Psychopharmacology and Psychiatry Updates

Demystifying Benzodiazepine Deprescribing: Smart Approaches to Tapering

Jun 15, 2025
Alexis Ritvo, a board-certified addiction psychiatrist and fellowship director at the University of Colorado, dives into the complexities of tapering benzodiazepines. She shares evidence-based strategies such as 'cut-and-hold' and 'microtaper' techniques tailored for patient comfort. The discussion emphasizes personalized approaches that enhance safety during withdrawal, alongside the challenges of dosage precision and patient adherence. By highlighting case studies, Ritvo showcases the importance of supportive therapies in navigating benzodiazepine deprescribing.
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ANECDOTE

Patient Fear Exemplifies Taper Challenges

  • Melissa, a 68-year-old on clonazepam for 15 years, experiences drowsiness and falls but fears tapering due to withdrawal distress.
  • This illustrates the difficulty patients face when discontinuing long-term benzodiazepines safely.
ADVICE

Cut-and-Hold Tapering Technique

  • Use the cut-and-hold technique for benzodiazepine tapering by reducing the dose by a percentage and stabilizing before further reduction.
  • Employ tablet cutters or medication scissors for precise dose reductions and coordinate with pharmacists for accuracy.
ADVICE

Microtapering for Gradual Reduction

  • Use microtapering by making very small daily dose reductions to help the brain adjust gradually to benzodiazepine withdrawal.
  • Use precision scales, liquids, or compounded prescriptions to achieve these small dose reductions effectively.
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