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The easiest way to taper Xanax, or any other benzo

As I've discussed elsewhere on this site, the benzodiazepine family of drugs (Xanax, Ativan, Klonopin-or generically: alprazolam, lorazepam, clonazepam) seem to generate a lot of negative press because they can cause dependence (you'll need to taper off them when you no longer need their services) and because they are abused, like many other drugs, by some folks.  So all benzos, under all circumstances are Bad.  Very Bad.  Watch out for addiction! (dependence is what is meant; addiction implies drug-craving, doctor-shopping, etc.).-yes, like all psychoactive medications, there are risks involved with benzodiazepines, but the risks pale compared to the alternatives used to treat anxiety, namely, some SSRI's, TCA's, dual-receptor antidepressants, MAO inhibitors, anti-convulsants, atypical antipsychotics, etc.

The only significant issue with benzos is dependence with a certain subpopulation of users-which requires, as mentioned,  tapering the drug, not unlike the tapering required for many drugs. Other side effects and issues are rare among those suffering an anxiety disorder. The reality of the situation is that despite recommendations to the contrary, benzos are the most prescribed class of drug for anxiety because, unlike the other classes of drugs mentioned, they are effective, fast-acting, tolerated well, seldom have side effects, and are very safe-even in overdose. In summary, unlike many of the other drugs mentioned in the previous paragraph, benzos are therapeutically sound-they work well. If you are a physician reading this post, please take note that  as a facilitator of a depression/anxiety/bipolar support group for the last thirteen years , I can assure you that (consistent with the medical literature), you will not find a population of individuals more fearful of dependence and more likely to be non-compliant when it comes to taking medication than those with anxiety disorders.  The problem with anxious patients (as opposed to abusers) is getting them to take enough medication to afford some relief from the harrowing torture of severe anxiety.  O.K., the sermon is over, now to address the topic of this post, namely, how to taper off benzos.  Here's the plan:

[1] Contact your doctor and make sure both of you are on board with the  taper. This step is absolutely necessary-after all, what I'm about to describe is a technique, not medical advice. If you taper while you are still suffering from anxiety, it will make it oodles more uncomfortable.  People that have difficulty tapering and experience "rebound anxiety" just a scare word, in my opinion-I think it means "the return of anxiety, but I've forgotten how unpleasant it is"), generic but severe anxiety, etc. during the taper are usually still ill.  It's sort of like stopping taking an antibiotic while you're still suffering from a bacterial infection and wondering why you are getting sick again. Don't do that.

[2]  Forget the switch to a longer half-life benzo,especially diazepam (brand name Valium).  The reasons for switching are, in theory, because Valium has a longer half-life and so, again in theory, the taper discomfort should be less; also, Valium (generic name diazepam) comes in lower doses than those "high potency" benzos like Xanax and Friends.  "High potency" really sounds like an impressive name for a drug, doesn't it?  Xanax must be a really more dangerous guy than ol' dudely Valium.  Nah.  "High potency" is a pharmaceutical term that just means how much drug you have to take to have a certain response.  So since perhaps 10 mg of Valium is "equivalent" (whatever than means, since it is like asking how many apples there are in a pear) to 1 mg Xanax, Xanax is ten times more potent!  Please don't be impressed.  If you've followed my reasoning so far, you may have realized that if 10 mg of Valium was formulated (combined with starch, sugar, other non-drug things collectively called "excipients") into 20 mg tablets whereas 1 mg Xanax was formulated into 50 mg tablets, the Valium formulation would be the "high potency" formulation.  Either way, you're just swallowing a tablet.

Why not use the switch to Valium first procedure, after all, it's all over the internet?  Here are my reasons:  first you have to switch from Xanax (or other benzo) to Valium.  That's not fun and takes awhile to do.  So first is the discomfort of the crossover to Valium.  Then there is the good chance that the Valium will cause depression...Xanax has weak antidepressant effects which you've lost, plus long half-life benzos-sorry, Klonopin (clonazepam) too, just seem to make people more depressed.  I don't know why, but then, neither does anyone else.  O.K.!  You've braved the switch to Valium, on to the taper!  But for many, if not most people, the Valium doesn't have significantly fewer withdrawal symptoms, they just take longer to show up.  So instead of feeling more anxious a day after decreasing the Xanax you're taking, it might take a week to feel equally crumby if you decrease the Valium you've switched to.  Are you starting to get the idea that this plan is a bit too involved for what benefits (if any) it provides?  Good.  Now I will solve-and from what I can tell, for the first time on the internet, the problem of how to work with those small Xanax, Ativan, or Klonopin tablets so you don't have to decrease the dosages in steps  that will cause more tapering discomfort than you want to endure. You can decrease the dosage by any step you want with this procedure. This is very sophisticated scientifically (probably that's why no one else has put it on the 'net as an option), so read carefully.  Here are the steps (finally) to facilitate your benzo taper:

[1] Steal an emery board from your husband, wife, or significant other.  If there is no emery board to steal (just trying to save a little time), buy some generic ones at the grocery store.

[2]  Let's say you're taking a typical dose of Xanax, 0.5 mg three times a day.  Take a tablet, which looks like this:


and sand it down with a couple swipes of the emery board so it looks like this:


Maybe you'll want to sand off more or less, just notice where you sanded it-in this example, just before the "X" in "Xanax".  Now, substitute the sanded Xanax tablet for one of the ones you usually take during the day and do the same thing (one sanded tablet per day) for at least three days.  If you start to feel anxious, go back to taking the full tablets, wait until you feel all right (give yourself a few days) and start again, sanding off less and trying the same procedure.  If you are O.K. with the way you feel even after three days, continue with the one sanded tablet for at least two weeks-that's right, two full weeks...we are trying make you as comfortable as possible.  I know that the "standard" taper is 25% of the total dose-in this case, about 0.4 mg of Xanax a week-but I think that is way too fast.

[3] Two weeks have gone by and you haven't even noticed the decrease in Xanax?-great! Now take two sanded tablets a day and one unsanded tablet for two weeks.

[4]  Gradually sand down the tablets, one at a time, consistent with your comfort level.  If you start to feel uncomfortable, go back to the last level you were comfortable with and maintain that dose for several days.

Graphically, the taper is :


keeping, in this example, all three tablets equally "sanded" as much as possible.

You have perfect control over how much you want to decrease the tablet for your next taper step.  Be sure to be in contact with your physician during this whole process; also, don't get all macho, whether you are male or female.  Taking a few months of painless taper certainly beats a few weeks of discomfort.  You are in no hurry, even though (I write this because I do it myself) you may get the urge to get things over quickly. Resist that urge.

Here's a picture of a 1 mg Ativan, indicating where how much you need to remove with an emery board (or use a Dremel tool with a clean cylindrical grinding drum; it works really well) to get different dosages for tapering (example: "0.8" means if you grind off the "nose" of the tablet, you'll have a 0.8 mg tablet).  I'll watch the traffic to this page and if there is sufficient interest, I'll put the three common benzos plus the generics on this page along with how much you need to remove to get desired dosages:


 

There you have it-the Internet premier of the easiest way to taper Xanax, or any other benzo!

If you have any comments, want to give me an award for my service to the benzodiazepine-tapering community, have urge to write me a nastigram, you have my e-mail address.

Seriously, though, this procedure works really well-and I hope it helps you taper your benzo with little or no discomfort.  Best of luck. Remember, talk to your doc and go very slowly...and you'll be fine.



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