepam 10mg	15mg
Stage 22 (1-2 weeks)	diazepam 2mg	diazepam 2mg	diazepam 10mg	14mg
Stage 23 (1-2 weeks)	diazepam 2mg	diazepam 1mg	diazepam 10mg	13mg
Stage 24 (1-2 weeks)	diazepam 1mg	diazepam 1mg	diazepam 10mg	12mg
Stage 25 (1-2 weeks)	diazepam 1mg	Stop diazepam	diazepam 10mg	11mg
Stage 26 (1-2 weeks)	Stop diazepam	--	diazepam 10mg	10mg
Stage 27 (1-2 weeks)	--	--	diazepam 9mg	9mg
Stage 28 (1-2 weeks)	--	--	diazepam 8mg	8mg
Stage 29 (1-2 weeks)	--	--	diazepam 7mg	7mg
Stage 30 (1-2 weeks)	--	--	diazepam 6mg	6mg
Stage 31 (1-2 weeks)	--	--	diazepam 5mg	5mg
Stage 32 (1-2 weeks)	--	--	diazepam 4mg	4mg
Stage 33 (1-2 weeks)	--	--	diazepam 3mg	3mg
Stage 34 (1-2 weeks)	--	--	diazepam 2mg	2mg
Stage 35 (1-2 weeks)	--	--	diazepam 1mg	1mg
Stage 36	--	--	Stop diazepam	--

Schedule 3 Notes:


1. 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).

2. 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).

3. 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.

4. 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.

5. 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)

	Bed-time dose
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)

	Morning	Midday/Afternoon	Evening/Night	Daily Diazepam Equivalent
Starting dosage	clonazepam 0.5mg	clonazepam 0.5mg	clonazepam 0.5mg	30mg
Stage 1 (1 week)	clonazepam 0.5mg	clonazepam 0.5mg	clonazepam 0.25mg diazepam 5mg	30mg
Stage 2 (1 week)	clonazepam 0.5mg	clonazepam 0.5mg	Stop clonazepam diazepam 10mg	30mg
Stage 3 (1 week)	clonazepam 0.25mg diazepam 5mg	clonazepam 0.5mg	diazepam 10mg	30mg
Stage 4 (1 week)	clonazepam 0.25mg diazepam 5mg	clonazepam 0.25mg diazepam 5mg	diazepam 10mg	30mg
Stage 5 (1 week)	Stop clonazepam diazepam 10mg	clonazepam 0.25mg diazepam 5mg	diazepam 10mg	30mg
Stage 6 (1-2 weeks)	diazepam 10mg	Stop clonazepam diazepam 8mg	diazepam 10mg	28mg
Stage 7 (1-2 weeks)	diazepam 10mg	diazepam 6mg	diazepam 10mg	26mg
Stage 8 (1-2 weeks)	diazepam 10mg	diazepam 4mg	diazepam 10mg	24mg
Stage 9 (1-2 weeks)	diazepam 10mg	diazepam 2mg	diazepam 10mg	22mg
Stage 10 (1-2 weeks)	diazepam 10mg	Stop diazepam	diazepam 10mg	20mg
Stage 11 (1-2 weeks)	diazepam 8mg	--	diazepam 10mg	18mg
Stage 12 (1-2 weeks)	diazepam 6mg	--	diazepam 10mg	16mg
Stage 13 (1-2 weeks)	diazepam 4mg	--	diazepam 10mg	14mg
Stage 14 (1-2 weeks)	diazepam 2mg	--	diazepam 10mg	12mg
Stage 15 (1-2 weeks)	Stop diazepam	--	diazepam 10mg	10mg
Continue reducing remaining diazepam by 1 mg every 2 weeks (see Schedule 3 Stage 26)

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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)

	Morning	Midday/Afternoon	Evening/Night	Daily Diazepam Equivalent
Starting dosage	clonazepam 1mg	clonazepam 1mg	clonazepam 1mg	60mg
Stage 1 (1-2 weeks)	clonazepam 1mg	clonazepam 1mg	clonazepam 0.5mg diazepam 10mg	60mg
Stage 2 (1-2 weeks)	clonazepam 0.5mg diazepam 10mg	clonazepam 1mg	clonazepam 0.5mg diazepam 10mg	60mg
Stage 3 (1-2 weeks)	clonazepam 0.5mg diazepam 10mg	clonazepam 0.5mg diazepam 5mg	clonazepam 0.5mg diazepam 10mg	55mg
Stage 4 (1-2 weeks)	clonazepam 0.5mg diazepam 10mg	clonazepam 0.5mg diazepam 5mg	Stop clonazepam diazepam 15mg	50mg
Stage 5 (1-2 weeks)	clonazepam 0.25mg diazepam 10mg	clonazepam 0.5mg diazepam 5mg	diazepam 15mg	45mg
Stage 6 (1-2 weeks)	clonazepam 0.25mg diazepam 10mg	clonazepam 0.25mg diazepam 5mg	diazepam 15mg	40mg
Stage 7 (1-2 weeks)	Stop clonazepam diazepam 10mg	clonazepam 0.25mg diazepam 5mg	diazepam 15mg	35mg
Stage 8 (1-2 weeks)	diazepam 10mg	Stop clonazepam diazepam 5mg	diazepam 15mg	30mg
Stage 9 (1-2 weeks)	diazepam 10mg	diazepam 2.5mg	diazepam 15mg	27.5mg
Stage 10 (1-2 weeks)	diazepam 12mg	Stop diazepam	diazepam 15mg	27mg
Stage 11 (1-2 weeks)	diazepam 10mg	--	diazepam 15mg	25mg
Stage 12 (1-2 weeks)	diazepam 10mg	--	diazepam 14mg	24mg
Stage 13 (1-2 weeks)	diazepam 10mg	--	diazepam 12mg	22mg
Stage 14 (1-2 weeks)	diazepam 10mg	--	diazepam 10mg	20mg
Continue from Schedule 5, Stage 10

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)

	Morning	Midday	Afternoon	Evening	Daily Diazepam Equivalent
Starting dosage	alprazolam 1mg	alprazolam 1mg	alprazolam 1mg	alprazolam 1mg	80mg
Stage 1 (1 week)	alprazolam 1mg	alprazolam 1mg	alprazolam 1mg	alprazolam 0.5mg diazepam 10mg	80mg
Stage 2 (1 week)	alprazolam 1mg	alprazolam 0.5mg diazepam 10mg	alprazolam 1mg	alprazolam 0.5mg diazepam 10mg	80mg
Stage 3 (1 week)	alprazolam 0.5mg diazepam 10mg	alprazolam 0.5mg diazepam 10mg	alprazolam 1mg	alprazolam 0.5mg diazepam 10mg	80mg
Stage 4 (1 week)	alprazolam 0.5mg diazepam 10mg	alprazolam 0.5mg diazepam 10mg	alprazolam 0.5mg diazepam 10mg	alprazolam 0.5mg diazepam 10mg	80mg
Stage 5 (1 week)	alprazolam 0.5mg diazepam 10mg	alprazolam 0.5mg diazepam 10mg	alprazolam 0.5mg diazepam 10mg	alprazolam 0.5mg diazepam 10mg	80mg
Stage 6 (1-2 weeks)	alprazolam 0.5mg diazepam 10mg	alprazolam 0.25mg diazepam 10mg	alprazolam 0.5mg diazepam 10mg	diazepam 20mg	75mg
Stage 7 (1-2 weeks)	alprazolam 0.25mg diazepam 10mg	alprazolam 0.25mg diazepam 10mg	alprazolam 0.5mg diazepam 10mg	diazepam 20mg	70mg
Stage 8 (1-2 weeks)	alprazolam 0.25mg diazepam 10mg	alprazolam 0.25mg diazepam 10mg	alprazolam 0.25mg diazepam 10mg	diazepam 20mg	65mg
Stage 9 (1-2 weeks)	alprazolam 0.25mg diazepam 10mg	Stop alprazolam diazepam 10mg	alprazolam 0.25mg diazepam 10mg	diazepam 20mg	60mg
Stage 10 (1-2 weeks)	Stop alprazolam diazepam 10mg	diazepam 10mg	alprazolam 0.25mg diazepam 10mg	diazepam 20mg	55mg
Stage 11 (1-2 weeks)	diazepam 10mg	diazepam 10mg	Stop alprazolam diazepam 10mg	diazepam 20mg	50mg
Stage 12 (1-2 weeks)	diazepam 10mg	diazepam 5mg	diazepam 10mg	diazepam 20mg	45mg
Stage 13 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 10mg	diazepam 20mg	40mg
Stage 14 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 5mg	diazepam 20mg	35mg
Stage 15 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 5mg	diazepam 15mg	30mg
Stage 16 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 5mg	diazepam 12.5mg	27.5mg
Stage 17 (1-2 weeks)	diazepam 5mg	diazepam 5mg	diazepam 5mg	diazepam 10mg	25mg
Stage 18 (1-2 weeks)	diazepam 5mg	diazepam 2.5mg	diazepam 5mg	diazepam 10mg	22.5mg
Stage 19 (1-2 weeks)	diazepam 5mg	Stop diazepam	diazepam 5mg	diazepam 10mg	20mg
Stage 20 (1-2 weeks)	diazepam 4mg	--	diazepam 5mg	diazepam 10mg	19mg
Stage 21 (1-2 weeks)	diazepam 4mg	--	diazepam 4mg	diazepam 10mg	18mg
Stage 22 (1-2 weeks)	diazepam 4mg	--	diazepam 3mg	diazepam 10mg	17mg
Stage 23 (1-2 weeks)	diazepam 3mg	--	diazepam 3mg	diazepam 10mg	16mg
Stage 24 (1-2 weeks)	diazepam 3mg	--	diazepam 2mg	diazepam 10mg	15mg
Stage 25 (1-2 weeks)	diazepam 2mg	--	diazepam 2mg	diazepam 10mg	14mg
Stage 26 (1-2 weeks)	diazepam 2mg	--	Stop diazepam	diazepam 10mg	12mg
Stage 27 (1-2 weeks)	Stop diazepam	--	--	diazepam 10mg	10mg
Continue reducing diazepam by 1mg every 2 weeks (see Schedule 3, Stage 26)

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)

	Morning	Midday/Afternoon	Evening/Night	Daily Diazepam Equivalent
Starting dosage	lorazepam 1 mg	lorazepam 1 mg	lorazepam 1 mg	30mg
Stage 1 (1 week)	lorazepam 1 mg	lorazepam 1 mg	lorazepam 0.5mg diazepam 5mg	30mg
Stage 2 (1 week)	lorazepam 0.5mg diazepam 5mg	lorazepam 1 mg	lorazepam 0.5mg diazepam 5mg	30mg
Stage 3 (1 week)	lorazepam 0.5mg diazepam 5mg	lorazepam 0.5mg diazepam 5mg	lorazepam 0.5mg diazepam 5mg	30mg
Stage 4 (1 week)	lorazepam 0.5mg diazepam 5mg	lorazepam 0.5mg diazepam 5mg	Stop lorazepam diazepam 10mg	30mg
Stage 5 (1 week)	Stop lorazepam diazepam 10mg	lorazepam 0.5mg diazepam 5mg	diazepam 10mg	30mg
Stage 6 (1 week)	diazepam 10mg	Stop lorazepam diazepam 10mg	diazepam 10mg	30mg
Stage 7 (1-2 weeks)	diazepam 10mg	diazepam 8mg	diazepam 10mg	28mg
Stage 8 (1-2 weeks)	diazepam 8mg	diazepam 8mg	diazepam 10mg	26mg
Stage 9 (1-2 weeks)	diazepam 8mg	diazepam 6mg	diazepam 10mg	24mg
Stage 10 (1-2 weeks)	diazepam 6mg	diazepam 6mg	diazepam 10mg	22mg
Stage 11 (1-2 weeks)	diazepam 6mg	diazepam 4mg	diazepam 10mg	20mg
Stage 12 (1-2 weeks)	diazepam 6mg	diazepam 2mg	diazepam 10mg	18mg
Stage 13 (1-2 weeks)	diazepam 6mg	Stop diazepam	diazepam 10mg	16mg
Stage 14 (1-2 weeks)	diazepam 5mg	--	diazepam 10mg	15mg
Stage 15 (1-2 weeks)	diazepam 4mg	--	diazepam 10mg	14mg
Stage 16 (1-2 weeks)	diazepam 3mg	--	diazepam 10mg	13mg
Stage 17 (1-2 weeks)	diazepam 2mg	--	diazepam 10mg	12mg
Stage 18 (1-2 weeks)	diazepam 1mg	--	diazepam 10mg	11mg
Stage 19 (1-2 weeks)	Stop diazepam	--	diazepam 10mg	10mg
Continue reducing night time diazepam by 1 mg every 1-2 weeks (See Schedule 3, Stage 26)

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Schedule 9. Withdrawal from temazepam (Restoril) 30mg
nightly with diazepam substitution. (30mg temazepam is
approximately equivalent to 15mg diazepam)

	Night time	Equivalent diazepam dosage
Starting dosage	temazepam 30mg	15mg
Stage 1 (1-2 weeks)	temazepam 15mg diazepam 7.5mg	15mg
Stage 2 (1-2 weeks)	temazepam 7.5mg diazepam 12mg	15.75mg
Stage 3 (1-2 weeks)	Stop temazepam diazepam 15mg	15mg
Stage 4 (1-2 weeks)	diazepam 14mg	14mg
Stage 5 (1-2 weeks)	diazepam 13mg	13mg
Stage 6 (1-2 weeks)	diazepam 12mg	12mg
Stage 7 (1-2 weeks)	diazepam 11mg	11mg
Stage 8 (1-2 weeks)	diazepam 10mg	10mg
Stage 9 (1-2 weeks)	diazepam 9mg	9mg
Stage 10 (1-2 weeks)	diazepam 8mg	8mg
Stage 11 (1-2 weeks)	diazepam 7mg	7mg
Stage 12 (1-2 weeks)	diazepam 6mg	6mg
Stage 13 (1-2 weeks)	diazepam 5mg	5mg
Stage 14 (1-2 weeks)	diazepam 4mg	4mg
Stage 15 (1-2 weeks)	diazepam 3mg	3mg
Stage 16 (1-2 weeks)	diazepam 2mg	2mg
Stage 17 (1-2 weeks)	diazepam 1mg	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)

	Morning	Midday	Evening/Night	Daily Diazepam Equivalent
Starting dosage	oxazepam 20mg	oxazepam 20mg	oxazepam 20mg	30mg
Stage 1 (1 week)	oxazepam 20mg	oxazepam 20mg	oxazepam 10mg diazepam 5mg	30mg
Stage 2 (1 week)	oxazepam 10mg diazepam 5mg	oxazepam 20mg	oxazepam 10mg diazepam 5mg	30mg
Stage 3 (1 week)	oxazepam 10mg diazepam 5mg	oxazepam 10mg diazepam 5mg	oxazepam 10mg diazepam 5mg	30mg
Stage 4 (1-2 weeks)	oxazepam 10mg diazepam 5mg	oxazepam 10mg diazepam 5mg	Stop oxazepam diazepam 8mg	28mg
Stage 5 (1-2 weeks)	Stop oxazepam diazepam 8mg	oxazepam 10mg diazepam 5mg	diazepam 8mg	26mg
Stage 6 (1-2 weeks)	diazepam 8mg	Stop oxazepam diazepam 8mg	diazepam 8mg	24mg
Stage 7 (1-2 weeks)	diazepam 10mg	diazepam 2mg	diazepam 10mg	22mg
Stage 8 (1-2 weeks)	diazepam 10mg	Stop diazepam	diazepam 10mg	20mg
Stage 9 (1-2 weeks)	diazepam 8mg	--	diazepam 10mg	18mg
Continue as on Schedule 2 from Stage 12

Schedule 10 Notes:


1. Oxazepam is short-acting (half-life 4-15 hrs) so substitution to diazepam (long-acting) is recommended.

2. Diazepam need only be taken twice a day.

3. 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)

	Morning	Midday	Evening/Night
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:


1. Chlordiazepoxide is long-acting so there is no need to take it more frequently than twice a day (hence Stages 4 and 5).

2. Because chlordiazepoxide is long-acting, there is no need for diazepam substitution.

3. 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)

	Night time	Daily Diazepam Equivalent
Starting dosage	zopiclone 15mg	10mg
Stage 1 (1 week)	zopiclone 7.5mg diazepam 5mg	10mg
Stage 2 (1 week)	Stop zopiclone diazepam 10mg	10mg
Stage 3 (1-2 weeks)	diazepam 9mg	9mg
Stage 4 (1-2 weeks)	diazepam 8mg	8mg
Then continue reducing diazepam by 1mg every 1-2 weeks as on Schedule 2

Schedule 12 Notes:


1. 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.

2. 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

Drugs	Dosage strengths and formulations*
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
* tabs: tablets, (s) scored; caps: capsules; 5ml = 1 teaspoon

Schedule 13 Notes:


Guidelines for benzodiazepine users who are also taking an antidepressant and wish to withdraw from both drugs

1. Complete the benzodiazepine withdrawal before starting to taper the antidepressant.

2. Allow at least 4 weeks after stopping benzodiazepines before starting on antidepressant withdrawal.

3. Consult your doctor before starting to withdraw the antidepressant and agree on a tapering schedule.

4. Antidepressant withdrawal must be gradual to avoid withdrawal effects.

1. Make each dose reduction as small as possible, e.g. by halving the tablets or using a liquid preparation.

2. If smaller doses are not available, reduce by taking a tablet every other day, then every third day, etc.

3. Allow 1-2 weeks between each dosage reduction.

4. 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.

5. 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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Index · Contents · Introduction · Chapter I · Chapter II · Withdrawal Schedules · Chapter III
Medical Disclaimer · Order A Printed Copy · Prof Ashton's Main Page · Supplement, April 2011

© Copyright 1999-2013, Professor C H Ashton, Institute of Neuroscience,
Newcastle University, Newcastle upon Tyne, NE4 5PL, England, UK

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© Ray Nimmo · 2013

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