Benzodiazepine Withdrawal Treatment and Medication

Benzodiazepines are a class of medications commonly prescribed to treat a variety of conditions, including anxiety and insomnia.^1,4 They include short-acting medications such as Xanax and Ativan and longer-acting medications such as Valium and Klonopin.

Benzodiazepines (commonly called benzos) are addictive and are frequently abused. Benzodiazepine withdrawal treatment can be crucial for a person trying to stop using benzos because the withdrawal symptoms can be severe.¹

Withdrawal from benzodiazepines can have serious side effects such as seizures, insomnia, tremors, and hallucinations,⁶ and it can even be fatal.³ In rare instances, seizures have even been reported with less than 15 days of benzodiazepine use at a therapeutic dose (meaning not using more than prescribed).³

Benzodiazepine Withdrawal Treatment Options

Detox or residential treatment centers are usually the best settings for people taking high doses of benzodiazepines. Types of treatment centers available to help with benzodiazepine withdrawal include the options below. Detox and inpatient or residential treatment centers that incorporate detox protocols are usually the best settings for people who have been taking high daily doses of benzodiazepines, are elderly, and who use benzodiazepines with alcohol. ⁴

If you or someone you love has been abusing benzodiazepines, seek out some form of addiction treatment or therapy after detox to best ensure a long-term recovery.

• Detox centers are medically supervised facilities. A person in detox for benzo withdrawal may be given certain medications to ease the process and minimize unpleasant symptoms or other medical complications. Medical staff are on hand to safely supervise the person through withdrawal.
• Residential or inpatient rehab often offers detox in addition to ongoing addiction treatment. Treatment typically includes group therapy, sessions with an individual counselor, and 12-step meetings, and it can last 28 days or longer.
• Partial hospitalization programs generally meet 5 days per week for about 6 hours per day. The program will mostly include groups, but it may also offer some individual counseling sessions or appointments with a psychiatrist. ⁵
• Intensive outpatient treatment usually meets two or more days per week for about 3 hours per day and includes group sessions. ⁵
• Traditional outpatient treatment may consist of weekly individual or group psychotherapy geared toward substance abuse recovery. Some counselors may coordinate with physician staff for any ongoing medication needs.
• Extended residential programs, such as a sober living home or a halfway house, may offer continued supervision while the person works to feel confident in their recovery.
• Self-help or community support groups are made up of people recovering from similar addictions. They usually do not include professional staffing. But they can be invaluable in maintaining long-term recovery.

Medications for Benzo Withdrawal

No medication is specifically FDA-approved for the treatment of benzodiazepine dependence. However, some medications are used off-label to treat benzodiazepine withdrawal or used to manage the spectrum of symptoms that can arise during withdrawal. Some of these medications include:²

• SSRI antidepressants may be used for anxiety. ⁴
• Anticonvulsants may be used for people with a history of multiple seizures. ⁴
• Beta-blockers may be used for physical symptoms such as tremors. ⁴
• Clonidine may be used to maintain normal blood pressure if the person’s blood pressure becomes too high during withdrawal.²
• Ondansetron can be given to treat nausea or vomiting during withdrawal.²
• Some medical professionals give pregabalin (Lyrica) to treat benzodiazepine withdrawal. However, this is an off-label use.²

Tapering Off Benzodiazepines

The most common treatment for benzodiazepine withdrawal is to taper the person down from the dose they were taking. In some cases, they may switch from one benzodiazepine to another.² If a person was taking a short-acting benzodiazepine, a healthcare provider may prescribe a longer-acting benzodiazepine at an equivalent dose. An equivalent dose may not be literally equivalent. Rather, it is a quantity that will produce similar effects.³

During a benzodiazepine taper, your healthcare provider will decrease your benzodiazepine dose until you are completely off the drug. This may happen quickly or slowly and can depend on many factors, such as:

• Which benzodiazepine you were taking.
• How much you were taking.
• What kind of withdrawal symptoms you have when the dose is decreased.

Because of the health risks, tapering off benzodiazepines should be done under the supervision of a healthcare professional.

Where Should I Taper Off Benzodiazepines?

Benzodiazepine dose tapering can be achieved more quickly in a detox center than in an outpatient facility.³ Some programs may also combine tapering with a form of therapy – typically cognitive behavioral therapy. ⁴

If you are tapering in an outpatient program, be patient. A slow taper can minimize the shock to your brain and your body, and you may experience minimal withdrawal symptoms and minimal rebound symptoms. It can take a while, but it’s worth the effort to protect your health and safety.

Cold-Turkey Benzodiazepine Detox

It may be tempting to detox yourself cold turkey in the comfort of your home. However, benzodiazepine withdrawal can have severe withdrawal effects up to and including death, and there is also the risk of relapse or other mental or physical complications.

Sometimes, people think it is better to just “get it over with.” But benzodiazepine withdrawal is unpredictable. ⁴ In addition to potential seizures, many people going through withdrawal experience a “rebound” effect in which their original anxiety or insomnia returns. ⁴

The safest way to detox is to get help at a detox center or seek assistance from a healthcare professional. Medical professionals can treat these conditions and prescribe alternative medications. ⁴