April 9, 2026

Benzodiazepines are approved to treat generalized anxiety disorder, insomnia, seizures, social phobia and panic disorder, according to the U.S. Food and Drug Administration. Regular use of BZDs, followed by sudden discontinuation or rapid dosage reductions, can result in severe and possibly fatal withdrawal symptoms. The American Society of Addiction Medicine's clinical practice guideline provides information on safely tapering 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, particularly when used in combination with central nervous systems depressants such as alcohol or opioids, according to ASAM. Risks include:

• Falls
• Motor vehicle accidents
• Cognitive impairment
• Delirium
• Overdose
• Death

To determine if your patient is a good candidate for tapering from BZDs, consider the following:

• 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 adults 65 years and older unless there are compelling reasons for continuation.

ASAM tapering strategy

• Initial reduction: Begin with dose reductions of 5% to 10% every two to four weeks.
• Maximum reduction: Avoid exceeding a 25% 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 (i.e., less than three months) may be able to taper more quickly.

ASAM information on monitoring and support

• 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. Consider connecting patients with 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, pause the tapering process until symptoms are resolved due to the risk for destabilization.

ASAM tips for patient education and engagement

• 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.

The above material is for informational/educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their evidence of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.