Tapering off benzodiazepines
Xanax, Klonopin, Ativan and Valium should never be stopped suddenly. A supervised, gradual reduction is both safer and far more comfortable than trying to white-knuckle it.
What benzodiazepines are, and why they are prescribed
Benzodiazepines calm the nervous system. They are prescribed for anxiety and panic disorder, for short-term insomnia, for muscle spasm, for seizures, and to manage alcohol withdrawal. They work quickly and they work well, which is part of the problem: a medication that reliably takes the edge off within twenty minutes is a hard one to stop taking.
Almost every clinical guideline treats them as a short-term option — weeks, not years. In practice a great many people have been taking one daily for a decade or more, often at a dose that no longer does what it did at the start.
In 2020 the FDA added a boxed warning to the entire class covering abuse, misuse, addiction, physical dependence and withdrawal reactions. That warning is not a reason to stop abruptly. It is a reason to stop carefully, with a provider.
Generic and brand names
Z-drugs such as zolpidem (Ambien) and eszopiclone (Lunesta) act on the same receptor system and behave similarly on withdrawal, but they are a separate class — they have their own page.
| Generic name | Common brand names | Typically prescribed for |
|---|---|---|
| Alprazolam | Xanax, Xanax XR | Anxiety, panic disorder |
| Clonazepam | Klonopin | Panic disorder, seizure disorders |
| Lorazepam | Ativan | Anxiety, sedation before procedures, status epilepticus |
| Diazepam | Valium | Anxiety, muscle spasm, alcohol withdrawal, seizures |
| Temazepam | Restoril | Short-term treatment of insomnia |
| Chlordiazepoxide | Librium | Anxiety, alcohol withdrawal |
| Clorazepate | Tranxene | Anxiety, seizure disorders |
| Triazolam | Halcion | Short-term treatment of insomnia |
| Oxazepam | Generic only in the US | Anxiety, alcohol withdrawal |
What long-term use can look like
Tolerance is the pattern most patients recognize first: the dose that used to settle things no longer quite does, and the day between doses gets harder rather than easier.
The same dose does less over time. Some people find their anxiety is worse on the medication than it was before they started it — an effect that only becomes visible once the dose comes down.
Difficulty forming new memories, word-finding trouble, and a general sense of mental fog that is often attributed to age or stress.
Drowsiness, slowed reactions and impaired driving, particularly with the longer-acting medications in this class.
A well-established risk in older adults, and one of the main reasons deprescribing guidelines single this class out.
Anxiety, sweating or agitation that arrives before the next dose is due, and that is relieved by taking it — a sign of physical dependence rather than of the original condition.
Taken together, benzodiazepines and opioids substantially increase the risk of dangerous respiratory depression. If you are on both, say so at intake.
What stopping abruptly can feel like
This is the class where abrupt discontinuation is genuinely dangerous. Do not stop a benzodiazepine on your own, and do not let a prescription run out unplanned — talk to a provider first.
Abrupt withdrawal from a benzodiazepine can cause seizures, including in people who have never had one. This is the reason a supervised taper is not optional.
Anxiety that is markedly worse than anything before the medication started, often with a sense of dread that feels physical.
Little or no sleep for several nights, which then makes every other symptom harder to bear.
Shaking hands, drenching sweats and a racing or pounding heart.
Light, sound and touch becoming painfully intense; tingling or burning skin sensations.
Disorientation, derealization, and in severe cases delirium. A medical emergency, and a reason to seek help immediately rather than push through.
Before you change anything
This page is general information about a group of medications. It is not medical advice about you, and it is not a reason to change a dose on your own.
Several of the medications Prescriby Health tapers can be dangerous to stop abruptly. If you are in withdrawal now, contact your prescriber or an urgent care service today. If you feel unsafe, call 911. For mental-health crisis support in the US, call or text 988.
How we taper benzodiazepines
Slowly, and in proportion. The dose comes down in planned percentage steps rather than fixed milligram cuts, so the reduction stays the same size relative to what you are actually taking. Where it helps, your provider may first move you from a short-acting benzodiazepine to a longer-acting one, which smooths out the peaks and troughs that make the process feel worse than it needs to.
There is no prize for finishing quickly. Holding a dose for a few extra weeks because a step was hard is a normal part of a successful taper, not a setback. We plan for holds from the start.
We take over prescribing the benzodiazepine for the duration of the taper, so the supply is predictable and you are never in the position of rationing tablets. You log symptoms between visits in the Prescriby app, and follow-ups are as frequent as your taper needs — weekly at the harder stages if that is what it takes.
Learn more
Related reading on tapering and on how the program works.
Intake, the taper schedule, follow-up intervals, cost, and who the program is and is not right for.
The six groups we work with, with generic and brand names for each.
Clinical insight, patient stories and company news from Prescriby Health.
Questions about benzodiazepines
No. Please do not. Abrupt withdrawal from a benzodiazepine can cause seizures, and severe withdrawal can require hospital treatment. If you are out of medication or in withdrawal now, contact your prescriber or an urgent care service today. If you feel unsafe, call 911; for mental-health crisis support, call or text 988.
Most people who come to us are physically dependent rather than addicted. Dependence means the body has adapted — you need it to feel normal, and stopping causes withdrawal. Addiction is a behavioral pattern: craving, loss of control, and continuing despite clear harm.
The distinction is not academic. Dependence after years of taking a medication exactly as prescribed is an expected physiological outcome, and the treatment for it is a careful taper, not a moral reckoning. If there is also a pattern of misuse, we would rather know at intake so the plan accounts for it.
Longer than most people expect and longer than for most other classes. Months rather than weeks is normal, and for someone on a high dose after many years it can be considerably longer. Your schedule is written for your medication, dose and history, and revised as you go.
Rebound anxiety during a taper is common, and it is usually temporary — it is the nervous system readjusting, not a return to baseline. What often surprises patients is that anxiety is better at the end of the taper than it was on the medication, because long-term use can itself worsen anxiety between doses.
That said, if the original condition is still present it needs treating in its own right. We will talk about what goes alongside the taper.
Temazepam, triazolam and others in this class are often prescribed for insomnia. Rebound insomnia during a taper is expected and short-lived, and the taper plan is built around it. Cognitive behavioral therapy for insomnia is the guideline-recommended first-line treatment for chronic insomnia and is worth having in place before or during the reduction.
Ready to talk about benzodiazepines?
Tell us the name on the box and how long you have been taking it. We will tell you what a taper would look like.
You do not need a referral. Providers are welcome to refer directly.