As you know, benzodiazepines (BZDs) are approved to treat generalized anxiety disorder, insomnia, seizures, social phobia, and panic disorder.¹ Regular use of BZDs, followed by sudden discontinuation or rapid dosage reductions, can result in severe and possibly fatal withdrawal symptoms. American Society of Addiction Medicine guidelines aim to assist providers in helping safely taper their patients from BZD medications while minimizing withdrawal symptoms.

Determining the Need for Tapering

The use of BZDs is associated with increased risk for adverse effects, including falls, motor vehicle accidents, cognitive impairment, delirium, overdose, and death, particularly when they are used in combination with central nervous systems depressants such as alcohol or opioids.²

The following recommendations can help you determine if your patient is a good candidate for tapering from BZDs:

• Assess risks vs. benefits of ongoing BZD use at least every three months by evaluating the potential harms of continued BZD use against the benefits for the patient.
• Identify physical dependence. Patients using BZDs regularly for more than a month are likely physically dependent and should not discontinue the medication abruptly.
• Consider patient-specific factors such as comorbidities, age, pregnancy status, and concurrent use of other substances, especially opioids. BZDs should be tapered in most older adults (i.e., 65 years and older) unless there are compelling reasons for continuation.

Tapering Strategy²

• Initial reduction: Begin with dose reductions of 5 to 10 percent every two to four weeks.
• Maximum reduction: Avoid exceeding a 25 percent dose reduction every two weeks.
• Adjust based on response: Tailor the tapering pace to the patient’s tolerance and withdrawal symptoms.
• Consider medication transition: For smoother tapering, transitioning to a comparable longer-acting BZD may be beneficial if the patient has no contraindication.
• Taper speed: Patients who have been taking lower doses for a relatively brief period (e.g., less than three months) may be able to taper more quickly.

Monitoring and Support²

• Regular assessments: Evaluate for withdrawal symptoms – anxiety, insomnia, and sensory disturbances – at each dose reduction.
• Pause or slow taper, if needed: If significant withdrawal symptoms occur, consider temporarily halting dose reductions until withdrawal symptoms subside or slowing the tapering process.
• Medications prescribed with BZDs to treat anxiety or insomnia symptoms: Use cautiously and only when necessary, as evidence for their effectiveness in facilitating BZD tapering is limited.
• Harm reduction strategies: Offer to provide opioid overdose reversal medication (e.g., naloxone) to those concomitantly taking opioids or otherwise at risk for opioid overdose, connect patients to local resources, and provide patient education based on each patient’s risks.

Special Populations

• Older adults: Monitor closely due to increased sensitivity and risk of falls.
• Pregnant or lactating patients: Tapering should be approached with caution; abrupt discontinuation can be harmful. Encourage breastfeeding, which can reduce neonatal withdrawal symptoms.
• Patients with substance use disorders: Coordinate care with addiction specialists and consider integrated treatment plans.
• Patients with co-occurring psychiatric disorders: Monitor sleep closely during BZD tapering in patients with mood or psychotic disorders, particularly for patients with bipolar disorder as sleep disruption can trigger episodes of mania. If patients experience significant sleep disruption, providers should pause the tapering process until symptoms are resolved due to the risk for destabilization.

Patient Education and Engagement²

• Inform patients about risks: Educate patients about the potential risks of long-term BZD use and benefits of tapering.
• Collaborative planning: Develop a tapering plan in partnership with the patient, considering their preferences and concerns.
• Provide resources: Offer written materials and support resources to assist patients throughout the tapering process.

Learn More

• Benzodiazepine Drug Information
• The Joint Practice Guideline on Benzodiazepine Tapering

¹ Benzodiazepine Drug Information, U.S. Food & Drug Administration, September 2020.   

² Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits, Journal of General Internal Medicine, June 2025.  

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