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Tapering: Difference between revisions
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==Tapering methods== | ==Tapering methods== | ||
[[File:Taper3.png|300px|thumbnail|right|This chart from [http://www.benzo.org.uk/manual/bzsched.htm#s3 the Ashton Manual] is an example of a slow taper from 6mg alprazolam daily with a diazepam substitution.]] | [[File:Taper3.png|300px|thumbnail|right|This chart from [http://www.benzo.org.uk/manual/bzsched.htm#s3 the Ashton Manual] is an example of a slow [[taper]] from 6mg alprazolam daily with a diazepam substitution.]] | ||
To taper successfully, users should decrease their dose each day or at least stay at the same dosage; however, if withdrawal symptoms are intolerable, one may be tapering too quickly and should slightly increase the dosage until withdrawal symptoms become minimal. Generally, the longer one has been on the drug, the longer the taper should be.<ref>http://www.hrpub.org/download/201310/app.2013.010202.pdf</ref> Slow tapers will result in less withdrawal symptoms than faster tapers. It may be helpful for users to stay at the same dosage for several days/weeks and then decrease amount slowly. | To [[taper]] successfully, users should decrease their dose each day or at least stay at the same dosage; however, if withdrawal symptoms are intolerable, one may be tapering too quickly and should slightly increase the dosage until withdrawal symptoms become minimal. Generally, the longer one has been on the drug, the longer the [[taper]] should be.<ref>http://www.hrpub.org/download/201310/app.2013.010202.pdf</ref> Slow tapers will result in less withdrawal symptoms than faster tapers. It may be helpful for users to stay at the same dosage for several days/weeks and then decrease amount slowly. | ||
In comparison to the [[cold turkey]], tapering can take more self-discipline. It is recommended that users give the drug to someone trustworthy and have them only give the dosage listed on the pre-planned tapering schedule daily. In some cases, however, the cold turkey method can be preferred by individuals or even more effective than tapering for some substances. For example, studies show that the cold turkey method of [[tobacco]] cessation is more likely to be effective for individuals looking to quit smoking.<ref>Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial | http://annals.org/article.aspx?articleid=2501853</ref> | In comparison to the [[cold turkey]], tapering can take more self-discipline. It is recommended that users give the drug to someone trustworthy and have them only give the dosage listed on the pre-planned tapering schedule daily. In some cases, however, the cold turkey method can be preferred by individuals or even more effective than tapering for some substances. For example, studies show that the cold turkey method of [[tobacco]] cessation is more likely to be effective for individuals looking to quit smoking.<ref>Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial | http://annals.org/article.aspx?articleid=2501853</ref> | ||
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Substances with long half-lives (like [[diazepam]]) are preferable to shorter-lasting ones (including [[alprazolam]] and [[lorazepam]]) because the latter are eliminated fairly quickly, resulting in its blood concentrations fluctuating instead of smoothly declining gradually. Tapering off of substances with short half-lives generally require taking multiple dosages per day and users will likely experience withdrawal symptoms between doses. Diazepam is the most commonly used drug for tapering off of [[benzodiazepines]] or [[alcohol]] because it has a half-life of 200 hours.<ref name="benzo">CHAPTER II: HOW TO WITHDRAW FROM BENZODIAZEPINES (aka The Ashton Manual) by Professor C Heather Ashton DM, FRCP | http://www.benzo.org.uk/manual/bzcha02.htm</ref> To avoid withdrawal symptoms when switching over to a longer-lasting one, users should factor in potency differences between the substances. | Substances with long half-lives (like [[diazepam]]) are preferable to shorter-lasting ones (including [[alprazolam]] and [[lorazepam]]) because the latter are eliminated fairly quickly, resulting in its blood concentrations fluctuating instead of smoothly declining gradually. Tapering off of substances with short half-lives generally require taking multiple dosages per day and users will likely experience withdrawal symptoms between doses. Diazepam is the most commonly used drug for tapering off of [[benzodiazepines]] or [[alcohol]] because it has a half-life of 200 hours.<ref name="benzo">CHAPTER II: HOW TO WITHDRAW FROM BENZODIAZEPINES (aka The Ashton Manual) by Professor C Heather Ashton DM, FRCP | http://www.benzo.org.uk/manual/bzcha02.htm</ref> To avoid withdrawal symptoms when switching over to a longer-lasting one, users should factor in potency differences between the substances. | ||
===Tapering schedule examples=== | ===Tapering schedule examples=== | ||
The overall schedule of the taper should be determined on an individual basis, depending on many factors including one's initial dosage, length of use, and specific substance used as well as its potency, duration of action, and half-life. | The overall schedule of the [[taper]] should be determined on an individual basis, depending on many factors including one's initial dosage, length of use, and specific substance used as well as its potency, duration of action, and half-life. | ||
As an example of a slow withdrawal schedule, a user taking 40mg diazepam a day (or the equivalent) could reduce their daily dosage by 2mg every one or two weeks until a dosage of 20mg diazepam per day is reached; this would take 10 to 20 weeks. Starting from 20mg diazepam per day, reducing the amount to 1mg per day every week or two may be preferable, taking a total of 20 to 40 weeks.<ref name="benzo"></ref> Some users may prefer to reduce faster and some may go even slower. | As an example of a slow withdrawal schedule, a user taking 40mg diazepam a day (or the equivalent) could reduce their daily dosage by 2mg every one or two weeks until a dosage of 20mg diazepam per day is reached; this would take 10 to 20 weeks. Starting from 20mg diazepam per day, reducing the amount to 1mg per day every week or two may be preferable, taking a total of 20 to 40 weeks.<ref name="benzo"></ref> Some users may prefer to reduce faster and some may go even slower. | ||