School of Neurosciences
Division of Psychiatry
The Royal Victoria Infirmary
Queen Victoria Road
Newcastle upon Tyne NE1 4LP

PROTOCOL FOR TREATMENT OF
BENZODIAZEPINE WITHDRAWAL

CHAPTER ONE

THE BENZODIAZEPINES:
WHAT THEY DO IN THE BODY

BACKGROUND

ABOUT THIS CHAPTER

THE BENZODIAZEPINES:

  • Potency
  • Speed of elimination
  • Duration of effects
  • Therapeutic actions of benzodiazepines
  • Mechanisms of action

    ADVERSE EFFECTS OF BENZODIAZEPINES:

  • Oversedation
  • Drug interactions
  • Memory impairment
  • Paradoxical stimulant effects
  • Depression, emotional blunting
  • Adverse effects in pregnancy
  • Tolerance

  • DEPENDENCE:
  • Therapeutic dose dependence
  • Prescribed high dose dependence
  • Recreational benzodiazepine abuse

    SOCIOECONOMIC COSTS OF LONG TERM BENZODIAZEPINE USE

    FURTHER READING

    Table 1: Benzodiazepines and similar drugs
    Table 2: Therapeutic actions of benzodiazepines
    Table 3: Some socioeconomic costs of
    long-term benzodiazepine use

    Fig. 1 Diagram of mechanism of action of
    the natural neurotransmitter GABA (gamma aminobutyric acid) and
    benzodiazepine on nerve cells (neurons) in the brain.

    CHAPTER TWO

    HOW TO WITHDRAW FROM BENZODIAZEPINES
    AFTER LONG-TERM USE

    BACKGROUND

    WHY SHOULD YOU COME OFF BENZODIAZEPINES ?

    BEFORE STARTING BENZODIAZEPINE WITHDRAWAL:

  • Consult your doctor
  • Make sure you have adequate psychological support

  • Get into the right frame of mind
  • Be confident
  • Be patient
  • Choose your own way

    THE WITHDRAWAL:

  • Dosage tapering
  • Switching to a long-acting benzodiazepine
  • Designing and following the withdrawal schedule

    FURTHER READING

    SLOW WITHDRAWAL SCHEDULES:

  • Withdrawal from high dose (6mg) alprazolam (Xanax) daily
    with diazepam (Valium) substitution.

  • Simple withdrawal from diazepam (Valium) 40mg daily

  • Withdrawal from lorazepam (Ativan) 6mg daily
    with diazepam (Valium) substitution

  • Withdrawal from nitrazepam (Mogadon) 10mg at night
    with diazepam (Valium) substitution

  • Withdrawal from clonazepam (Klonopin) 1.5mg daily
    with substitution of diazepam (Valium)

  • Withdrawal from clonazepam (Klonopin) 3mg daily
    with substitution of diazepam (Valium)

  • Withdrawal from alprazolam (Xanax) 4mg daily
    with diazepam (Valium)substitution

  • Withdrawal from lorazepam (Ativan) 3mg daily
    with diazepam (Valium) substitution

  • Withdrawal from temazepam (Restoril) 30mg nightly
    with diazepam (Valium) substitution

    CHAPTER THREE

    BENZODIAZEPINE WITHDRAWAL SYMPTOMS,
    ACUTE AND PROTRACTED

    MECHANISMS OF WITHDRAWAL REACTIONS

    ACUTE WITHDRAWAL SYMPTOMS INDIVIDUAL SYMPTOMS,
    THEIR CAUSES AND
    HOW TO DEAL WITH THEM:

  • Insomnia, nightmares, sleep disturbance
  • Intrusive memories
  • Panic attacks
  • Sensory hypersensitivity
  • Depersonalisation, derealisation
  • Hallucinations, illusions, perceptual distortions
  • Depression, aggression, obsessions
  • Muscle symptoms
  • Bodily sensations
  • Heart and lungs
  • Problems with balance
  • Digestive problems
  • Fits, convulsions

    EXTRA MEDICATION DURING BENZODIAZEPINE WITHDRAWAL:

  • Antidepressants
  • Beta-blockers
  • Hypnotics and sedatives
  • Other drugs

    BENZODIAZEPINE USE DURING AND AFTER WITHDRAWAL.

    COURSE OF WITHDRAWAL

    PROTRACTED WITHDRAWAL SYMPTOMS:

  • Anxiety
  • Depression
  • Sensory and motor disturbances
  • Possible mechanisms of
    persisting sensory and motor symptoms
  • Poor memory and cognition
  • Do benzodiazepines cause structural brain damage?
  • Gastrointestinal symptoms
  • How long do benzodiazepines stay
    in the body after withdrawal?

    FURTHER READING

    Table 1: Benzodiazepine withdrawal symptoms
    Table 2: Some protracted benzodiazepine withdrawal symptoms
    Table 3: Some possible causes of protracted benzodiazepine withdrawal symptoms

    REASONS FOR A DIAZEPAM ( Valium ) TAPER,
    Professor C. Heather Ashton, April, 2001

    FOR 12 YEARS ( 1982-1994 ) HEATHER ASHTON RAN A BENZODIAZEPINE
    WITHDRAWAL CLINIC FOR PEOPLE WANTING TO
    COME OFF THEIR TRANQUILLISERS AND SLEEPING PILLS.

    Much of what she knows about this subject was taught to her by
    those brave and long-suffering men and women.
    By listening to the histories of over 300 'patients" and
    by closely following their progress
    ( week by week and sometimes day by day ),
    she gradually learned what long-term benzodiazepine use
    and subsequent withdrawal entails.

    TO VIEW THIS
    FREE MANUAL
    CLICK HERE

    HEATHER ASHTON'S C.V.

    OTHER WORKS BY HEATHER ASHTON

    SPECIAL NOTICES

    This new manual was first introduced to
    the medical community in September 2000.
    The College of Pharmacists of British Columbia
    was the first regulatory body in the world to see it
    and immediately requested 830 copies and sent them out to
    every pharmacy in British Columbia on Oct 12, 2000

    In March 2001, in a joint venture,
    The College of Physicians and Surgeons of Saskatchewan and
    The Saskatchewan Pharmaceutical Association provided every doctor's office
    and pharmacy in the province with this manual.

    THIS IS COPYRIGHTED MATERIAL.
    Copyright © 2001, Professor C H Ashton. All Rights reseved.
    No part of this work may be reproduced or copied
    in any form or by any means – graphic, electronic or mechanical,
    including photocopying, recording, taping or information retrieval systems –
    without written permission of Professor Ashton.


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